Quiz 2 Flashcards
(123 cards)
1
Q
Social Determinants =
A
= the conditions in which people are born, grow, live, work, and age, including the health care system
2
Q
Social Determinants of Health Include
1) E_______
2) _______ stability
3) Em_______
4) N_______
5) Risky _______/ innate individual traits
A
1) Education
2) Economic Stability
3) Employment
4) Neighborhood
5) Risky behaviors/innate individual traits
3
Q
What is a health disparity?
A
A particular type of difference in health (or in the most important influences on health that could potentially be shaped by policies)
It is a difference in which disadvantaged social groups (poor, racial/ethnic minorities, women) experience social disadvantage and discrimination, and systematically experience worse health or greater health risks than more advantaged social groups
4
Q
Intersectionality (4)
A
Interplay = multiple identities leading to disadvantage (oppression/discrimination)
Life experiences = greatly influence health and well being
Combined effect = health must be studied
Multiple identities = should be considered when discussing helath
5
Q
What adverse childhood experiences influence health throughout life?
A
Bottom - Up
- Adverse childhood experiences
- Disrupted neurodevelopment
- Social/emotional, and cognitive impairment
- Adoption of health and risk behaviors
- Disease, disability, and social problems
- Early deatj
6
Q
Social Context of Health Disparities = _____/______ minorities experience higher rates of discrimination or oppression bc of legacy of ______ and discrimination in the US
A
Racial/ethnic
Slavery
7
Q
Factors that contribute to racial and ethnic health disparities are?
A
- mistrust of medical professionals
- language barrier
- reduced access to healthcare
- poverty
- differing cultural norms
8
Q
Who has the highest rate of HS non-completers?
A
Latinos
9
Q
Higher educational attainment is associated with what protective factors?
A
- Life skills including control, negotiation, and flexibility
- Social networks
- Financial stability
- Reduced stress
10
Q
Significant income disparities in the US are highest amongst?
A
Blacks, Latino, American Indeans
11
Q
Low economic stability is associated with
A
- Poverty -> increased morbidity, mortality
- Negative association between income and risk behaviors
- Education-> protective factor against disease across lifespan
12
Q
Unemployment is associated with
A
worse perceived physical and mental health, especially in the last month of unemployment for > 1 year
13
Q
Low income neighborhoods are associated with
A
- less green space
- higher crime rates
- higher unemployment
- higher levels of environmental toxins
- less political influence
14
Q
Nearly 30% of america lacks access to ?
A
Healthy food (food desserts)
15
Q
Who binge drinks the most?
A
White people, but american indians have greater intensity and frequency
16
Q
Who smokes the most?
A
American indians, multi-racial
17
Q
What disease disparities are present in the US
A
- Cardiovascular Disease (HTN, stroke, kidney disease)
- Chronic Diseases (obesity, HIV/AIDS)
- Suicide
- Cancer
18
Q
Who has higher rates of HTN?
A
Blacks, Latinos have higher rates, but lower control
19
Q
Who has increased death related to kidney disease, heart disease, stroke?
A
Blacks, Latinos
20
Q
Who is more likely to have a stroke?
A
American Indians (200% more likely)
21
Q
Obesity rates are highest among?
A
Blacks, Latinos (especially women)
22
Q
___ women vs. ____ women are more likely to die of liver disease
A
Black more than White
23
Q
Who has a higher incidence/prevalence of HIV/AIDs despite similar rates of unprotected anal sex
A
MSM
24
Q
Suicide is higher in ?
A
Blacks 18-24, While men over 45 later on
25
Who has the highest mortality rate for ALL CANCERS?
Blacks
26
Who has more colonoscopy's but lower survival rates of colon cancer
Blacks
27
____ women are more likely to die from breast cancer despite 10% less chance of it
Black women (40% more likely to die)
28
Who is 2x more likely to have cervical cancer and mortality than whites?
Latino women
29
Higher rates of lung and prostate cancer in?
Black men
30
Greater deaths from stomach cancer in?
Asians
31
Vulnerable populations include
disabled, homeless, immigrants, LGBTQ, limited english proficiency, women, children, older adults, poverty, prisoners, religious groups, rural populations, substance users, veterans
32
What is Health Equity ?
= When everyone has the opportunity to "attain their full health potential" and no one is "disadvantaged from achieving this potential bc of their social position or other socially determined circumstance"
33
```
Working towards health equity series
1st Generation =
2nd Generation =
3rd Generation =
4rd Generation =
```
```
1st = document existence of disparities
2nd = cause
3rd = provide solutions
4th = implement/incorporate solutions
```
34
Affordable Care Act states that ->
Created by the Office of?
___ national standards
Everyone deserves the same care and equal treatment (obama implemented this to get rid of health disparities)
Office of Minority Health
14
35
3 themes of the Affordable Care Act
1) Culturally competent care
2) Access to language services
3) organizational supports for cultural competence
36
An American Culture of Health is one which?
- good health flourishes across geographic, demographic, and social sectors
- attaining best health possible is valued by entire society
- everyone has access to affordable, quality health care
- NO ONE IS EXCLUDED
- Health care is efficient and equitable (less burdened by too much spending)
WE'RE ALL IN THIS TOGETHERRRRR
37
Explicit Bias =
Self Aware, Intentional, Belief that it is justified
38
Implicit Bias =
unconscious, activated by situational and social cues, influenced by perception, behavior, and memory
39
LGBTQ Health Disparities
- Access to health care
- Clinical preventative services
- Injury and violence
- Mental Health
- Nutrition, physical activity, obestiy
- Reproductive and sexual health
- Substance Abuse
- Tobacco
40
Lesbian women are 2x at risk for being?
Obese
41
LGBT have high/highest rates of ?
Suicide, HIV, alcohol, tobacco, drug abuse
42
Causes of LGBTQ health disparities are?
- Personal risk behaviors
- Social and economic realities
- Stigma
- Lack of knowledge by providers
43
Negative attitudes/lack of knowledge of LGBTQ population leads to poorer healthcare d/t?
- decreased access and utilization of care
- non-disclosure of sexual orientation
- lack of same sex insurance benefits
- low SES of lesbian women
- role of marriage equality
44
SADCOST =
```
STD's
Attitudes (of HCP's)
Depression, Anxiety, Suicide
CVD, Cancer
Overweight, Obesity, eating disorders
Substance abuse
Trauma and violence
```
45
LGBT Youth Special Concerns
- coming out
- family rejection
- homelessness
- substance abuse
- mental health/suicide
46
LGBT Midlife/Family Issues
- insurance, access to preventative care, access to chronic disease management
- lack of same sex insurance
- relationships, marriage equality, family of origin issues
- becoming parents, adoption donor issues, fertility and pregnancy
47
LGBT Older Adult Issues
- Financial Concerns
- Social isolation
- Acute Care issues
- Long term issues "back in the closet", caregiver issues
- end of life issues
48
Sexual health assessment components of LGBTQ
| 1) Routine Screenings =
1) on all organs as long as they're present (testicular/prostate exam, pap smear, gonorrhea/chlamydia screen; breast exams, mammograms; periodic syphilis, HIV, other STI)
49
Why is there a higher risk of breast cancer in male to female transgenders?
Bc they are receiving estrogen supplements/risk of breast cancer from residual breast tissue
50
MTF still have a _____ gland
| WTM might still have ______
Prostate
| Uterus/Ovaries
51
When taking a sexual history what do you want to establish first?
What do you want to ask when communicating with them?
Trust (try to have rapport with patient before examining sexual areas)
What is their preferred name and pronoun preference
Include gender intake form
Avoid using clinical terms when assessing (use vagina not neo vagina)
52
The first step to providing culturally sensitive care to LGBT community is?
Self assessment, Self-Reflection
- Assume you have biases, prejudices
- Conscious biases and Subconscious (implicit biases/microaggressions)
- Language
- Physical space of our practices
53
What are other methods to provide culturally competent care to LGBT?
- Attend cultural competency training
- Ask your patient about sexual orientation and gender identity
- Do research!
54
Gender Identity =
What you in your head, define your gender, based on how much you align (or don't align) with what you understand to be options for gender
55
Gender expression =
The ways you present gender through your actions, dress, and demeanor, and how those presentations are interpreted based on gender norms
56
Biological Sex =
The physical sex characteristics you're born with and develop, including genitalia, body shape, voice pitch, body hair, hormones, chromosomes, etc.
57
Sexual Attraction =
| Romantic Attraction =
Sexual orientation
| Emotional attraction
58
Environmental Risk Factors for substance use
```
Maltreatment
Inadequate supervision
Parental substance abuse
Chaotic home
Peer influence
Poor academic achievement
Impulsive behavior
Inattention and irritability
Substance availability
Early onset of SUDs
```
59
What neuro/psych disorders put someone at risk for substance abuse? (4)
Conduct disorder
ADHD
Anxiety, Depression
PTSD
60
Biggest risk factor for substance abuse is? *
Having first drink early in life
61
3 factors that leave health care professionals more susceptible to substance abuse
1) Presence of coexisting psych illness
2) Family history of SUDs
3) Abuse of opioids
62
Which health care professions are more susceptible to substance abuse?
Anesthesiologists, MD's, RN's - have higher rates of SUDs and more likely to relapse once in treatment (debatable)
63
Potential Effects of Substance Abuse
What medical illnesses can SUD's lead to (4)
- Drunk Driving
- MVA
- Unsafe sexual activity
- Falls
- Passing out in dangerous places
- Liver disease, HTN, heart disease, cancer
64
Behavioral therapy =
Behavioral and counseling techniques designed to promote behavior change typically using methods that can be applied with only minimal adaptation to addiction across substances
65
Types of Cognitive Behavioral therapy (2)
- Motivation Enhancement therapy (effective for alcohol/smoking)
- 12 Step Facilitation (AA)
66
12 step program =
Process that involves treatment staff enhancing patient motivations to commit
67
Categories of Pharmacotherapy's for Substance Abuse (3)
Pharmacotherapy =
Replacement
Antagonism
Tangental
= to target specific neurobiological addiction path ways (opioid or nicotine)
68
Replacement drugs =
replaces the drug of addition with one that has same activity at the receptor but much lower addictive potential (nicotine patch)
69
Antagonism drugs =
blocks the action of the drug of dependence (narcan if addicted to morphine)
70
Tangentinal drugs =
drugs with a variety of mechanisms
71
Drugs to combat Alcohol addiction (3)
Disulfuram, Acamprosate, Naltrexone*
Naltrexone + CBT superior to other meds and counseling methods for tx of alcohol dependence
72
Drugs to combat Nicotine addiction (3)
Varenicline, Buproprion, Nicotine replacement
73
Drugs to combat Opioid addiction (3)
Methadone, Buprenorphine, Naltrexone
74
Drugs to combat cocaine/meth ?
No FDA approved meds for stimulant addiction
75
Combined Treatments = ___ + ____
pharmacotherapy + specific behavioral counseling techniques
76
SANE Model =
The work of Sexual Assault Nurse Examiners is complex and multifaceted as nurses must attend simultaneously to sexual assault patients PSYCHOLOGICAL, MEDICAL, FORENSIC, and LEGAL
77
Duties of a SANE nurse
- Provide Nursing/Medical Care
- Obtain a medical and forensic history
- Perform physical assessment
- Identify, collect, preserve, and document forensic evidence
- Photograph injuries
- Provide fact and expert witness testimony
- Psychosocial support
- Pregnancy Prevention
- Post Exposure prophylaxis to prevent HIV infection
- Additional STD Prevention (Chlamydia, Gonorrhea, Trichomonas)
- Follow-up care resrouces
78
SANE Timelines
- Evidence collection within
- Kit Storage
- Post Exposure HIV Meds
- 96 hours
- 30 days (NY state)
- 72 hours
79
SART =
= A community- based team that coordinates the response to victims of sexual assault. The team may be comprised of SANEs, hospital personnel, sexual assault victim advocates, law enforcement, prosecutors, judges, and any other professional with a specific interest in assisting victims of sexual assault
80
Primary Prevention of Sexual Assault =
= Activities that take place before sexual assault has occurred to prevent initial perpetration or victimization
81
Secondary Prevention of Sexual Assault =
= Immediate responses after the sexual violence has occurred to deal with the short-term consequences of violence
82
Tertiary Prevention of Sexual Assault =
Long term responses after sexual violence has occurred to deal with the lasting consequences of violence and sex offender tx intervention
83
Rape Trauma Syndrome =
Is the psychological TRAUMA experienced by a rape victim that incldues disruptions to normal physical, emotional cognitive, and interpersonal behavior
84
What is the #1 Date Rape drug?
Alcohol
85
When a girl gets raped but she was drunk, is it partially her fault?
NUUPEE
86
Effects of Alcohol on Men =
More powerful, sexual, aggressive
Thinks girls are flirting with them when they're not
87
Effects of Alcohol on Females =
Ignore, miss cues that suggest sexual assault is likely
| Can't resist an assault
88
Other Date Rape Drugs
Rohypnol
GHB
Ketamine
Eye Drops
89
Which one is ALMOST tasteless (has a salty taste)
GHB
90
Which one is the mind eraser?
Roofies (Rohypnol)
91
Which ones are very dangerous, can lead to seizures, coma, death?
GHB, Ketamine
92
Which one is used as an animal tranquilizer
Ketamine
93
What is a wood lamp?
UV light to detect semen
94
Global health indicators
- Morbidity, Mortality
- Infectious, Communicable diseases
- Trauma
- DALY
- Country income, development, governance, corruption
- Health worker to population ratio
- Beds per 1000
95
DALY =
Disability adjusted life years (the years you lose to disability) Difference life expectancy - age you start having disabilities
96
Development =
Process of how a country achieves a stable society and stable economy according to the countries standards
97
HIV vs. Malaria
What kills more people malaria or HIV?
Which one is less funded?
Which one are people higher at risk for?
- Malaria bc they don't have access to medicines in certain countries
- Malaria
- HIV
98
Zika =
Who does it affect severely?
intersection of two diseases (transmitted by mosquito and then sexually transmitted)
Babies will have lots of health issues (MICROCEPHALY)
99
What makes HIV so challenging to combat?
because of its physiologic complexity and link to human behavior
100
Malaria =
When was it eliminated in the US?
A neglected tropical disease
1947
101
What are some global health priorities (2) besides Malaria/HIV
- most health systems around the world are unprepared to care for immigrants
- data quality has been poor
102
3 types of immigrants =
1) Legal (work visa, asylum seeker, green-card, lottery winners)
2) Undocumented
3) Refugees
103
Nursing Implications for Immigrants
1) Questions to ask on assessment
2)
1) How did they migrate? where do they live/with how many people? Who are their family left behind? in what circumstance? Language skills
104
What does lack of data on global health mean for researchers and policy makers?
Prevents strategic planning when crises sporadically arise
105
Key causes of death globally (first four) =
Leading causes of deaht in the US
Heart Disease*, Cancer , Stroke, COPD
Heart Disease, Cancer, Malignant Neoplasmas, COPD, Alzheimers, Diabietes, Flu/Pneumonia (#7), Nephritis, nephrotic syndrome, nephrosis, suicide
106
What came first, palliative or hospice care?
Hospice care (1967)
Palliative care (1975)
107
Who defined the term palliative care and opened the first hospital based palliative care?
Where was it?
Dr. Balfour Mount
Royal Victoria Hospital at McGill University in MONTREAL, CANADA
108
What is the palliative care "credo"?
"To be able to live until one dies" , at their maximum potential, performing to the limit of their physical and mental capacity with control and independence whenever possible" - Cicely Saunders
109
Outcome Measures in Palliative/End of Life Care
WHAT IS EMPHASIZED?
- Physical and emotional symptoms
- Support of function and autonomy
- Advance Care Planning
- Aggressive Care near Death
- Patient and family satisfaction with care, relieve family burden
- Provider continuity and ease of contact
- Bereavement assessment and care planning/support
QUALITY OF LIFE*
110
2 Simultaneous roles of the RN in end of life care
THE GOOD LIFE = Promotion of a ROBUST, healthy, full life
THE GOOD DEATH = Help patients and families prepare for the best possible death
111
What is THE GOOD LIFE?
- "When at the end of the tether, one has enjoyed, all is done.."
- Not to have any regrets
- Engaging in "good" activities-what we like doing, enjoy doing, had fund doing
- ..."being able to say--"I've done all that i wanted to. I have no desire to do anything else; dying the good death when you die"
112
Spiritual Literacy
- an integral part to the practice of the world's great Religions
- "religions are like the separate fingers and are all quite distinct from each other. But if you trace them to their source, the palm of the hand, you see that they come together in their depths."
113
In regards to Spirituality
What is important for health care workers?
- Self Awareness, caution, sensitivity
- Awareness of the potential for diverse spiritual taxonomies that are developed through experience and exposure to situations across the life span
114
How have funeral customs evolved?
- Death and control of dying now moved into the hospital
- Death is now an exceptional occurrence surrounded by machines and health care professionals rather than community, clergy, and family
- Children are sheltered, No pets allowed!
- At time of death, body is transferred to funeral home, body not seen until properly embalmed
- The funeral director role appears (1885) - this person manages teh moving, viewing, preparing, disposition of the body
115
What is THE GOOD DEATH?
A Beautiful death; aesthetic term, robust life is involved
- Goal in life: as your energy begins to run out, so does your body and vice versa
- "You only die once, if you play your cards right, that should be enough"
116
Development landmarks and taskwork
- sense of completion, meaning
- experience of love
- acceptance of finality, existence
- surrender to transcend, unknown
117
Death is a loss of?
- physical health, belief in remaining healthy indefinitely, confidence in certainty, order, predictability, and security of life: family, roles, identity, job employment, feeling competent, indepedent, control of bowel, life, everything, people thought to be friends, possessions, superficial relationship with God, hope, meaning
118
Traditional Death =
What centuries ?
- death was normal part of life and living, was familiar, not feared
6-15th century
119
The Death Event =
Who is incorporated first?
What is the prevailing idea?
Presided over and organized by the DYING person, total awareness and preparation
Community incorporated first, Family second
120
Personalization death =
| When does this idea come about?
= in the reflections of dying, each person expected to discover the secret of his/her uniqueness
- 15-16th century (Renaissance,Reformation)
121
How is death seen now?
No longer a passage into eternity but as a break from society, is irrational and violent
122
Assisted Dying Prescription
9 g of secobarbital (capsule) or 10 g of phenobarbital (liquid)
- antiemetic 1 hour before
- take on empty stomach with juice or other sweet beverage
123
First hospice hospital by who and where?
Cicely Saunders, London
