Care of specific populations: Migrants
Migrant workers health problems include:
1. Dental disease
2. TB
3. Chronic conditions
4. Stress, anxiety, & other mental health conditions
5. Leukemia
6. Iron deficiency anemia
7. Stomach, uterine, & cervical cancers
8. Lack of prenatal care
9. Higher infant mortality rates
Primary Prevention for Rural or Migrant Health care:
-educate on measures to reduce exposure to pesticides
-teach on accident prevention
-prenatal care
-mobilize preventative services (dental, immunizations)
Secondary Prevention measures for Rural/Migrant Health care:
SCREENING! screen for:
-pesticide exposure
-skin cancer
-chronic preventable diseases
-communicable diseases
Tertiary Prevention measures for Rural/Migrant Health care:
-treat for symptoms of pesticide exposure
-mobilize primary care and emergency services
Client's rights include...
-right to info disclosure
-privacy
-informed consent
-info confidentiality
-participation in treatment decisions
Autonomy
respecting a client's right to choose (i.e. refusing chemo)
Nonmaleficence
doing no harm
Beneficence
maximize benefits and minimize possible harms
Justice situation:
determining eligibility for health care services based on income and fiscal resources
HIPAA rules about information security:
-only staff assigned to the patient may view/read client's health record (no other nurses or doctors)
-client's have the right to read or obtain a copy of their health record
-nurses may not photocopy any part of med record except for authorized exchange
HIPAA info security protocols include:
-log off computer before leaving workstation
-never share ID or password
-never leave med records where ppl can see it
-shred any printed info about client after use
-don't use or view social media in clinical settings
-no posting about clinical stuff
Caring for a client with gonorrhea:
-nationally notifiable disease
-women are frequently asymptomatic
-CDC recommends yearly screening for all sexually active women 25 yrs or older or w/risk factors
-at risk pregnant women must be screened at first prenatal visit
-identify & treat all partn
Referrals: Client barriers include:
-lack of motivation
-inadequate info about community resources
-inadequate understanding of the need for referral
-accessibility needs
-priorites
-finances
-cultural factors
Referrals: Resource barriers include:
-attitudes of health care personnel
-costs of services
-physical accessibility of resources
-time limitations
-limited expertise working w/culturally diverse populations
Just because someone is exposed to asbestos once doesn't mean they will develop health problems...
long term exposure can lead to mesothelioma and lung conditions. Risk factors include workers (office buildings with it when they work there everyday).
Priority action(s) in developing a disaster plan:
-set up communication alternatives
-highlight possible evac routes
-identify local & distant meeting places
-create disaster kit
AS A NURSE:
-identify at risk populations in community
-identify community disaster warning system & how to access
-identify 1
Hyperthyroidism: Radioactive iodine therapy home safety:
Client is radioactive!
-no pregnant people
-no breastfeeding
-keep distance from others, limit visits to 30 min at a 6 ft distance
-drink lots of fluid
-maintain good hygiene to prevent infection
Teaching safe disposal of insulin syringes:
-put in strong plastic container i.e. old detergent container (no soda bottles)
-DO NOT recycle old needles, throw container in trash
-seal the container when 3/4 full with duct tape
-facilities throw it in sharps red container
Teaching about use of crutches:
-don't alter crutches after fitting
-follow prescribed crutch gait
-support body weight at the hand grips w/elbows flexed at 30 degrees
-position crutches on unaffected side when sitting or rising from a chair
Demographics of homeless population:
-families w/children are the fastest growing segment
-people with mental illness (large segment)
-veterans
-substance abuse disorders
-youth and runaways
-intimate partner abuse victims
-people with HIV or AIDS
-older adults
Planning Primary Prevention Activities
-determine solutions
-establish goals
-give responsibilities to individuals
-determine resources
-screening and education
-determine funding, develop budget
-plan for evaluation
Parish nursing:
promotes health and wellness within populations of faith communities
-work with: pastoral care staff, professional health care members, and volunteers to provide holistic approach to healing
Functions:
-personal health counseling
-health education
-liaiso
Windshield survey:
-nurse and other driver drive through community assessing components
-time consuming
-provides descriptive overview of community
-results limited because it is only based on visualization & doesn't include community member input
nurse looks for:
-pets and
Positive Mantoux skin test for TB includes:
an induration-palpable, raised, hardened area of 10 mm or greater in diameter
Positive Mantoux test indicates that...
the client has developed an immune response to TB it does not confirm active TB
Mantoux test: an induration of 5 mm may be considered
positive mantoux test in immunocompromised clients
Recognizing signs of abuse:
Child:
-unexplained injury
-unusual fear of nurses or others
-injuries/wounds not mentioned in hx
-fractures, including other healed fractures
-presence of wounds/fractures/injuries in various stages of healing
-subdural hematomas
-trauma to genitalia
-ma
Manifestations of alcohol withdrawal:
-abd cramping
-vomiting
-tremors
-restlessness
-irritability
-increased HR
-transient hallucinations or illusions
-anxiety
-increased BP and RR
-increased temp
-tonic-clonic seizures
-alcohol withdrawal delirium (2-3 days after stopping)
Provide culturally appropriate care by:
-addressing clients by last name until told otherwise
-introduce thyself and explain position
-be authentic and honest about what you don't know about a culture
-use culturally sensitive language
-don't make assumptions about the client
-encourage the cli
Identifying hazards in occupational environments:
-exposure to chemicals
-worker inexperience/age/pregnancy
-lifting heavy loads
-constant sitting
-stress and burnout and violence
-temp extremes
-noise extremes
-not having proper protective equipment
Diet teaching for adolescents:
1. Calories/day for 15 yr old male & female=
2. Adolescents have an increased need for...
3. Adolescents require at least ____/day of Calcium
Teach them:
1. 2000 for female, 4000 for male
2. Iron (11-15 mg extra/day)
3. 1300 mg
Teach: don't skip meals, eat more calcium, nutrient-dense snacks (fruit, pretzels, smoothies, cheese)
identify agent factors in the epidemiological triangle:
Chemical agents: drugs and toxins
Physical agents: noise and temp
Infectious agents: viruses and bacteria
Agent is the animate/inanimate object that causes the disease
Using web-based info:
-must be credible, avoid .com (use .gov)
-must use appropriate terminology (no layman terms)
-EBSCO, CDC, NICBH are good sources
Providing information on immunizations is a part of the...
primary prevention
Calculating prevalence proportion:
# of existing cases in the population at a specific time
divided by
population total= _____per 1000
Caregiver burden responses:
fatigue
difficulty sleeping
illness
PTSD interventions
-therapeutic relationship w/client
-assess for suicide idealization & use precautions if necessary
-use multiple strategies to reduce anxiety
-allow time to express feelings
rationalization
coming up with reasons that avoid the true reason (i.e. I got cancer of the liver because its in my genes not because I drink to excess every day)
Providing teaching to a patient who speaks a different language than the nurse:
-interpreters should not be family members
-interpreters should have knowledge of health care terminology
-client preferences should be considered when choosing the age and sex of interpreters
-interpreters should not be from the same community as the cli
Exposure to anthrax:
-IV cipro prophylactically
-abx to stop disease progression
s/s:
-headache
-fever
-muscle aches
-chest discomfort
-severe dyspnea
-shock
Pertussis education:
-droplet precautions
-whooping cough
-incubation 7-10 days
-common cold s/s
-antibiotics
Women's health after menopause:
-increase iron
-vitamin B12
-lots of fluids
-mammogram every year to 2 years
-colon cancer screening
-regular dr visits
-skin assessment
-immunizations
-vision checks
HIV/AIDs targets CD4+ T-lymphocytes, decreased count...
determines stage of disease, lower the count the worse the disease.
Tests for HIV/AIDS
ELISA
Western blot
indirect immunofluorescence assay test
Determining disease incidence rate:
# of new cases in the population at a specific time
divided by
population total
times
1000=______per 1000
Screening goals:
provide accurate, reliable results, can be inexpensively and quickly administered to large groups and produce few/if any side effects
priority finding in school health screenings:
-abuse evidence
-vision and hearing changes
-height and weight changes
-scoliosis
-infestations
first step in developing a community health plan
identify population specifics
nonpharm interventions to manage nausea:
-eat cold or room temp foods
-high carb, low fat
-avoid fried foods
-do not eat prior to chemo or radiation
-sit up for 1 hr following meal
-ginger
Case manager nursing responsibilities:
-promoting interprofessional services & increased client/family involvement
-decreasing cost by improving client outcomes
-providing education to optimize health participation
-advocating for services & client rights
Rheumatoid Arthritis: Teaching About Hydroxychloroquine
-advise client to have a baseline eye exam & follow-up eye exams every 6 months w/ophthalmologist
-stop med & notify provider if blurred vision occurs
Manifestations of measles:
-mild to moderate fever
-conjunctivitis
-fatigue
-cough, runny nose, red eyes, sore throat
-rash
-
koplik spots
(tiny white spots) appear in mouth in 2 days before rash
-red/reddish brown rash on face then spreading downward
-spike in fever with rash
Hepatitis and Cirrhosis: Client Education
-contact precautions as needed
-high carb, high cal, low-mod fat & protein diet
-small frequent meals
-no alcohol
-limit physical activity
-avoid sex until hep antibody test is neg
-proper hand hygiene
Communicable Diseases, Disasters, and Bioterrorism: Caring for a Client Who Has Ringworm
clean all surfaces: furniture, counters, stuffed animals, etc.
Infection Control: Caring for a Client Who Has MRSA
-complete full course of antimicrobial therapy
-avoid overuse of antimicrobials
Endocrine Disorders: Teaching About Somatropin
-monitor growth patterns
-rotate injection sites
-mix gently do not shake prior to admin
-obtain baseline weight and height
Cardiac Glycosides and Heart Failure: Indications of Digoxin Toxicity
-hypokalemia
-fatigue
-weakness
-vision changes
-GI affects
Fastest growing homeless population=
families with kids
Calculate disease Prevalence
existing cases divided by population total X 1000
Calculate disease incidence
new cases / population total X 1000
Reportable diseases to the CDC include:
-gonnorhea
-varicella
-syphillis
Windshield survey measures
-population: ethnicity
-housing
-social: public resources/protection
-natural environment
-place
secondary data
use of existing data (statistics)-prevalence of disease
reportable to the state health department:
-suspected cases of child neglect/abuse
-elder abuse/neglect
-syphillis
women health screening:
Cholesterol 45-65
Fecal occult blood test 50 yrs and older
Disposal of insulin syringes
metal container/heavy plastic container
Leading cause of death in adolescents
MVAs
Dehydration effects:
impaired motor control
alcohol withdrawal symptoms
-appear within 4-12 hrs
-abd cramping
-vomiting
-tremors
-restlessness
-inability to sleep
-TACHYCARDIA
-HTN
-transient hallucinations or illusions
-anxiety
-increased RR, temp
-tonic clonic seizures
-diaphoresis
meds for alcohol withdrawal
-diazepam
-carbamazepine
-clonidine
-chloridiazepoxide
-phenobarbital
-
naltrexone
alcohol withdrawal delirium symtoms
-appear 2-3 days after stopping
-hallucinations
-severe HTN
-cardiac dysrhythmias
-delirium
-can progress to death
alcohol abstinence meds:
-disulfuram
-naltrexone
-acamprostate
immunizations to not give preggos
-MMR
-rubella b/c infection can develop
-herpes zoster
-varicella
immunization to give preggo
TDaP
Epidemiological triangle
Agents:
1. Chemical: drugs, toxins
2. Physical: noise, temp
3. Infections: viruses, bacteria
Epidemiological triangle
Hosts:
-age
-gender
-genetics
-ethnicity
-immunological status
-physiological state
-occupation
Epidemiological triangle
Environment:
1. Physical: geography, water/food supply, presence of reservoirs/vectors
2. Social: access to health care, increase work environment, poverty
If you see education or immunizations think:
PRIMARY PREVENTION
If you see screenings (lice, TB, HTN, cancer) or safety checks (home safety, outbreak control) think:
SECONDARY PREVENTION
If you see rehab, support groups, counseling, therapy, disease management, etc, think:
TERTIARY PREVENTION
Web-based information, use...
EBP that is validated by peer-review
no bias (quality), number of studies, participants, strength of it (quantity), repeatable results (consistency)
Domains of learning
Cognitive:
involves knowledge of development of intellectual skills
i.e. discusses how sodium intake affects BP
Domains of learning
Affective:
Involves change of attitude & development of values
i.e. acceptance of having a colostomy & maintains self-esteem
Domains of learning:
Psychomotor:
involves performance of a skill
i.e. community nurse teaches a client how to self-admin insulin
Prioritizing client care
Systemic before local:
Life before Limb
interventions for a patient with shock comes before interventions for a patient with localized limb injury
Prioritizing client care
Acute (new injury or illness) before Chronic:
care of a pt w/a new injury/illness or acute exacerbation of previous comes before care of a pt w/long term illness
Prioritizing client care
Actual problems before potential future problems:
admin of meds to a pt experiencing acute pain comes before ambulation of a pt at risk for thrombophlebitis
eastern chinese/asian medicine beliefs
an imbalance in nature is believed to cause disease
mexican culture medicine beliefs
hot-cold theory of balance in relation to health and illness that accompanies belief in framework
christian religions medicine/health beliefs
believe in faith healing
Caribbean nations health/medicine beliefs:
voodoo and witchcraft
Native American health/medicine beliefs
-use of religion
-avoiding eye contact
-use of spiritual practices
-use of healing practices
Hispanic health/medicine beliefs:
-avoid direct eye contact
-use therapeutic touch
-use face, hand, and body gestures
-respect them wanting to use traditional therapies
Cold or other illnesses are not contraindicated for getting...
immunizations
infants get what vaccine at 12 months?
first year of life?
MMR
Rotavirus
vaccines 6 weeks to 6 years
5 vaccines of DTaP
vaccines 11-12 years
meningococcal conjugate
vaccines at 60 yrs
herpes zoster
case manager role
-provide referral info
-facilitates movement of pt through health care system
-negotiation
-collaboration
What is HMO?
insurance group that provides health services for a fixed annual fee
there is an agreed upon payment level
anthrax exposure, need access to...
it is used as...
ciprofloxacin, used as prophylactic tx
what are administered if manifestations of anthrax infection are present?
antitoxins and IV abx
early manifestations of anthrax
-dry cough
-mild chest pain
-fever
-fatigue
inhaled anthrax is not...
transmitted person to person
TB: PATIENTS WHO HAVE RECEIVED ____________WITHIN THE PAST YEAR CAN HAVE A FALSE-POS MANTOUX TEST
bacillus calmette-guerin vaccine
TB s/s
-persistent cough >3 weeks
-chest pain
-weakness
-anorexia
-hemoptysis (coughing up blood)
-dyspnea
-fever
-night sweats
-chills
nursing care/interventions for TB pts
-N95 or HEPA mask
-negative airflow room
-airborne precautions
-pt must wear N95 or HEPA when being transported
-cough & expectorate sputum into tissues and discard in provided sacks
-foods rich in protein, iron, and vitamin C
TB meds:
What to know for Isoniazid
-take on empty stomach
-watch for hepatoxicity & neurotoxicity
-tingling of extremities
-vitamin B6
-do not drink while taking
TB meds:
What to know for Rifampin
-observe for hepatotoxicity
-urine & secretions will be orange
-report yellowing of skin
-report pain or swelling of joints
-report loss of appetite
-report malaise
-no alcohol
TB meds:
What to know for pyrazinamide:
-observe for hepatotoxicity
-drink glass of water with each dose & lots throughout the day
-report yellowing of skin
-report pain or swelling of joints
-report loss of appetite
-report melaise
-no alcohol
TB meds:
Streptomycin, what to know:
-use in clients who have multi-drug resistance
-can cause ototoxicity (monitor hearing)
-report significant changes in urine and renal function
Hep A
-ingest contaminated food/water
-close personal contact w/infected people
-fecal-oral route
Hep B
-blood
-unprotected sex w/infected ppl
-born to infected mom
-contact w/infected blood
-injection drug users
Hep C
-blood
-drug abuse
-sex
Recommendation for saturated fat intake is no more than...
75% of total daily caloric intake
Triage; mass casualty victims that have agonal respirations will get a...
black tag-cannot save
Community based=
individuals and families; management of acute and chronic conditions where individuals and families live, work, and attend schools
Community oriented=
at risk individuals, families, groups, community
-determining the health needs of a community
-intervening at individual, family, and group level to improve the collective health of the community
Normal sodium
Na
levels:
135-145
Normal Potassium
K
levels
3.5-5
Normal Calcium
Ca
levels
9-10.5
Normal Magnesium
Mg
levels
1.8-3
Normal fasting glucose
70-110
Normal Hgb males=
females=
males=14-18
females=12-16
Normal Hct males=
females=
males=42-52%
females=37-47%
Normal LDL
<100
Normal HDL males=
females=
males=>60
females=>70
Normal platelets
120,000-450,000
Normal Albumin
3.8-5
Normal BUN
10-20
Normal GFR
90-120
Normal HbA1c
4-5.6%
Normal WBC
4500-11000
Normal PT
11-13.5
distributive justice
fair distribution of the benefits and burden in society
epidemiological principles:
analyze incidence and track outcomes of interventions for a particular disease or condition
Outbreak of scabies is suspected, which action first?
determine incidence rate
MRSA should be on what precautions?
contact
Breast cancer prevention, women should begin...
yearly breast exam and mammography at age 40
Faith and parish nurses cannot...
do anything physical to a patient: no wound care, hospice, homecare, med giving, etc. They are just a liason
HPV teaching
-no need to notify state or local depts.
-teach how to apply cream to lesions
primary syphilis:
chancre
process evaluation for quality improvement plan:
-focus groups
-satisfaction survey
-written audits
-interviews
written materials for programs:
write at 6th grade levels
asian health beliefs:
-steam removes toxins from body
-heated blankets (yin yang)
Orthodox judaism diet
avoids dairy and meat at the same time
American indian health/medicine beliefs
shaman to seek healing from infection
local disaster plans are organized by
the office of emergency managment
ADHD teaching
-consistent daily routine
-limit distractions
public health nursing:
reviewing morbidity and mortality data for the community
Assessing a client who is experiencing alcohol withdrawal; expect what findings?
-fine hand tremors
-vomiting
-restlessness
Caring for a client who has alcohol disorder; no longer experiencing manifestations of withdrawal. What med would be prescribed to maintain abstinence?
Disulfuram
Providing teaching to family of pt w/substance use disorder; what indicates understanding of teaching?
-eliminate any codependent behavior
-primary goal is abstinence
-she needs to discuss feelings to help recover
Client asks for additional info about hospice; make what statement?
a component of hospice care is to control manifestations
school nurse schedules therapy for child with cerebral palsy. what role is nurse functioning?
case manager
what factors are physical agents?
-noise
-light
include what info when conducting work site survey?
work practices of employees
school nurse is planning promotion and disease prevention for upcoming school year; which situations would be considered 2ndary prevention:
routinely checking students for peduclosis throughout the school year
what role is the nurse functioning as when providing info to families, admins, teachers, and parent-teacher groups to decisions that promote the health or the students
consultant
what role is the nurse functioning in when coordinating comprehensive services for students with complex health needs
case manager
what role is the nurse functioning in when developing a trusting relationship with students and provides support on issues affecting their lives?
counselor
What is the most important preventable cause of death in the US according to the CDC?
smoking
The prompt use of what drug at the onset of symptoms can prevent serious complications of delirium tremens
benzodiazepines
Advocating for a newly approved community health clinic in an area of the city that has fewer resources. Nurse is advocating for the leaders to uphold which ethical principle?
distributive justice
what indicates understanding teaching of TB precautions?
-I will wash hands each cough
-I will wear a mask when I am in a public area
Nurse is teaching a pt who has TB. What statement should be included in teaching?
you will need to provide sputum samples every 4 weeks to monitor the effectiveness of the meds
TB pt has been placed on a multimed regimen. What instructions should be given about ethambutol?
watch for vision changes
New prescription for isoniazid; report which adverse finding?
tingling in hands
manifestations of TB
-persistent cough
-fatigue
-night sweats
-purulent sputum
Preparing to conduct a windshield survey; include what as components of assessment?
-ethnicity
-natural community boundaries
-presence of public protection
completing needs assessment and analysis of data. do what first?
compile collected data into a database
planning community health program. include what as a part of the evaluation plan?
compare program impact to similar programs
Conducting community assessment. What method is being used when having direct conversations w/someone in the community?
key informant reviews
collecting date to identify health needs in local community. identify what as 2ndary data?
-birth statistics
-previous health survey results
-health records
example of a nurse functioning as a consultant:
updating state officials about the health needs of the local community
case management nurse would do what?
identify referrals that that client needs
implementation phase of the case mgmt process for the pt w/lupus that lost her insurance?
coordinating services to meet the clients needs
examples of resource barrier
costs associated with services
contraindications for pt with HIV during labor:
-episiotomy
-forceps
-internal fetal monitoring
expect what in TORCH infection:
-joint pain
-malaise
-rash
-tender lymph nodes
prescribe what for gonorrhea?
ceftriaxone
what can be treated during labor or immediately following birth?
-gonorrhea
-chlamydia
-HIV
-Group B
Prevent TORCH?
avoid consuming undercooked meat while preggo
Pt presnts with linear clusters of fluid-containing vesicles with some crusting?
herpes zoster
what stages of illness for severe sore throat, pain when swallowing, and swollen lymph nodes
illness
manifestations of systemic infection
-fever
-malaise
-increased PR and RR
plan of care for a pt diagnosed with pertussis?
-wear mask when providing care within 3 ft of client
-surgical mask on client when transporting
-wear gown when performing care that may result in secretion contamination
manifestations of possible child neglect?
underweight
poor hygiene
portals of exit
-skin
-GU tract
-mucous membrane
component of disaster prevention?
identifying community vulnerabilities
Cat A bio agents:
-plague
-tularemia
-botulism