Community Exam 2 PDF

Crisis/Abuse - 5 questions Dynamics & Characteristics of a Crisis ○ Internal or external force disrupts system of balance ○ Attempts to restore balance via coping ○ Precipitation by a specific identifiable event that becomes too much for usual problem solv...

Crisis/Abuse - 5 questions Dynamics & Characteristics of a Crisis ○ Internal or external force disrupts system of balance ○ Attempts to restore balance via coping ○ Precipitation by a specific identifiable event that becomes too much for usual problem solving skills ○ Normal in that all people feel overwhelmed occasionally ○ Possibly not an event but a person’s perception of the event ○ Resolution either positive or negative; Adaptive -> growth and improved health; Maladaptive -> resulting in illness or death theory Types of Crises ○ Developmental -> periods of disruption that occur at transition points during normal growth & development ○ Situational -> stressful disruptive event arising from external circumstances that occur suddenly, often w/o warning to a person, group, aggregate, or community ○ Multiple -> different kind of crises can overlap actual experience compounding the stress felt by persons involved Primary Prevention ○ Health promotion & education Anticipatory guidance; parenting skills Positive coping strategies; social problem solving skills & assertiveness skills Social support & other resources ○ Health protection Reduce factors that increase vulnerability Reduce hazards in some events Secondary Prevention ○ Early diagnosis; recognize s/s of crisis & s/s of abuse ○ Prompt treatment  Provide necessary assistance including emergency medical and emotional support & assist with reaction to event and functioning Ensure safety, Allow behavior (dependence, grief, etc), Refer to resources, Set goals w/ client ○ Reporting of abuse Tertiary Prevention ○ Rehabilitation Promote adaptation to changed level of wellness, Promote independence, Reinforce newly learned behaviors/lifestyle changes/coping strategies, Explore application of learned behaviors to new situations, Identify and use additional resources ○ Continue primary prevention to avert future crisis Specific Abusive Situations ○ Shaken Baby Syndrome Bilateral retinal hemorrhages; Subdural or subarachnoid hematomas; No other external signs of abuse; Possible breathing difficulties, Seizures, Dilated pupils, Lethargy, & Unconsciousness ○ Munchausen Syndrome by Proxy Parent or caretaker attempting to bring medical attention to self by injuring or inducing illness in the child ○ Internet crimes against children, Child abduction, Crimes against children by babysitters, School violence ○ Physical Abuse Bruising, Lacerations, Abrasions, and Fractures would be associated w/ physical abuse Partner/Spousal Abuse ○ Types Dating violence Spousal abuse; Intimate partner violence; Domestic violence (physical, sexual, emotional, economic, or psychological abuse) Violence during pregnancy  ○ Cycle of Violence Tension building Acute battering Loving reconciliation Increasing spiral of violence Batterer Characteristics ○ Low income, Low self-esteem, Low academic achievement, Involvement in aggressive or delinquent behavior as youth, Heavy alcohol & drug use, Depression, Anger & hostility, Personality disorders, Prior history of being physically abusive, Having few friends and being isolated from other people, Unemployment, Emotional dependence and insecurity, Belief in strict gender roles (male dominance and aggression in relationships), Desire for power & control in relationships, Being a victim of physical or psychological abuse (consistently one of strongest predictors of perpetration) Victim Characteristics ○ Prior history of IPV, Female, Young age (esp pregnant), From low income house, Witnessing/experiencing abuse as kid, Low education level, Unemployment, Single parent w/ kids or separated/divorced/widowed, For men - having different ethnicity than partner, For women - greater education level than partner, For women - being AA/Indian, For women - being disabled, For women - having verbally abusive or jealous or possessive partner, Veterans & active duty military, Some research indicates higher levels of IPV in same sex (esp emotional victimization) Effects of Violence on Children ○ Increased risk of becoming abuse victim or perpetrator later in life, Increases risk of substance abuse, Effects can be seen in emotional/cognitive/physical/ and/or behavioral ways, Risk of depression & anxiety is increased, Can hinder health & development, Lifelong impact, Increased risk of poor school performance, Increased risk of exhibiting  delinquent activity/criminal activity, Risk of issues with sleep and aggression, Risk of issues with concentration and separation anxiety Other Forms of Family Violence ○ Suicide (warning signs - IS PATH WARM) ○ Homicide ○ Rape ○ Elder abuse IS PATH WARM Suicide Warning Signs ○ I - Ideation ○ S - Substance abuse ○ P - Purposelessness ○ A - Anxiety ○ T - Trapped ○ H - Hopelessness ○ W - Withdrawal ○ A - Anger ○ R - Recklessness ○ M - Mood change Mistreatment of Elders ○ Neglect, Physical, Sexual, Emotional, or Fiduciary abuse Perpetrator characteristics Victim characteristics Risk factors (invisibility, vulnerability) Prevention Factors that Contribute to Elder Abuse ○ Social isolation, Emotional or financial dependence on victim, Alcohol use, Abuse happens more frequently to those w/ dementia & those w/ mental illnesses are often perpetrator, Invisibility - less social interaction & less likely to report a family member out of fear of privacy, Vulnerability - based on dependency and increased by 1) impairment & isolation 2) poverty &  pathologic caregivers 3) learned hopelessness and living in violent subculture 4) living in deteriorating housing & crime ridden neighborhoods Prevention of Elder Abuse ○ Awareness and education about types of abuse via media campaigns, Increasing attention directed at unique care needs of elders (resources & need for caregiver respite), Training for caregivers, Statutory requirements for reporting abuse & providing crisis hotline, World elder abuse awareness day ALL ABUSE MUST BE REPORTED Role of CHN in Caring for Families in Crisis ○ Assessment - nature of crisis; response to crisis; immediate problem; perceptions; available support; coping abilities ○ Planning - factors affecting clients; general health status, age, past experiences, assets, liabilities, religious factors ○ Implementation - demonstrating acceptance; confronting crisis, finding facts, expressing feelings, not offering false reassurance, seeking coping mechanisms, encouraging no blame ○ Evaluation of resolution - anticipatory planning Human Trafficking - 5 questions Elements of trafficking ○ Fraud, force, coercion Estimated 14,500 - 17,500 people trafficked into US each year (does not include people trafficked within US borders) Most @ Risk ○ Primarily female (20% male), Transient living (frequent movers), Youth, Unaccompanied minor, Foster system, CPS involved, Hx of sexual/physical abuse, Substance use, LGBTQ+, Gang involvement, Disability, ESL Risk factors & Comorbidities  ○ Exposure to violence/sexual violence, Psychological violence, Children removed, Abortion while trafficked, Recieved injury, Mental health issue, STI, Addiction, Suicidal Traffickers target your basic needs ○ Food, Shelter, Money, Safety, Job, Love. Trusting relationship is established Psychosocial Red Flags ○ Scripted/inconsistent story, History of physical/sexual abuse, Unable to provide address (new to town, unsure of how long they have been in area), Can’t provide emergency contact, No social network, Cash pay, Anxiously refuses to be w/o phone (multiple phones), No ID, Not allowed to speak for themselves, Avoids eye contact, If alone demonstrates evidence of controlling or dominant relationship, Not trusting, Hostile behavior Physical Exam Red flags (sex & labor trafficking) ○ Constitutional Well groomed (age inappropriate grooming) or Unkempt Sex trafficking language used ○ Dermatological - tattoos or branding ○ GU STI, Genital/anal trauma, High # of partners, Discharge ○ Obstetrics ○ HEENT Pharyngeal trauma Broken teeth, Hearing loss, Vision issues ○ Substance abuse Agitation, Track marks, Skin popping, DTs ○ Neuro HA, AMS, Concussion, Dizziness ○ MS Neck & back pain, Fractures, Blunt force trauma  ○ Dermatological Unexplained injuries, Cigarette burns, Obvious neglect, Cellulitis, Tinea, Lice, Scabies ○ GI Parasitic/bacterial infections, Abd trauma, Vitamin & mineral deficiencies ○ CV Bacterial endocarditis, Viral cardiomyopathy, Sepsis, Arrhythmias ○ Infectious Disease Shingles, TB, HIV, Hep a/b/c, Endemic specific disease ○ Psycho-somatic Sleep disorders, Chronic fatigue, Chronic pain, Eating disorders ○ Developmental Physical & cognitive disabilities, Delayed milestones, Stated age does not match presentation Psych in sex/labor trafficking ○ Stockholm syndrome, PTSD, Suicidal ideation, Self-harm, Memory loss, Hostility & emotional blunting, Difficulty concentrating Labor trafficking Red Flags ○ Constitutional Poor hygiene, Unkept appearance ○ Respiratory Signs of chronic inhalation of airborne contaminants/fumes/dust particles, Endotoxin asbestos exposure, Inhalation injuries ○ Dermatologic Frostbite, Occupation dermatitis or secondary to prolonged exposure to industrial/agriculture chemicals ○ Signs of substance abuse N/V, Agitation, Most commonly abused -> Stimulants & ETOH ○ MS  Work related injuries, Exposure to injuries r/t lack of PPE, Severed limbs (fingers), Back & neck strains, Chronic muscular complaints ○ CV Heat stroke, Hypothermia, Signs of prolonged environmental exposure Psychological Impact of Complex Trauma ○ Disruptions to secure attachments Trauma, Neglect, Chronic stress Any event that imposes feelings or terror & helplessness in child Lack of physical proximity of a caregiver to provide for their basic needs, safety, and emotional engagement Effects of trauma experienced by trafficking victims extend far beyond time under traffickers control. Effects of the trauma disrupt coping mechanisms, undermine self confidence, and inhibit ability to form healthy & trusting relationships Some survivors exhibit complex trauma life behavior similar to those seen in torture survivors EMPOWER Method ○ E - Eye contact @ eye level & Explain exam ○ M - Meet immediate physical needs (food & water) & Monitor for signs of distress ○ P - Provide professional interpreter & Private exam ○ O - Open ended questions ○ W - Wait for response ○ E - Equip w/ options/resources & Establish rapport ○ R - Reinforce victim’s safety/bravery & Respect victim’s choices Assessment Considerations ○ Recognize control & make opportunity to get pt alone ○ Develop trust, Provide privacy, Use medical interpreters, Use female providers & limit people, Turn off communication devices, Disclose limitations of confidentiality, Use pts own words in documentation  Prioritize Safety ○ Safety plan, Protect from accompanied person, Recognize threat of harm to victim & family, Violence can be from trafficker or victim as they are still afraid to leave Mandatory reporting ○ Charge nurse/manager, CPS, Law enforcement (coordinate arrival), Pt consent is NOT required, Report concerns for further investigation, National human trafficking hotline Epidemiology/outbreak surveillance - 10 questions Principal science of PH - study of the distribution & determinants of health related states and events in specified populations Epidemiology ○ Focus on studying patterns, causes, and effects of health and disease conditions in populations ○ Provides foundation for understanding the spread of diseases, identifying risk factors, and developing prevention strategies Purpose of Epidemiology in Community Health ○ Collection & Data Analysis Identify health problems and risk factors, Monitor health trends by tracking incidence & prevalence & spread of disease, Inform PH intervention, Evaluate program effectiveness, Shape health policy Theories & Investigative Models ○ Epidemiological Triangle Host - susceptible human or animal who harbors and nourishes a disease causing agent Agent - factor that causes or contributes to health problem or condition Environment - all external factors surrounding the host that might influence vulnerability or resistance  ○ Wheel Model of Human-Environment Host - genetic, personality (human characteristics) Environmental - social, biological, physical Frequency rates - measures of health and disease includes those related to birth, death, and morbidity (includes incidence, prevalence, birth, death, mortality, fertility Incidence - Occurrence of new cases in a population over a specific time period Prevalence - All people with a particular case in a given population Proportion & Ratio ○ Measures used to describe the frequency & relationship of health events w/in a population ○ Proportion - a type of ratio that illustrates the relationship between the part to the whole (usually as a % and indicates fraction of the population affected by condition) Useful for assessing impact of health condition in specific population ( 10 out of 100 w/ lice) ○ Ration - compares occurrence of 2 quantities or a comparison of any 2 values (shows their relationship rather than their part to whole) Useful in comparing rates of disease, risk factors, and other health related metrics between groups (30 new cases in males and 15 in females in 2024) Determining Disease Patterns - Rates ○ Rates - statistical measures expressing the proportion of people with a given health problem among population at risk ○ Rate = (# of health events in a specified time/ Population in same area in same specified time) x 100 Risks (epidemiologic concept) ○ Probability that disease or unfavorable health condition will develop, Directly influenced by biology/environment/lifestyle/system of healthcare, Risk factors - specific exposure factors, Frequently external to individual, Lifestyle changes may have an effect on factors  Risks (comparing 2 rates) ○ Attributable risk - estimate of disease burden, subtract rate of non-exposed individuals from exposed ○ Relative risk ratio - ratio Surveillance ○ Ongoing systematic collection of community health info ○ PH Nurse Data collection to identify trends in disease incidences (morbidity), Identify risk factors of specific populations or aggregates, Assess effectiveness of a program and to implement interventions targeted to high risk groups Methods of Epidemiology Process ○ Descriptive Describe characteristics of people in study, Covers person/place/time, Develop hypotheses about cause of disease ○ Analytic Test hypotheses & investigates, Observational studies (cross-sectional, retrospective, prospective), Experimental studies - controlled process involving exposure for each individual (clinical trial) or community (community trial) & tracking of the individuals/communities in trial over time to detect effects of exposures Communicable diseases - 13 questions Principles of Infection & Infectious Disease Occurrence ○ Multicausation (host, agent, environment) ○ Spectrum of infection ○ Stages of infection Latency, Communicable, Incubation period Spectrum of Disease Occurrence ○ Incidence - occurrence, rate, or frequency of disease  ○ Endemic - disease that is always present in population w/in geographic area ○ Outbreak - disease spreads quickly to more people than expected ○ Epidemic - outbreak of disease that spreads quickly and affects many individuals at the same time ○ Pandemic - widespread occurrence of infectious disease over a whole country or world at a particular time Chain of Transmission ○ Pathologic agent -> reservoir -> portal of exit -> transmission -> portal of entry -> host susceptibility (continues over and over) Breaking the Chain of Transmission ○ Inactivating the agent, Eliminating the nonhuman reservoir, Controlling (human reservoir & ports of exit/entry), Host immunity Immunity ○ State/quality of being resistant to particular infectious diseases or pathogens ○ Natural - protecting body develops after fighting off an infection Active - body actively produces own antibodies (recovered from infection) Passive - person receives antibodies from outside source (breastfeeding) ○ Artificial Active - person vaccinated with weakened/inactive pathogen (Flu, MMR) Passive - directly receiving antibodies from another source (immune globulin) Chlamydia ○ Most prevalent STD worldwide TB ○ Transmitted primarily through air via respiratory droplets  ○ Infection (new or latent) -> treat w/ Isoniazid for 6-9 months for all new/latent infections to prevent progression to active disease ○ Treat HIV infected pt ith Isoniazid in combo w/ antiretrovirals HIV ○ Transmission -> Direct person to person via unprotected sexual contact or from mother to fetus/ mother to infant (during birth or via breastfeeding) Hep B ○ Incubation period -> 60-90 days; Range 45-180 days Pertussis ○ General unimmunized population at risk (under 5 most at risk) ○ No passive immunity from mother ○ Infection w/ pertussis (whooping cough) confers immunity, but this immunity is not lifelong Tetanus ○ Etiological agent -> clostridium tetani; a gram + spore forming bacterium (anaerobic pathogen) Gonorrhea ○ REPORT to local health department Measles ○ Transmission -> direct/indirect contact w/ nasal or throat secretions of infection person (HIGHLY communicable) ○ Infants of mothers who have had the disease protected for 6-9 months Syphilis ○ Etiological agent -> Treponema palladium (bacteria) ○ Bacteria causes infection by making entry through broken skin or mucous membranes, most often genitals Care of Family - 7 questions The Family ○ Can be defined in many ways by many people (a gang is a family)  ○ Kinship, Relation & residence, Who ever they say they are, Important individuals Conceptual Frameworks ○ Interactional framework Family as a unit of interacting personalities; emphasis on communication, roles, conflict, coping patterns, and decision-making processes Neglects interactions w/ external environment ○ Structural-functional framework Family as social system relating to other social systems in external environment ○ Developmental framework Life cycle perspective; examination of member’s changing roles & tasks in each progressive lice cycle stage Purpose of the Family ○ Purpose Meet the needs of individual family members (provide economic & protective needs & practical & emotional support) Meet the needs of society (socializes children to sociocultural norms) ○ Family is a buffer between individuals and society Effects of Family on the Individual ○ Family influences the health of individuals through various means; Adherence to shared beliefs & cultural patterns, Social characteristics (housing, community, etc), Biological variants, Financial resources, Exposure to similar dietary behaviors and health related lifestyles, Health care seeking pattern and adherence to professional advice, Family life events and crisis  Characteristics of a Healthy Family ○ Facilitative process of interaction exists among family members, Individual member development enhanced, Role relationships structured effectively, Healthy home environment & lifestyle, Regular links w/ broader community are established Characteristics of the Changing Family ○ Marriage Americans getting married later in life, Never married rates on rise, Increasing rates of cohabitation (not married) ○ Children Americans having fewer children, Americans having children later in life, More Americans not having children ○ Household Increasing number of households w/ 2 or more generations of adults, Increased # of languages spoken in the home Nursing Process ○ Same process w/ different focus (work w/ family collectively & the family is the client/focus) Family Health Practice Guidelines ○ Start where the family is, Work w/ family as a group, Recognize the validity of family structural variations, Emphasize family strengths, Adapt nursing interventions to family’s stage of development Assessment Models ○ Friedman family assessment model 6 broad categories of interview ?s Identification data, Developmental stage & history of the family, Environmental data, Family structure, Family functions, Family stress & coping  ○ Calgary family assessment model (CFAM) Structural (who is the family), Developmental (where is the family in the family life cycle), Functional (how to individuals related to one another Nursing Process - Assessment ○ Family interview - Demographics, Physical environment, Psychological & spiritual environment, Structure/roles, Functions, Values & beliefs, Communication patterns, Decision making patterns, Problem solving patterns, Coping patterns, Health behavior, Social & cultural patterns Assessment Methods ○ Genogram - graphical depiction of the family structure, symbols ○ Eco-map -family interaction w/ community Nursing Process - Diagnosis ○ Health promotion, Role relationships, Coping/stress tolerance Nursing Process - Plan ○ Work with the family to plan a solution/intervention Nursing Process - Implement & Evaluate ○ Nurses help families in the following ways Providing direct care, Removing barriers to needed services, & Improving capacity of the family to act on its own behalf and assume responsibility ○ Nurses help families implement the plan & evaluate if the family met the desired outcomes Barriers ○ Family apathy, Indecision about outcome or actions, Nurse imposed ideas, Negative labeling, Overlooking strengths, Neglecting cultural or gender implications, Perception of hopelessness, Fear of failure, Limited access to resources and support, Limited finances, Fear/distrust of healthcare system Case Management - 5 questions Variety of pt care coordination programs - located in acute hospitals or community settings (AKA care management & care coordination) Case managers work in various community health settings ○ Pt centered medical homes, Occupational health, Geriatric settings, Ambulatory care clinics Case management ○ Aims to provide a “service delivery approach” to ensure.. Cost effective care, Access to care, Prevent/provide alternatives to institutionalization, Effective coordination of services, Pts improved functional capacity Supposed to reduce risk and cost of care in population CASE management looks at INDIVIDUALS CARE management looks ar POPULATIONS Essential Activities ○ Case management consists of programs that apply systems, evidence based science, incentives, and information to improve medical practices ○ Overall goal is to improve coordination of services (elderly, low income families, ppl w/ chronic illnesses) Care Coordination ○ Approach to integrate fragmented care, Improves transition btwn providers, Reduces unnecessary costs & resources ○ ANA definition -> deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient’s care to achieve safer and more effective care Transitional Care Management ○ Face to face visits w/ high risk pts post hospitalization to prevent readmission & improve pt outcomes History of Case Management ○ PH programs - sanitation, nutrition, disease prevention  ○ Behavioral health - institutionalized pt -> community (helped to avoid service fragmentation or interruption) Purpose of Case Management ○ Pt centered & system centered process, Helps navigate complexities of healthcare delivery system, Improve pt health outcomes, Reduce/eliminate fragmented care, Ensure pt has access to care needed Case Management in the Community ○ Chronic care management, Transitional care management, Pt centered medical home, High risk clinic settings, PH clinic settings, Occupational health, Hospital Occupational Health - 5 questions No work environment is completely risk free - Focus on preventative care and health restoration in the context of a safe and healthy work environment OSHA (regulatory agency) ○ Occupational safety & health administration - federal agency charged with promulgating & enforcing occupational health standards ○ Occupational and Safety Act of 1970 ○ Code of Federal Regulations (29CFR1910) Construction has highest number of fatal work injuries Occupational & Environmental Health Nursing ○ Ensure workforce is healthy and productive, Traditional focus on illness & injury care, Specialty focus for identifying and assisting in the management of physical/chemical/biologic/ergonomic/psychosocial factors in workplace affecting workers health & safety Occupational Health Nurse Activities ○ Supervising care for emergencies & minor illnesses, Counseling employees about health risks, Following up with workers comp claims,  Performing periodic health assessment, Evaluating health status of employees returning to work, Disaster planning, Safety in work place Research Priorities in Occupational Health Nursing ○ Effectiveness of primary health care delivery @ worksite, Effectiveness of health promotion nursing intervention strategies, Nature & effects of stress and workplace stressors, Occupational hazards of health care workers Core Content/Curriculum ○ Chemical hazards, Biological hazards, Physical hazards/ergonomics principles, Psychophysiological/stress management/record keeping, Safety & industrial hygiene issues, Standards & regulations, Emergency response, Health education & promotion, Information, Disease management, Clinical practice, Management Home Health - 5 questions Providing health care services to individuals in their homes w/ goal of helping them regain independence while improving their health outcomes Eligibility for Home Health services ○ Under care of physician (physician authorization), Plan of care regularly review by physician, Required skilled nursing care or therapy, and Homebound (unable to leave home w/o considerable effort d/t illness or injury Home visits are pt focus Home Health Practice ○ Prep - establish trust and credibility, Referral, Initial phone call, Improving communication (let social graces shine), Building trust, Application of nursing process (treatment plan and nursing care plan - specific interventions to treat issue), Assessment, Diagnosis/planning, Intervention, Evaluation