Final Exam review 2021 Flashcards
1
Q
Types of Natural Disaster
A
- avalanches
- blizzards
- Communicable disease epidemics
- Drought/wildfires
- Earthquakes
- Hurricanes/tornados/cyclones
- volcanic eruptions
2
Q
Human Made disasters
A
- terrorism/wars
- riots
- Explosion/bombings
- fires that are man-made
- structural collapse
- flood/mudslides
- toxic and hazardous spills
- mass transit accidents
- pollution
3
Q
Definition of a disaster
A
Any event that causes a level of destruction, death or injury that affects the abilities of the community to respond to the incident using available resources
4
Q
Mass casualty is how many people?
A
100 or more people involved
5
Q
Multiple casualties are how many people?
A
more than 2 and less than 100 people are involved
6
Q
Characteristics of Disasters are
A
- frequency (how often do they occur)
- predictability (contains primary, secondary, tertiary)
- imminence (speed of onset)
7
Q
Primary Intervention of disasters are
A
Primary–> before a disaster occurs- develop a disaster plan
- conduct drills/practicing, walkthrough to identify hazards.
- Identify vulnerable populations that are at risk
8
Q
Secondary prevention of disasters are
A
Secondary–> early intervention (triage, search and rescue)
-immediate first aid to prevent further damage that would lead into
Tertiary, where rehab would be.
9
Q
Tertiary level of prevention for disasters
A
Tertiary–> focus is recovery, access for hazards in community after the
disaster (contaminated water, structural problems in buildings-rehab after
The disaster)
-rehab-> to get the community back to prior functioning
-FEMA will help out
10
Q
What 2 branches of government respond to disasters?
A
- Local–> communicate to residents
-prepare citizens for all kinds of disasters
-local office of emergency management develops and tests
Disaster plans
-Management during a disaster includes:
A. evaluation
B. Search
C. Rescue - State–> state department of Emergency management called
When a disaster cant be managed on a local level-provide technical
Support and coordination of resources
*If those fail–> go to the federal government to get funds/resources
Ahead of time if you know it will hit
11
Q
Federal government response to natural disasters and departments responsible for emergencies
A
Homeland Security- 2003
-coordinated effort to help with the search, rescue, triage, after the disaster
1. National response plan–> integrates homeland security, emergency
Medical services, police, fire, public health and public safety
2. Federal Emergency Management Agency–> manage federal response
And recovery after a natural disaster, manages the National Flood
Insurance Program
Federal Government
1. Department of Health and Human Services- after the rescue, ensures
That water, food and shelters are available
2. Public Health System- keep public informed of health risks and preventative
Measures
3. The American Red Cross- works with FEMA and homeland security to
Provide and manage services during a disaster. ARC is a voluntary
Organization. Focus on meeting immediate disaster-related needs
-after the disaster, the ARC works with the salvation army and FEMA
12
Q
Stages in disaster management
A
- Preparedness and Planning stage–> occurs before a disaster is imminent
- Response Stage- begins immediately after a disaster occurs. Includes evacuation, search and rescue. STARTS system for triage, communication is a major problem
- how are responders notified, where are additional supplies kept? (need to reach workers) - Recovery Phase–> begins when the danger from the disaster is past. Search for additional problems that may harm a population (are there live wires, downed trees, gas leaks, structural collapses potentially)
13
Q
Category A: HIGHEST–> biological agents
A
-can be used by terrorists to eliminate large populations EXAMPLES anthrax botulism ebola plague smallpox
14
Q
Category B: 2nd highest priority–> Bioterrorism
A
viral encephalitis staphylococcus salmonella ecoli brucellosis-bacteria- RX ABX Typhus- transmitted via water
15
Q
Category C: Lowest priority
A
1- agents ate produced in a lab
2- multi-drug resistant TB
Nipah virus- bats are possible reservoirs and cause meningitis and encephalitis
Hantavirus- spread by respiratory secretions, produces [pneumonia and renal failure
16
Q
Nurses Role in Disasters
A
-Educate the public health staff and population about the disaster plan
-Provide medical care in shelters
-Follow a disaster, assess for and report environmental hazards, use case
Findings for communicable diseases (contact tracing–> secondary), advocate
For community needs, assess populations for current immunizations
*there is training required
17
Q
Nurses Role in shelters
A
PRIORITY–> MASLOWS hierarchy of needs
-provide the basics (food, clothing, shelter, rest)
-attempt to recover needed items (meds, glasses)
-help people to make decisions
-delegate tasks to people to be able to help
-refer victims to mental health workers as needed and workers as well
*Look at psychological 1st aid- are they Suicidal? How are they feeling, are
They separated from family?
-this allows the first needs are met
-make sure to follow up references for PTSD
18
Q
When should disaster management begin?
a. immediately after the disaster
b. before a disaster occurs
c. throughout the disaster period
d. after assistance has arrived from the red cross
A
b. before a disaster occurs
19
Q
A riverfront community builds a retaining wall to divert floodwater away from the town. Which stage of disaster management does this address?
a. response
b. preparedness
c. recovery
A
b. preparedness
20
Q
The nurse is assessing a community following a natural disaster to look for additional dangers. This would be which level of prevention?
a. primary
b. secondary
c. tertiary
A
c. tertiary
21
Q
- You are working as a public health nurse in New England during the winter months. An ice storm cripples the city and electrical outages affect the power grid. Trees and frozen wires are down throughout the city and the timeline for restoration of power is 7 to 10 days. You expect the management team to classify this occurrence as a(n) _________ according to established guidelines.
A)emergency
B)natural disaster
C)terrorism
D)accidental disaster
A
B)natural disaster
22
Q
2.The national weather service warns of an impending ice storm that may have crippling effects on the community. Widespread electrical outages are predicted as well as freezing temperatures. The community health nurses are mobilized to establish emergency living quarters and clinics for those without heat. The impending crisis will affect the health and well-being of the community and the community responses are considered the ______ phase of disaster management.
A)impact
B)postimpact
C)pre-impact
D)preparation
A
C)pre-impact
23
Q
5.Response to a disaster is in its final phase. Although still in the recovery phase of the response, an evaluation meeting is arranged. The purpose of the evaluation meeting is to
A)analyze the strengths and weaknesses of the response and submit a plan to improve response in the future.
B)create a report that exemplifies the cohesiveness of the departmental response to the disaster.
C)analyze the effectiveness of the disaster relief teams from respondent states.
D)create a post-disaster report for FEMA.
A
A)analyze the strengths and weaknesses of the response and submit a plan to improve response in the future.
24
Q
- A tornado touched down in the city where you are employed as a public health nurse. As a member of the disaster management team, your role includes which of the following? (select all that apply)
A) Search and rescue
B)Clinical assessment and triage
C)Providing health education
D)Hazardous materials management
A
B)Clinical assessment and triage
C)Providing health education
25
7. You are a member of the Emergency and Disaster Preparedness Committee for your organization. Your role is to head the Data Collection subcommittee. What are the key areas that would be included in your plan?
A) Morbidity, mortality, mental health, and infectious disease
B) Morbidity, mortality, displacement, and community infrastructure
C) Morbidity, mortality, mental health, and chronic illness
D)Morbidity, mortality, displacement, and healthcare workers
A) Morbidity, mortality, mental health, and infectious disease
26
8. You are a public health nurse and a first responder in a community disaster, secondary to a flood. One section of the town has experienced a loss of water and electricity for 4 days. What actions would you take to meet the needs of the community at this time?
A) Refer the members of the community to a spiritual outreach program.
B)Provide access to safe food and water.
C)Inform the fire department of potential risks within the community setting.
D)Provide an immunization program.
B)Provide access to safe food and water.
27
9. The informal partnerships that the public health nurses have in the community have the potential to play an important part in recognizing diseases caused by bio-terrorist agents because
A) the nurse will recognize changes within the community setting.
B) the members of the community will comfortably report suspicious behaviors.
C) the partnerships discourage terrorist activities.
D) the partnerships contribute to and are essential for disease surveillance.
D) the partnerships contribute to and are essential for disease surveillance.
28
Child and Adolescent Health
*major threat to child/kids is
```
#1 POVERTY (no money/limited and leads to poor nutrition,
Childhood diseases (obesity, type 2 diabetes), no access to healthcare (poor teeth/health)
```
other factors are:
single parenting
parents educational level
health insurance (may not qualify for Medicaid)
29
What is the most common cause of death in children from birth up to 1-year-old?
SIDS
- mostly occurs between 1 and 5 months
- more common in males
30
what is the #1 accidental injuries in children ?
Accidental injuries
- #1 --> motor vehicle accidents
- drowning
- burns
- suffocation
* all are the leading cause of death after 1 year of age
31
Primary prevention for children and adolescents
PRIMARY Prevention
- education on the toys, drowning, how to put baby to sleep, sex education
- proper nutrition --> decreases OBESITY
- exercising--> decreases OBESITY
- Immunizations and contraindications to them
- mandatory child safety seats
- teen pregnancy programs
32
Immunizations (some of the dates of when to get and what nurses should do prior to administering them) ?
Immunizations
-Infants--> Hep B at birth, childhood immunizations at 2 months
-Older children--> NJ requires children to get the flu vaccine and pneumonia vaccine
(8 weeks- 4 years)
-EXEMPTIONS--> religious and medical
_Gardasil--> 9-45
*Nurses--> make sure to give the parents/patients the PIS (patient information sheet) about the immunization
And sign a consent form (get it signed by parent)
-you want to give and handout (PIS) and discussion of CDC recommendations as well
33
Contraindications for immunizations
- HIV/ immunocompromised
- cancer
- religious/medical issues
34
the leading cause of death and injury in adolescents are?
```
#1 MVA
* non Hispanic blacks is gun violence
```
35
School Nursing
Requirements to give medication ?
- permission from parents
- medication is in the original container
- doctors prescription signed form--> action plan
36
What are some health services that school nurses provide?
1. immunizations
2. screenings
3. emergency care and care of sick child
4. medication administration
5. care of children with special needs- IEP, medication, In-class help
6. Nutrition- identify children with problems
7. Healthy school environment- free of physical and psychological hazards
And violence prevention programs
8. Counseling, psychological and social services- report abuse or neglect
9. Health promotion for the staff, family and communities
37
Roles of the school nurse
```
Direct caregiver
Healthcare educator
Case manager
Consultant
Community outreach
```
38
Levels of Prevention for school nurses
Primary--> health education, safety assessment of the school, assess the water
For lead (early identification), poor ventilation, playground for hazards
Secondary--> care for ill or injured child, give inhaler when needed to prevent
Serious exacerbations, screenings (scoliosis, prostate)
Tertiary--> for chronic illnesses, kids with disabilities (diabetes, feeding tubes, asthma attack, nebulizer treatments)/special needs
39
1. The school nurse provides a critical link between the child, the family, and the education and health care systems. Using your knowledge of the eight recommended components of a comprehensive school health program, which component includes the physical, emotional, and social conditions that affect the well-being of students and staff?
A) Parent/community involvement
B) Healthy school environment
C) Counseling and psychology services
D) Health promotion for staff
B) Healthy school environment
40
2. The school nurse provides a critical link between the child, the family, and the education and health care systems. Using your knowledge of the eight recommended components of a comprehensive school health program, what should be included in a K-12 health education curriculum? (select all that apply)
1. Consumer health
2. Environmental health
3. Sexuality education
4. Nutrition counseling
5. Promote physical development
1. Consumer health
2. Environmental health
3. Sexuality education
4. Nutrition counseling
41
3. The Early Periodic Screening, Diagnosis, and Treatment (EPSDT) screening act required that children and adolescents who received Medicaid and were younger than 21 years of age have access to the periodic screenings. Using your knowledge of screenings, what requirements were included in the act?
A) Speech/language screening and assessment
B) Occupational therapy assessment
C) Physical therapy review
D) Nutrition screening and assessment
D) Nutrition screening and assessment
42
7. Numerous prevention and intervention programs have been implemented that have now made children and adolescents safer in school. Using your knowledge of levels of prevention, behavioral techniques for classroom management is an example of what level program?
A) Primary
B) Secondary
C) Primary and secondary
D) Secondary and tertiary
A) Primary
43
8. Numerous prevention and intervention programs have been implemented that have now made children and adolescents safer in school. Using your knowledge of levels of prevention, what are examples of secondary prevention programs? (select all that apply)
1. Parent training
2. Home visitation
3. Cooperative learning
4. Positive youth development programs
A) 1, 2
B) 1, 3
C) 2, 4
D) 3, 4
A) 1, 2
1. Parent training
2. Home visitation
44
14. There are different types of school health service visits. Using your knowledge of health assessment skills, what is an example of an individual health assessment?
A) Counseling
B) Complaints of fatigue and headache
C) Vision screening
D) Height and weight
B) Complaints of fatigue and headache
45
16. Schools, where children and adolescents spend one-third of their day, present an ideal setting for providing health education. A health education curriculum is an important part of a comprehensive kindergarten to grade 12 school health programs. Using your knowledge of school nurse roles, what is the school nurse's role in health education?
A) Teacher
B) Policy maker
C) Consultant
D) Advocate
C) Consultant
46
Mens Health
What are the mens leading cause of death ?
```
Men's leading cause of death-->
#1 Heart disease- cardiovascular disease
-cancer
-unintentional injury
-stroke
-COPD
-DM
-suicide
-kidney disease
-Alzheimer's disease
```
47
Socialization of males
men tend to AVOID healthcare as long as possible
- ER visits for injury are higher for men than women
- men generally have longer hospital stays than women
- they are more stoic
48
Factors related to mortality
1. Suicide- 5 times greater for men than women, they follow through with deadlier Means (gun, hanging)
2. Homicide- 4-6 times greater for men than women
3. Alcohol-related death- 3 times greater for men than women
49
Barriers to Healthcare in Men are?
-men work during the day and long hours, so they cant make appointments during the
Day
-need more primary care givers that specialize in men's health
-doctors office hours that are more flexible
-men's health education needs to start early
50
LEVELS OF PREVENTION FOR MEN
Primary--> education, health promotion
Secondary--> screenings, dental exams every 6 months- 1 year
-eye exams every 3-5 years
-Prostate exam yearly starting at 50
-B?P, cholesterol yearly
Tertiary-> rehabilitation that is focused on lifestyle changes
51
Senior Health
Goal for senior health is?
GOAL--> maximize their functional status and minimize functional decline
52
Some terms related to seniors?
Ageism- prejudice for older people
Gerontology- study of the aging process
Geriatrics- study of disease in older adults
Gerontological Nursing- nursing specialty for older adults
53
Psychosocial needs in Seniors health are?
Retirement- may have role changes and lower income
Relocation- may or may not be the person's choice, due to income changes, family
Loss of independence, especially driving
54
LEVELS OF PREVENTION IN THE OLDER ADULT
PRIMARY--> health promotion
-educate on exercising, eating healthy food choices, safety education in the home
-recommended immunizations (tetanus--> every 10 years, influenza yearly, pneumonia-->
At 65 years old, shingles at 50 or 60 (2 doses 6 months apart) HEP a and Hep b for high
Risk adults
SECONDARY--> health screening (early intervention), getting yearly physicals,
Lab work routinely as needed
TERTIARY--> for chronic diseases (want to rehabilitate to better functional status and
Well being while living with the chronic condition)
-chronic disease management--> prevent complications, increase the body's healing capacity, maintain and improve self-care (advocate for self-care), achieve the highest
Possible quality of life, delay deterioration and decline
-PT, Rehab, OT
55
*Most common chronic conditions in older adults
* Most common chronic conditions
1. Arthritis
2. Htn
3. Heart disease- leading cause of death
4. Diabetes
5. Hearing and vision impairment
6. Cancer
7. Stroke
8. Pulmonary diseases
56
Safety Issues in Older Adults
Falls risk- meds, orthostatic hypotension (getting up too fast), HTN, alcohol use, poor
Home environment
Fall prevention--> teach them adequate nutrition (keep bones strong-vit D & calcium),
Exercise (30 minutes a day), environmental factors (scatter rugs, poor lighting, not having
Proper equipment to move around in home)
Crime--> Primary prevention is to teach home safety, protect against scammers (don't
Give banking information to anyone over the phone or email), have pensions and checks
Direct deposited.
57
Patient Self-determination Act
Living Will- (a form of an advance directive) it is a written statement detailing a person's desires regarding their medical Treatment in circumstances in which they are not able to express informed consent, especially in advance directive
-someone is appointed as the power of attorney to make decisions on their behalf when they are incapacitated
Advance directives-
Durable power of Attorney - allowing an individual to appoint someone to make healthcare decisions on their behalf, that person can refuse or accept treatment for that person if they are unable to do so
Guardianship- a conservator serves to make decisions regarding the persons property or income. An interested party must file a petition with the county clerk where the incapacitated person lives
DNR- do not resuscitate, no code or allow natural death, indicating that a person does not want to receive CPR if that persons heart stops beating. It can also prevent other medical intervention (pain medicine, nutrition, other medicines, cardiac drugs, chest tube, breathing tube)
EMERGENCY providers can still give--> oxygen, control bleeding, position for comfort, emotional support)
58
Faith Nursing
*vulnerable populations, end of life issues violence prevention and accountability are all issues in parish nursing
It supports caring and concerns for others and stems from community of faith
59
Key elements of Faith nursing
- spiritual dimension (hospice, end-of-life)
- clients are members of the faith community
- promotes self-care across the lifespan
- understanding of connection between health, faith and nursing
- Uses principles of holistic health- connection between spiritual, physical, psychological, and social dimensions of health
60
Goal of faith nursing
GOAL--> develop and sustain health ministries within faith communities organized around: health, healing, and spiritual and holistic health
Interventions--> FOCUS is PRIMARY PREVENTION (Educating the client)
-they are based on the values and beliefs of the faith
-uses the nursing process
-care based on ANA standards
-follows nurse practice acts (scope and standards of practice)
-maintain confidentiality
61
Models of Parish Nursing
1. Institutional- contractual with health care institutions
2. Congregational- nurse accountable to the congregation
3. Circle model of Spiritual care
C= caring
I=intuition
R=respect
C=Caution
L=Listening
E=emotional support
62
Roles of the Parish Nurse
1. Health education- group and individual education
2. Personal health counselor- assess for emotional distress
3. Referral agent to HCP's
4. Health advocate- help obtain services
5. Coordinator of volunteers and support groups
6. Advocate= for the individual and community (advocate for autonomy in the client-self-care)
63
1. There are a variety of models of faith-based nursing practice. Using your knowledge of these various models, what is parameter in a congregation-based model?
A) Nurse serves a health system with assignment to particular congregational setting.
B) Serves as a liaison to the congregational setting.
C) Helps plan and coordinate care.
D) Supports the concept of faith-based nurse
D) Supports the concept of faith-based nurse
64
12. Parish nurses engage in primary, secondary, and tertiary prevention activities in their congregations. Using your knowledge of levels of prevention, what is an example of a tertiary prevention strategy?
A) Smoking cessation programs
B) Heart-healthy eating programs
C) Maximize function for people with diabetes
D) Exercising to maintain health
C) Maximize function for people with diabetes
65
14.
Parish nurses engage in primary, secondary, and tertiary prevention activities in their congregations. Using your knowledge of levels of prevention, what are examples of primary prevention activities?
1. Minimize the effects of stroke
2. Setting up a mammogram screening van
3. Smoking cessation program
4. Heart-healthy eating program
A) 1, 2
B) 1, 4
C) 2, 3
D) 3, 4
D) 3, 4
3. Smoking cessation program
4. Heart-healthy eating program
66
Homeless Populations
| Vulnerable populations is due to?
due to poverty (leads to high risk work, overcrowded living, limited access to health care, have multiple cumulative risks, poor nutrition, more stress, poor quality schools, disparities in health care-> vicious cycle
67
Aggregates
| Types of vulnerable populations
- pregnant teens
- substance abusers
- the elderly
- homeless people--> HIGHEST RISK(require the most interventions) --> mental health issues, many chronic illness, who live in substandard housing
- mentally ill
- handicapped
68
Poor Health Outcomes in vulnerable populations
- chronic diseases
- communicable diseases
- high crime rates, domestic violence, mortality rates
- high rates of maternal and infant mortality (lack of prenatal care)
69
Caring for vulnerable populations?
Caring for Vulnerable Populations
1. Outreach- provides services where people normally gather-access to services
- provide vaccines, information and services to the homeless, you want to go where the people are
2. Comprehensive services- provide multiple services in one visit (good for people with transportation issues)
3. Provide education to help groups achieve a sense of control, however you want to get it a crossed
70
Who are the highest in homelessness?
```
#1 MEN, single mothers and children (increasing)
-an individual who lacks a fixed, regular, and adequate nighttime residence and an individual who has a primary nighttime residency that is a shelter, temporary place to stay
```
71
Contributing factors to homelessness?
Contributing Factors
1. Loss of job
2. Being asked to leave the home
3. Domestic violence
4. Mental health issues
5. Substance abuse
6. Release from jail or mental health institution
7. Disability- physical
8. Natural disasters and fires
72
Social Factors contributing to homelessness
- shortage and affordable housing
- insufficient income and lack of employment
- inadequate support services for low income people
- veterans- mental health or substance abuse
73
Who helps homeless people find housing?
HUD
HUD--> provides financing for housing and works with the state
Section 8--> provides landlords with $ for low income tenants and public housing
74
Problems with finding medical care in the homeless populations
PROBLEMS WITH FINDING MEDICAL CARE
1. Availability
2. Accessibility --> can they get there? Do they have transportation
3. Accommodation --> is the professional accepting of me
4. Affordability - most will not have birth certificate or address to help
5. Acceptability
75
Levels of Prevention in the homeless and vulnerable populations
Primary- immunizations, basic human needs, education, increased affordable housing, health care and social services
Secondary- screening to identify illness early
Tertiary--> treat mental illness and substance abuse, provide shelters for the homeless and victims of domestic violence
76
1. Underserved population is a subgroup of the population that has a higher risk of developing health problems because of a greater exposure to health risks because of marginalization in what areas?
1. Age
2. Gender
3. Sociocultural status
4. Access to psychological resources
A) 1, 2, 3
B) 1, 2, 4
C) 1, 3, 4
D) 2, 3, 4
1,2,3
1. Age
2. Gender
3. Sociocultural status
77
Health status of Homeless adults in men are?
```
they are the largest homeless population
Main health problems are:
1. alcoholism and drug abuse
2. serious mental health problems
3. STD
```
78
Health status in homeless adults in women are?
Main health problems are:
1. nutritional
2. prenatal care
3. alcohol and drug abuse
4. victims of violence
5. STD
79
8. When it comes to elder care in rural communities, seven factors compound disease prevention and health promotion efforts to identify and reduce modifiable risk. Availability is one of the seven As of challenges to elders in rural areas. What is the definition of availability?
A) Insufficient number and diversity of formal services and providers; lack of acceptable services and human service infrastructure
B) Shortages of adequate, appropriate, and affordable transportation; cultural and geographic isolation
C) Poverty and inability to pay for services
D) Low levels of information dissemination and literacy issues
A) Insufficient number and diversity of formal services and providers; lack of acceptable services and human service infrastructure
80
9. When it comes to elder care in rural communities, seven factors compound disease prevention and health promotion efforts to identify and reduce modifiable risk. What is lack of basic information on what is needed using research rigor and analyses called?
A) Awareness
B) Adequacy
C) Acceptability
D) Assessment
D) Assessment
81
15. What is the U.S. federal designation for those populations that face economic barriers or cultural and/or linguistic access barriers to primary medical care services called?
A) Health professional shortage area
B) Medically underserved area
C) Medically underserved population
D) Undeserved population
C) Medically underserved population
82
17. When it comes to elder care in rural communities, seven factors compound disease prevention and health promotion efforts to identify and reduce modifiable risk. What is it called when the elder in a rural community is reluctance to ask for help?
A) Awareness
B)m Adequacy
C) Acceptability
D) Assessment
C) Acceptability
83
Violence includes what population
*scattered among all ages and gender and it does not discriminate
Reporting--> DUTY to DISCLOSE--> to start investigation into a potential abusive case
Adult male/Female--> you cant make them leave
Violence- use of physical force (sexual, physical) against another person or against oneself
-it is predictable and preventable
\
84
Factors that contribute to violence
Factors that Contribute to Violence
1. Poverty, unemployment, economic dependence
2. Access to firearms
3. Intolerance or racism
4. Cultural or religious intolerance
5. Media influence
6. Drug and alcohol abuse
7. Dysfunctional family, lack of emotional support
8. High population density
85
Intimate Partner Violence
| Risk factors
a. Low self-esteem
b. Poverty
c. Risky sexual behavior
d. Eating disorders and depression
e. Alcohol and drug abuse
f. Trust and relationship issues
g. Development of abusive patterns- previous exposure to violence
h. Abuse often escalated in frequency and severity
i. Maybe found in all ethnic, economic, educational groups
86
Elder Abuse
- physical abuse
- psychological abuse
- physical neglect
- financial abuse
- highest risk- frail elderly females
- person may be socially isolated
- dependent on family for support (victim is in poor physical health and mental health)
87
Identification of potential abuse
Identification of Potential Abuse
a. Fear of the caregiver
b. Unexplained injuries
c. Withdrawn behaviors
d. Social isolation
e. Lack of compliance with treatment plans
f. Poor hydration and nutrition
g. Untreated health problems
h. Financial mismanagement-have pension direct deposited
88
Levels of prevention in violence (all types)
Levels of Prevention
Primary
-education (main intervention) -> parenting classes, teach anger management in schools, caregiver education, improve security in homes, form neighborhood watches, preventative mental health services
-a nurse advocates for elected officials to make nonviolence a priority
Secondary
- identify individuals/families at risk
- provide early intervention- HIGHEST PRIORITY
- screening for intimate partner violence
- screening for elder abuse, child abuse, and potential for community violence
Tertiary (REFERRAL is an important component)
GOAL- provide rehabilitative services
-collaborate with mental health and social workers in coordinating care
-provide counseling for victim and abuser
-crisis lines and shelters for victims
-providing an injured victim in a safe location after the person has been abused
89
2. Intimate partner violence fundamentally is based in the desire for control on the part of the perpetrator. What is a relationship risk factor for intimate partner violence?
A) Emotional dependence and insecurity
B) Belief in strict gender roles
C) Desire for power and control
D) Unhealthy family relationships and interactions
D) Unhealthy family relationships and interactions
90
Family Health
Who is a critical resource in family health ?
the family
91
Importance of Family( what are they)?
- To meet the needs of society
- To meet the needs of the individual family member
- Family is an important unit of healthcare
Assessments need to include broader concepts of community and interactions between family and community
92
Community health nurse how do they work with families?
Community Health Nurse: working with families
1. Family is critical resource
2. Any dysfunction in a family unit will affect the members and unit as a whole
3. Case Finding can identify a health problem which leads to risks for the entire families
93
Healthy families have what characteristics ?
Healthy Families
1. Interact with each other and establish priorities
2. Affirm, support and respect each other
3. Engage in flexible role relationship
4. Share leisure time
94
Theories in Family Health
| Systems theory-->
characteristic of a system (family is based on this theory)
- a system is greater than and different from the sum of its parts
- system can be open, closed or random
Terms in systems theory
- suprasystem- large system, environment or community
- Subsystem- smaller unit (parents and children)
- *Change in one part of the system effects the entire system
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Family Theory approach
- any dysfunction that affects one family member will probably affect others and the family as a whole
- the wellness of the family is highly dependent upon the role of the family in every aspect of healthcare
- The level of wellness of the whole family can be raised by reducing lifestyle and environmental risks
- Commonalities in risk factors and diseases shared by family members can lead to case finding within the family
- Assessment- the individual is assessed within the large context of the family
- Family is a vital support system to the individual member
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Structural-functional conceptual Framework
i. Internal Structure- family composition, member and roles
ii. External structure- extended family and larger systems (including work, health and welfare) --> ask who participates? And how do they participate?
iii. Instrumental functioning (ADLS) -everyday life activities
Expressive functioning- communication, problem-solving, range of emotions expressed
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Developmental theory
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4. Developmental Theory (Erik Erickson)
Family life cycle
1) Beginning family
2) Early childbearing family
3) Preschool children
4) School-aged children
5) Teenage children
6) Launching family
7) Middle-age family
8) Aging family
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What are alterations in family development?
divorce or remarriage
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Family assessment tools are
Family Assessment Tools
• Genogram--> a tool that helps the nurse outline the families structure
• Family health tree--> family's medical and health histories
• Ecomap--> depicts a family's linkages to their
suprasystems- large system, environment or community
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Women's Health
| when was the first women's rights convention?
1848- Elizabeth cady Stanton created the 1st women rights movement
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The leading cause of death in women is? followed by others
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Leading Cause of Death= Cardiovascular disease (1- ages 35-44)
Cancers--> 1- lung, 2- breast, 3-colon
Older women--> unintentional injuries= FALLS
Domestic violence (15-44) major cause of injury
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Maternal Mortality (what is the highest risk)?
> HIGHEST RISK? = older age, African American, rising C-sections, obesity, poor nutrition, access to prenatal care
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Leading cause of maternal mortality
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Leading Cause of Maternal Mortality
1- Pulmonary emboli
2- Infection
3- Pregnancy induced HTN
4- Ectopic Pregnancy
5- Hemorrhage
6- CVA
7- Anesthesia
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Levels of prevention in women's health?
LEVELS OF PREVENTION
1- Primary- education to prevent high cardiovascular disease, osteoporosis, cancer
2- Secondary- screenings
Tertiary- monitoring patients with diabetes, rehab after MI and CVA
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What are the core functions of public health?
1. Assessment
2. Assurance
3. Policy Development
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What are the symptoms of acute and chronic pesticide poisoning?
Risk = toxicity x exposure (they are dose related for acute and chronic)
Acute= (occurs soon after exposure)from a single exposure (effects) or repeated exposure over a short time, such as a accident from mixing or applying pesticides (can be deadly)
Symptoms--> rash, headache, eye irritation, trouble breathing, chest pain, dizziness, blurred vision, sweating (diaphoresis), burning throat and lungs
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Chronic= effects of long term or repeated lower level exposures to a toxic substnace (may take years to produce signs and symptoms)
Symptoms
-neurological/memory loss
-cancer
-genetic changes
-causes birth defects (sterility)
-liver damage
-reproductive disorders
-nerve damage
-allergic sensitization- allergies to pesticides
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2. What is the main health concern of rural residents?
Access to health care
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3. What would be a good way to provide health care to migrant populations?
Answer--> nursing outreach in these areas
- community based care- home care and faith community care
- informed care system- family and friends
- Public health departments- may cover large areas, they will go out to these populations to provide nursing care
- give them educational material as they move around a lot
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What is the goal to home healthcare?
Goal is to maintain or improve the quality of life for patients and their
families/caregivers, or support patients in transition to their end of life
-maximize self-care (advocate for this)
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Skilled nursing care examples are?
Skilled nursing care
1. Evaluation of care
2. IV administration of medication
3. Assessments
4. Management of care
5. Wound care
6. Changing a foley catheter
7. Teaching (education)
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Medicare and medicaid
part of the social security act and:
Medicare= primary payer (1965- allows for short-term, intermittent skilled health services in the home for clients 65 and older and are homebound)
Medicaid (1965)- provides home health services for low-income clients or clients with a disability
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Supportive Health care services are approved for how many hours and days per week? What services are offered?
2 hours a day for 3 days a week
| -PT, OT, social services, home health aides, respite care, adult daycare services, nutrition, and provision of meals
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1. Home care is part of a continuum of care where clients have the opportunity to live through the experiences of subacute, chronic, and end-of-life care. Using your knowledge about home health care, what is assisted living?
A) A model of care for the elderly or disabled that includes services such as home care to maintain the independence of clients
B) Coordination of a plan or process to bring home health services together as a common whole in a cost-effective way
C) The condition where a client cannot leave his or her home without taxing effort
D) A home health agency that is not freestanding in the community is one of many specialty services offered at an independent setting.
A) A model of care for the elderly or disabled that includes services such as home care to maintain the independence of clients
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2. You are preparing a presentation on care management for a group of student nurses. Based on your knowledge of community health nursing, what will be a key point to include in this presentation about care management?
A) Development and coordination of care for a selected client and family
B) Management of health care that occurs in the setting clients considers their home
C) Sharing of evidenced-based practice and skills as an integration strategy with clients and families in homes and other health care settings
D) Coordination of a plan or process to bring health services together as a common whole in a cost-effective way
D) Coordination of a plan or process to bring health services together as a common whole in a cost-effective way
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What levels of disease management emphasize prevention using evidence-based practice?
secondary and tertiary
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how is case management and care management related?
Case management can be considered a building block of care management.
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Who regulates the provision for home healthc care?
state and federal government
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You know those home health agencies are certified through a process where stipulated conditions must be present in order for the agency to give services to the public and receive payment for those services. Using your knowledge about financing, what criteria an individual has to meet in order to receive Medicare for home health services?
1. Home bound
2. Specific plan of care
3. Skilled health care needs
4. Intermittent care needs
5. Continuous 24-hour necessity for care
1. Homebound
2. Specific plan of care
3. Skilled health care needs
4. Intermittent care needs
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what are the criteria of providing care over several hours during the day, several days during the week, for a specified time period called?
intermittent care needs
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Your patient wants to know how long Medicare will pay for skilled needs. Using your knowledge about financing, what specific time period is appropriate for renewals if skilled needs continue to exist?
60 days
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The community health nurse can receive a referral to a home health agency at any time. Using your knowledge of home visits, generally home care agencies make sure to do the initial visit within what time frame after receiving a referral?
24 hours
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The community health nurse can receive a referral to a home health agency at any time. Using your knowledge of home visits, what phases are included in a home visit?
1. Initiating a visit
2. Preparation
3. Actual visit
4. Termination of the visit
5. Plan personal safety of visit
1. Initiating a visit
2. Preparation
3. Actual visit
4. Termination of the visit
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Hospice nursing is for people with how much time to live and what parameters?
14. HOSPICE (6 months or less to live, DR needs to certify this)
- promote not cure the disease
- care and support for people who have a terminal illness
- caregiver most important to assess
- collaborative team
- care is available 24 hours a day
- IV pain meds provide short term relief
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Hospice care includes services that are reasonable and necessary for the comfort and management of a terminal illness. What services might be included?
1. Physician services
2. Nursing care
3. Long-term inpatient pain control
4. Hospice aide service
5. Medical social services
1. Physician services
2. Nursing care
4. Hospice aide service
5. Medical social services
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A dying client may decide to receive comfort measures only. What does comfort care measures focus on?
1. Quality of life
2. Length of life
3. Comfort focus of care
4. Cure as an attainable goal
Quality of life and comfort measures
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Advance directives are legal documents that allow people to convey their wishes for end-of-life care and include living wills, durable powers of attorney for health care, and healthcare proxies. What is a living wills?
Document describing clients' wishes regarding treatment intended to sustain life
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A client has been prescribed opioid analgesics. The client asks the nurse how long before the sedation will subside. The nurse would tell the client what time frame?
24 to 48 hours
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A dying client is experiencing constipation. What would be an appropriate nursing intervention for this client?
administer lactulose
