Chapter 20, 21, 22, 28, And 30 Study Guide

Question 1

What is preventive care?

Answer 1

-Among programs to prevent physical illness and other health problems among adolescents are immunizations and TB testing

-As well as school- and community-based education, and support programs
1. Basics of handwashing for elementary school students to health risk behavior for adolescents
2. In some communities, the school-based clinic dispenses condoms. In many states, adolescents have the right to consent for sexual and reproductive health care without parental permission
3. C/PHNs should educate parents about the effects of smoking in the home and its relationship to adolescent smoking

Question 2

What is secondary prevention?

Question 3

What is tertiary prevention?

Question 4

What is injury prevention?

Answer 4

-Accident and injury control programs serve a critical role in protecting the lives of school-age children and adolescents

-Efforts to prevent motor vehicle accidents, a major cause of adolescent death, include driver education programs, better highway construction, improved motor vehicle design and safety features, and continuing research into what causes various types of crashes

-Injury prevention and reduction have been addressed through multiple strategies
1. These include state laws requiring the use of safety restraints; installation of driver and front passenger airbags; substitution of other modes of travel (air, rail, or bus); lower speed limits; stricter enforcement of drunk driving laws; graduated drivers licenses (GDLs) for teenagers; safer automobile design; and helmets for motorcyclists, bicycle riders, and skaters

-In developing interventions, community health nurses need to recognize that adolescents are prone to risk-taking/novelty-seeking behaviors as a result of their cognitive, physical, and psychosocial developmental stage

-Safety programs also seek to protect school-age children and adolescents from the hazards of poisonings, ingestion of prescription or OTC drugs, product-related accidents (unsafe toys, bicycles, skateboards, skates, playground equipment, and furniture), and recreational accidents, including drowning and sports-related injuries
1. Generally, the community health nurse can educate families to recognize potentially hazardous situations and encourage efforts to eliminate them
2. Working with school nurses and school district officials to reduce playground hazards can contribute to the reduction of school-related injuries

-Programs that protect school-age children and adolescents against infectious diseases encompass such efforts as closing swimming pools that have unsafe bacteria counts, conducting immunization campaigns in conjunction with influenza or measles outbreaks, and working with hospital pediatric units to reduce the incidence and threat of iatrogenic disease

-C/PHNs can advance the prevention of unintentional injuries and deaths by working with families to initiate consistent use of seat belts and child safety seats in vehicles and the use of helmets and other protective gear for children riding bikes and skateboarding

-Where water is a natural hazard, wearing life jackets while boating and swimming can help decrease accidental drowning

-Promotion of smoke and carbon monoxide detectors, poison prevention, and sudden infant death syndrome (SIDS) education can help to further decrease injury death rates

-Teaching parents about presetting hot water heaters to lower than 130°F, recognizing the hazards of infant walkers, storing matches and lighters safely, and using pool fencing can help to prevent common unintentional injuries

-Advocacy for stricter seat belt and child safety seat enforcement, as well as programs to provide child safety seats and bicycle helmets, has been shown to positively affect mortality and injury rates
1. Enforcement of seatbelt laws, graduated driver licensing programs, and adolescent education about MVC causes are also effective-

Question 5

What is the most common STD among adolescents?

Answer 5

-Chlamydia, gonorrhea, and syphilis are other STDs/STIs found in the adolescent population

-Gonorrhea is the most commonly reported STD

Question 6

What is involved with suicide prevention in teens?

Answer 6

-School-based programs to educate adolescents about depression and suicide prevention have been useful

-Suicide prevention programs and direct intervention by counselors or school nurses to determine an adolescent’s suicide intentions may be effective school-based interventions
1. It is important for counselors to identify markers for attempted suicide, such as a precipitating event, intense affective state, suicide ideation or actions, deterioration in social or academic functioning, or increased substance abuse

-Hallmarks of good prevention programs include student education on suicide awareness and intervention; coping and problem-solving skills training; skill building by reinforcement of strengths and protective factors while dealing with risk-taking behaviors; and teaching about the association between suicide and mental health (especially depression)
1. Suicide screening is often thought to be effective in reducing suicidal ideation

Question 7

How is teenage suicide solved?

Answer 7

-There is some evidence that universal school-based programs decrease the number of adolescent suicide attempts

-The SOS Signs of Suicide program is an evidence-based school-based intervention that educates adolescents about poor mental health, suicide, and coping mechanisms
1. It has been shown to decrease self-reported suicide attempts

-Skills training programs that target a broader range of problems (e.g., depression, anxiety, negative self-perceptions) have been effective in teaching adolescents how to monitor feelings, identify triggers, and avoid and reframe negative thoughts
1. Relaxation skills training, learning how to seek out help from others, and promoting healthier responses to stress have also been successful in impacting internalizing behaviors

-The Substance Abuse and Mental Health Services Administration (SAMHSA) awards grants in support of youth suicide prevention programs
1. SAMHSA has also developed a suicide prevention toolkit to help school around the nation implement programs

Question 8

What is the primary prevention for preventing teen pregnancy?

Answer 8

-Teaching about contraception has not been shown to increase the risk of adolescent sexual activity or STIs, but it may decrease the risk of pregnancy

-A systematic review and meta-analysis assessing the effectiveness of school-based programs found that sex education, of any type, when compared to no education was associated with delayed adolescent sexual intercourse

-Research, however, was divided regarding effectiveness in preventing teen pregnancy
1. Besides formal education through schools, adolescents note that peers, the media, and parents are also sources of information on sexual health
2. Between 70% and 78% of teens report talking with a parent about sex, although girls more often talk with parents about how to say no to sex or use birth control

-Nurses can provide information and counseling on birth control and emergency contraception to adolescent clients and collaborate with schools to promote effective pregnancy prevention programs

-Pregnancy prevention programs can be effective in reducing teen pregnancy and birth rates, as well as in reducing the number of second births to teenage mothers

Question 9

What is pediculosis?

Answer 9

-Pediculosis (head lice), another highly communicable disease, is a frustrating and common problem for many preschool and school-age children

Preschoolers and elementary-age children and their caretakers and family members are at highest risk for head lice

-Close crowded conditions can also be a risk factor
1. Although lice are wingless, because children frequently play close to each other, they easily move from child to child

-Head lice may be white, gray, or brown in color—about the size of a sesame seed
1. They attach to the scalp and lay eggs (nits) in the hair
2. Nits typically hatch within 8 to 9 days
3. They reach adulthood during the next 9 to 12 days and live about 30 days
4. Without treatment, the cycle repeats every 3 weeks

-Complete eradication generally requires that all viable nits be removed along with lice; family and close contacts should be checked for head lice and, if found, treated at the same time

-Treatment typically involves over-the-counter insecticide shampoos (or pediculicides), such as pyrethrin-based RID and Nix or prescribed medications such as Ulesfia, Natroba, or Sklice

-School nurses and C/PHNs also need to educate families about reducing re-infestations by careful application of pediculicides, retreating in 2 weeks if necessary, and cleaning of any fomites (e.g., combs, hats, towels, sheets, clothing, and upholstered furniture) and removal of any viable nits
1. Drying sheets, blankets, and towels on high heat and washing all hats and clothing are effective measures
2. It is not necessary to use fumigant sprays, as they can be toxic

Question 10

How are dental caries prevented?

Answer 10

Fluoridated drinking water, the availability of school-provided fluoride rinse or gel, and dental sealant programs are proven methods of reducing dental caries in school-age children

Question 11

How is childhood obesity addressed?

Answer 11

-Multiple factors influence childhood obesity including genetics, decreased physical activity, increased television time, familial weight, poor nutrition knowledge, food insecurity, parental smoking, not having family mealtime, perceived neighborhood safety, and low economic status

-Early childhood may be the best time to modify preventable factors influencing obesity
1. Studies recommend that health care providers begin discussing behaviors such as family mealtime and parental smoking with families of young children to reduce the risk of childhood obesity

-The causes of childhood obesity are multifactorial, and as a result, health care providers should take a multiple health behavior approach

-Parental support and influence are key - parents can help their younger children develop healthy eating habits by following recommendations of the American Heart Association and the CDC, for example:

1. “Eat the Rainbow”
   *Provide a variety of fruits and vegetables
   *Let children pick fruits/vegetables and have them help cook or prepare it
2. Choose lean meats, poultry, beans for protein
3. Watch out for added sugars
   *Avoid/limit sugar-sweetened drinks
4. Help kids be physically active at least 60 minutes each day
5. Serve whole-grain/high-fiber cereals and breads
6. Serve low-fat and fat-free dairy products (two to three cups of milk daily)
7. Read food nutrition labels—pick healthy nutritional foods
8. Be a role model—help your child develop healthy habits early

-The benefits of following a healthy diet, increasing physical activity, and maintaining a healthy diet are well-documented

Question 12

How is a testicular self-exam performed?

Answer 12

-It is best to do the testicular self exam during or right after a warm shower or bath
1. The warmth relaxes the scrotum making the exam easier

-Don’t be alarmed if one testicle seems slightly larger than the other, or if one testicle hangs lower than the other - that’s normal

-You should also be aware that each normal testicle has a small, coiled tube called the epididymis that can feel like a small bump on the upper or middle outer side of the testis

-Normal testicles also contain blood vessels, supporting tissues, and tubes that carry sperm
1. Some men may confuse these with abnormal lumps at first (if you have any concerns, ask your doctor)

1. Stand in front of a mirror if possible
2. Check for any swelling on the scrotal skin
3. Examine each testicle with both hands
4. Hold your testicle between your thumbs and middle fingers and roll it gently but firmly between your fingers
5. Look and feel for any hard lumps or nodules (smooth rounded masses) or any change in the size, shape, or consistency of your testicles
6. You should not feel any pain when performing the self-exam (be aware of any dull soreness or heaviness)
7. The testicles should be smooth and firm to the touch

Question 13

What are examples of primary prevention for men and women?

Answer 13

-Primary prevention activities focus on education to promote a healthy lifestyle

-When working with individuals, the C/PHN should encourage routine health examinations, healthy eating habits, adequate sleep, moderate drinking, and no smoking

-Among aggregates, the community health nurse focuses on community needs for services and programs that will keep that population healthy, such as providing flu vaccine clinics, teaching sexual responsibility, and preventing STIs

-The community health nurse may collaborate with community leaders and other stakeholders in designing programs, work with committees to secure funding, or approach the state legislature to lobby for needed changes to state laws and policies governing the health of adults

-At other times, the nurse works with small groups of adults who could benefit from making healthy choices in diet, relaxation, and physical activity
1. Likewise, it is not unusual for the C/PHN to work with an individual to promote healthy living

Question 14

What are examples of secondary prevention for men and women?

Answer 14

-Secondary prevention focuses on screening for early detection and prompt treatment of diseases

-Throughout the life span, screening tests can help adults identify disease early

-A significant amount of the community health nurse’s time is spent in assessing the need for planning, implementing, or evaluating programs that focus on the early detection of diseases

-This is followed with teaching to prevent further damage from the disease in progress or to prevent the spread of the disease, if it is communicable

-Examples of secondary prevention programs include establishing mammography clinics, teaching breast and TSE, and screenings—blood pressure, blood glucose, BMI, and cholesterol

-Wherever adults gather in groups, this is a good place to provide both primary and secondary health care and prevention services

Question 15

What are examples of tertiary prevention for men and women?

Answer 15

-The tertiary level of prevention focuses on rehabilitation and preventing further damage to an already compromised system

-Many adults with whom a community health nurse works have chronic diseases, conditions resulting from another disease, or long-standing injuries with resulting disability

-Ideally, negative health conditions can be prevented
1. If not, the next best thing is for them to be diagnosed early, without damage to an individual’s health
2. But if negative health conditions have not been treated or brought under control, then the individual is at a tertiary level of prevention

-At this level of prevention, the nurse focuses on maintaining quality of life

-Depending on the client’s age, tertiary prevention can be simple or very complex
1. A 19-year-old man who breaks his leg while skiing needs information about using crutches safely, a reminder to eat protein foods for bone healing, and an appointment to return to his health care provider if he experiences various symptoms and to get the cast removed
*He generally needs no additional help from others
*Tertiary prevention in this case is uncomplicated
2. On the other hand, a 62-year-old woman who is 70 lb overweight with out-of-control blood glucose levels, symptoms of congestive heart failure, and difficulty walking more than 20 ft has much to accomplish in order to feel healthy
*On assessment, the nurse discovers that the woman has been as much as 80 lb overweight for 40 years
*Tertiary prevention is this case is very complicated

-Caring for people at the tertiary level of prevention can become quite complicated because many body systems may be involved
1. In addition, all people function within many social systems, which may include family expectations, roles people have within the family, expected behaviors, community system knowledge and involvement, personal expectations, motivation, and support
2. Working at the tertiary level involves all of the nurse’s skills in addition to community resources and a client who can be or wants to be motivated

Question 16

What are the routine screening recommendations for lung cancer?

Answer 16

Annual screening for lung cancer using low-dose computed tomography scan is recommended for individuals 55 to 74 years of age who currently smoke or have smoked in the past 15 years and have at least a 30-pack history

Question 17

What are the routine screening recommendations for colon and rectal cancer?

Answer 17

The U.S. Preventative Services Task Force recommends that screening for colon and rectal cancer should begin at age 50 years for men and women who are at average risk and repeated every 10 years

Question 18

What are the routine screening recommendations for diabetes mellitus?

Answer 18

-The American Diabetes Association (2018) recommends screening for diabetes for all people beginning at age 45 years and repeated every 3 years if test results are normal and for asymptomatic adults who are overweight and/or obese

-Individuals with more than one risk factor may need to be screened more frequently

Question 19

What are the routine screening recommendations for STIs in women?

Answer 19

-HPV: screen women 30 to 65 years old every 5 years with high-risk HPV testing (alone or with cytology screening)

-Chlamydia and gonorrhea: annual screening for women under age 25 years or older women with risk factors

-HIV: screen individuals aged 15 to 65 years; annual screening if high risk; younger or older depending on risk factors

Question 20

What are the routine screening recommendations for cancer in women?

Answer 20

Breast Cancer:
-Women, age younger than 50 years: should be an individual decision and the patient’s context (risk for disease) should be taken into account (Grade C)

-Women, aged 50 to 74 years: biennial (every other year) screening with mammography (Grade B)

-Women, aged 75 years and older: evidence is insufficient to assess the benefits and harms of screening mammography (Grade I)

-Women who have a first-degree relative with breast cancer (mother, sister), have a breast cancer gene (BRCA1 or BRCA2), or have had previous breast cancer are at a higher risk for developing the disease than other women in the general population
*Therefore, these individuals need to consult their physicians regarding timelines for screenings

Cervical Cancer:
-Women younger than 21 years: recommend against screening (Grade D)

-Women age 21 to 29 years: every 3 years with cervical cytology (Grade A)

-Women age 30 to 65 years: every 3 years with cervical cytology alone, or every 5 years with high-risk human papillomavirus testing (hrHPV), or every 5 years with hrHPV and cytology combination (Grade A)

-Women older than 65 years: recommend against screening with adequate screening previously and not at high risk (Grade D)

Question 21

What are the routine screening recommendations for prostate cancer in men?

Answer 21

-Starting at age 50, all men should talk to their health care provider about the pros and cons of screening for prostate cancer

-This discussion should start at age 45 if a man is Black or has a father or brother who had prostate cancer before age 65

-Men with two or more close relatives who had prostate cancer before age 65 should talk with their health care provider about screening for prostate cancer at age 40

Question 22

What disorders are included in a CVD screening?

Answer 22

-Cardiovascular disease (CVD) describes a group of heart and blood vessel disorders including hypertension, coronary heart disease (CHD), stroke, arrhythmias, valvular heart disease, peripheral vascular disease, and cardiomyopathies

-Risk factors that can be modified, treated, or controlled include high blood cholesterol, high blood pressure, smoking tobacco, physical inactivity, diabetes, and obesity/overweight

-Risk factors that are known to contribute to heart disease are stress, alcohol consumption, and diet and nutrition

Question 23

What is menopause?

Answer 23

-Menopause is a time that marks the permanent cessation of menstrual activity (last menstrual period)

-The average age is 51 years (range = 45 to 58); however, it can occur earlier

-Natural menopause is defined as cessation of menstrual periods for 12 consecutive months, with no other apparent cause

-Menopause symptoms differ among women and may last months to years

-They range from hardly noticeable in some women to very severe in others

-Symptoms include nervousness or anxiety, hot flashes (flushes), chills, excessive sweating (often at night), excitability, fatigue, mood disorders (apathy, mental depression, crying episodes), insomnia, palpitations, vertigo, headache, numbness, tingling, myalgia, urinary disturbances, and vaginal dryness

-According to the Study of Women’s Health Across the Nation (SWAN), hot flashes and some of the other menopausal symptoms last an average of 7.4 years, persisting 4.5 years once menopause is reached
1. However, these symptoms may persist for longer, particularly in African American women and those who are overweight or obese

-The Endocrine Society recommends diagnosis of menopause based on the cessation of menstruation for 12 consecutive months

-Recommendations for women in the menopausal transition include discussions about menopausal symptoms, osteoporosis, cancer screening, and assessment for CVD; along with a determination of the need for appropriate menopausal hormone therapy (MHT)

-For women under age 60, or who are <10 years past onset of menopause, with bothersome menopausal symptoms, MHT may be an appropriate treatment option
1. Health care providers must take patient risk for CVD, venous thromboembolic events, and breast cancer into account when considering initiation or continuation of MHT and should use a shared decision-making approach
2. Women who are not candidates for oral MHT may be able to use transdermal routes or nonhormonal therapies to relieve symptoms, depending on risk factors and contraindications

-Some women choose to use bioidentical hormone therapy—chemically similar hormones derived from plants—that may (e.g., micronized estradiol and progesterone) or may not be approved (e.g., Triest, Biest, pregnenolone) by the Food and Drug Administration (FDA)

-Current evidence does not support the use of bioidentical hormone therapy over conventional MHT

-Women may also choose natural products (e.g., phytoestrogens, black cohosh, DHEA, dong quai, vitamin E) for symptomatic relief
1. Women choosing natural or herbal supplements should be counseled on lack of evidence supporting efficacy and long-term safety, as well as potential side effects and drug interactions

-Other complementary health approaches women may choose for menopausal symptom relief includes hypnotherapy, meditation, yoga, and acupuncture

Question 24

What is the Women’s Health Initiative?

Answer 24

-The Women’s Health Initiative (WHI) was a major research program addressing the most common causes of death, disability, and poor quality of life in postmenopausal women—CVD, cancer, and osteoporosis

-The WHI addressed CVD, cancer, and osteoporosis and was one of the largest prevention studies of its kind in the United States, starting in 1991 and spanning 15 years

-This study was sponsored by the NIH and the NHLBI, involved 161,808 women ages 50 to 79 years, and was considered to be one of the most far-reaching clinical trials for women’s health ever undertaken

-To date, more than 616 publications have been associated with findings from this study, which address coronary artery calcium, breast cancer risk, colorectal cancer, venous thrombosis, peripheral arterial disease risk, risk of CHD, dementia and cognitive function, and the effects of estrogen alone in reducing the risk of CHD

Question 25

What is the definition of health disparity?

Answer 25

-The overarching goal of the Healthy People initiative is to eliminate health disparities and improve the health of all Americans

-A health disparity is defined as a difference in health status that occurs by gender, race/ethnicity, education or income, disability, geographic location, or sexual orientation

-Health disparities occur when one segment of the population has a higher rate of disease or mortality than another or when survival rates are less for one group when compared with another

-Often, persons with the greatest health burden have the least access to health care services, adequate health care providers, information, communication technologies, and supporting social services

-Interdisciplinary, collaborative, public, and private approaches as well as public–private partnerships are needed to develop strategies to address the health disparity goal of Healthy People 2030

Question 26

What factors are used to determine health disparities?

Answer 26

-Health disparities occur when one segment of the population has a higher rate of disease or mortality than another or when survival rates are less for one group when compared with another

-Often, persons with the greatest health burden have the least access to health care services, adequate health care providers, information, communication technologies, and supporting social services

Question 27

What is the most common type of cancer among adults?

Answer 27

While the lung cancer death rate continues to decline, it remains the number one cause of cancer deaths among adults in the United States

Question 28

What is the leading cause of death in men and women?

Answer 28

Heart disease is the first-leading cause of death in adults

Question 29

What are the signs and symptoms of benign prostatic hypertrophy (BPH)?

Answer 29

-Symptoms of BPH are caused by an obstruction of the urethra and gradual loss of bladder function, which results in incomplete emptying of the bladder

-The most commonly reported symptoms of BPH involve lower urinary tract symptoms (LUTS), such as hesitant, interrupted, or weak urinary stream, urgency or leaking of urine, and more frequent urination, especially at night

Question 30

What is the fastest-growing form of drug abuse?

Answer 30

-The illegal use of prescription opioids, synthetic opioids (fentanyl), and heroin is a major public health concern in the United States

-The abuse of opioids, leading to opioid use disorder, has become a national epidemic and public health concern
1. Approximately 2.1 million people had an opioid use disorder, including 1.7 million people with a prescription pain reliever use disorder and 0.7 million people with a heroin use disorder

Question 31

What services are provided by continuing care retirement centers?

Answer 31

-The concept of continuing care retirement communities (CCRCs), sometimes referred to as total life care centers, allows older people to “age in place,” with flexible accommodations designed to meet their health and housing needs

-CCRCs are the most expensive long-term care solution available to seniors; however, they provide all levels of living, from total independence to the most dependent

-Residents entering CCRCs sign a long-term contract that provides for housing, services, and nursing and dementia care
1. Many seniors enter into CCRC contracts while they are healthy and active, knowing they will be able to stay in the same community and receive nursing care should this become necessary
2. Currently, CCRCs are redesigning their homes and apartments to fit the needs of the baby boomers, who want more of a village feel
3. Dedicated memory care units in long-term and assisted living are part of the redesign
4. Older adults who invest in a CCRC need to have financial means to support the entrance and monthly fees (entrance fees can be as high as $1,000,000)

-The growing Village Concept is a relatively new, self-supporting solution for independent living in which older adults live in their own homes, in a neighborhood, or in some cases high rise city apartment buildings
1. Neighbors share services such as transportation, grocery shopping, or helping with household chores provided by village providers, either professional or volunteer
2. The village encourages socialization with a wide offering of activities among the members, and some hold wellness activities
3. This option requires a membership fee, on average, about $450 a year to provide services

Question 32

What is elder abuse?

Answer 32

-Elder abuse or mistreatment (i.e., abuse and neglect) is defined as intentional actions that cause harm or create a serious risk of harm to a vulnerable elder by a caregiver or another person who stands in a trust relationship with the older adult

-Signs of elder abuse may be missed by professionals working with older adults because of lack of training on elder mistreatment or lack of reporting
1. In addition, older adults themselves may be unwilling to speak up for fear of retaliation, physical inability to report, cognitive impairment, or they do not want to get the abuser (90% of whom are a family member) in trouble

-It is notable that financial abuse often accompanies one of the other forms of abuse
1. The financial abuse of seniors is a growing problem, often called the “crime of the 21st century”
2. A senior can be financially stable and living independently and may suddenly become destitute and forced out of the home as a result of financial abuse
3. The most common perpetrators of elder abuse are spouses or partners of elders, often in a relationship with long-term domestic violence
4. Family members account for 76% of reported mistreatment
5. Abusers, particularly adult children, are often dependent on the victim for financial assistance, housing, or because of personal problems such as mental illness, alcohol, or drug abuse

-Various state, local, and county agencies investigate and enforce elder abuse laws
1. The first agency to respond to a report of elder abuse in most states is APS
2. In some states, certain professionals are required or encouraged to report elder abuse; there are generally doctors and nurses, psychologists, police officers, social workers, and employees of banks and other financial institutions

Question 33

What are the risk factors for falls in older adults?

Answer 33

-Risk factors for falls include the following:
1. Difficulty with walking and balance
2. Vitamin D deficiency
3. Medications that effect balance such as tranquilizers, sedative, or antidepressants
4. Vision problems
5. Poor footwear
6. Hazards such as throw rugs, clutter, and uneven steps

-Environmental hazards (e.g., lack of nonslip surfaces and handrails) and host conditions (e.g., poor vision, problems with balance) are often the causative factors in falls

Question 34

How do you address constipation in the elderly?

Answer 34

-They should also avoid the habitual use of laxatives, instead adding more fluids, fiber, and bulk to their diet with fresh fruits and vegetables

-Also, inadequate fluid intake can contribute to bowel and bladder problems

-Increased physical activity and exercise help maintain regularity of bowel function in older adults

Question 35

What are the strategies to prevent Alzheimer’s disease?

Answer 35

-The C/PHN can conduct family teaching regarding health behaviors that may reduce the risk of ADRD, such as staying active, exercising, healthy eating habits, adequate sleep, and managing cardiovascular risk factors (diabetes, smoking, obesity, and hypertension)

-The C/PHN can stress the importance of completing the Medicare Annual Wellness Visit, including routine cognitive screening to detect early signs and symptoms of MCI, which provide the opportunity to investigate other possible causes of decline

-Early detection benefits also include the following:
1. Effective management of coexisting conditions
2. Appropriate use of available treatment regimens and holistic modalities
3. Pursing health-promoting activities; brain games, exercise, improved nutrition, and sleep patterns
4. Coordination of care between all members of the health care team, including providers and caregivers
5. Encouraging the client and family to participate in activities that bring joy/are meaningful
6. Accessing support services, day centers, and caregiver support groups

Question 36

What are the characteristics of a health older adult?

Answer 36

-Many factors contribute to healthy aging, including a lifetime of healthy habits and circumstances, a strong social support system, and a positive emotional outlook

-Good health in the older adult means maintaining the maximum possible degree of physical, mental, and social vigor

-It means being able to adapt, to continue to handle stress, and to be active and involved in life and living

-In short, healthy aging is being able to function, even when disabled, with the assistance of others as needed

-Wellness among the older population varies considerably
1. It is influenced by many factors, including personality traits, life experiences, current physical and cognitive health, current societal supports, and personal health behaviors

-Other actions that can increase healthy aging include addressing health disparities among older adults, encouraging people to plan for end-of-life care and communicate their wishes through advance directives, improving oral health and increasing physical activity among seniors by promoting environmental changes, increasing adult immunization levels, and preventing falls
1. Some older adults demonstrate maximum adaptability, resourcefulness, optimism, and activity
2. Others, often those from whom we tend to draw our stereotypes, have disengaged and present a picture of dependence and resignation
3. Most older adults are somewhere in between these two extremes
4. Although the level of wellness varies among older adults, that level can be raised

Question 37

What are the primary preventions for the elderly?

Answer 37

-Primary prevention activities involve those actions that keep one healthy

-Such primary prevention activities as health education, follow-through of sound personal health practices (e.g., flossing, seat belt use, exercise), recommended routine screenings, and maintenance of an appropriate immunization schedule ensure that older adults are doing all that they can to maintain their health

Question 38

What are the nutrition and oral health needs for the elderly?

Answer 38

-People who have maintained sound dietary habits throughout their life have little need to change in old age

-Adults aged 80 years and over had the lowest rate of obesity

-Emphasis on drinking plenty of fluids, including water, tea, and coffee, and consuming a diet high in fiber
1. Although multivitamins are not meant to replace food as a source of nutrients, taking them as a supplement to food to achieve recommended intakes may be a good idea

-It is generally believed that older people need to maintain their optimal weight by eating a diet that is low in fats, moderate in carbohydrates, and high in proteins with a daily calorie count of 1,200 to 1,600

-Older adults need less vitamin A but more calcium and vitamin D (for healthy bones), more folic acid, and more vitamins B6 and B12 (for cognitive health) than younger adults

-Many communities offer meals to seniors, either at senior centers or by way of Meals on Wheels, through grants provided by the Older Adult Nutrition Program

-Poor oral health has been associated with peripheral vascular disease, diabetes, and risk for death caused by pneumonia in nursing homes
1. Even those with dentures must be vigilant in maintaining oral health, as they are still at risk from inflammatory processes leading to diseases such as pneumonia

-Many older adults, especially those who are disadvantaged or have limited incomes, have decreased nutritional and fluid intake, changes in gums, and increased periodontal disease, as well as a higher incidence of dry mouth

-Fluid intake and oral hygiene are appropriate topics for anticipatory guidance from C/PHNs working with older adults
1. Take the time to assess the older adult’s oral cavity, including mucosa, denture fit, and any complaints about chewing or swallowing

-In addition to maintaining a healthy diet, older adults are cautioned to limit the use of alcohol
1. Use of alcohol can lead to falls or car crashes

-As with all adults, older persons should avoid tobacco, drink fluoridated water or use fluoride toothpaste, practice good oral hygiene, and have regular dental checkups

Question 39

What are the exercise needs for the elderly?

Answer 39

-Older adults need to exercise; in fact, they thrive when exercise is incorporated into their daily routine

-Research demonstrates that exercise and increased physical activity have multiple benefits for the older adult, including:
1. Arthritis relief, restoration of balance and reduction of falls, strengthening of bone, proper weight maintenance, and improvements in glucose control, cognitive and brain function, and overall mortality
2. A healthy state of mind, improved sleep, and reduced risk of heart disease
3. Decreased incidence of osteoporotic fractures due to a reduced risk of falling, with an exercise routine that includes activities to improve strength, flexibility, and coordination, even among the very old

-The C/PHN should explore the kinds of activity that appeal to older adults, including walks. A wide variety of activities are appropriate for and benefit older adults:
1. In one study, older adults who were informed about the benefits of walking walked more than those who were reminded of the negative consequences of not walking
2. Exercise may occur with others in connection with such activities as homemaking chores, gardening, hobbies, or recreation and sports
3. Resistance training (with small dumbbells or resistance bands), along with either Tai Chi or regular walking, has been shown to increase muscle strength, stability, and functional ability among seniors
4. Physical disabilities need not be a barrier to exercise, as there are specialized exercise programs (e.g., chair aerobics, wheelchair fitness)

Question 40

What are the sleep needs for the elderly?

Answer 40

-Sleep is another area of focus in Healthy People and is important to older adults for the following reasons:
1. In older adults, adequate sleep is necessary to fight off infection and support the metabolism of sugar to prevent diabetes or to work effectively and safely
2. Sleep timing and duration affect a number of endocrine, metabolic, and neurological functions that are critical to the maintenance of individual health
3. Untreated, sleep disorders and chronic short sleep are associated with an increased risk of depression, heart disease, high blood pressure, obesity, diabetes, and all-cause mortality

-Some changes in sleep are natural with aging, such as:
1. Decreased slow-wave or deep sleep due to the body producing lower levels of growth hormone
2. Altered circadian rhythms, causing the older adult to want to go to sleep earlier in the evening
3. Nighttime wakefulness and interrupted sleep due to pain, the need to void, medications, and snoring, which may worsen with age

-The C/PHN can assess and help older adults having sleep challenges by:
1. Asking them to keep a sleep journal
2. Investigating their nighttime voiding patterns
3. For men, assessing for the possibility of an enlarged prostate, which can cause problems with complete bladder emptying and may need treatment

-Objectives for Healthy People 2030 focus on reduction of accidents due to driving while drowsy, providing treatment for those with obstructive sleep apnea, and sufficient sleep

Question 41

What are the economic security needs and poverty for the elderly?

Answer 41

-Economic security is a major need for older adults

-Many older adults work beyond retirement age for reasons of enjoyment and purpose, but they may also be concerned about having financial stability through the rest of their lives

-Factors affecting economic security in older adults include the following:
1. Having to spend retirement resources caring for elderly parents or grandchildren
2. Limited income and reliance on Social Security and Supplemental Security Income, with half of all people on Medicare in 2016 having incomes of <$26,200

-Fearing the potential cost of major illness and wanting to avoid being a burden on family or friends, many older people conserve their limited finances by practices that may threaten their health:
1. Adopting frugal eating patterns
2. Skipping or taking only partial doses of medications
3. Limiting the use of home heating and cooling
4. Spending little on themselves, in general

-For older adults today who have lived many years past retirement without sufficient financial security to maintain them throughout these additional years, fears are not unfounded

-Many older adults are not aware that there are important preventive health measures and community-based programs that can maximize function and help older adults maintain health at a higher level
1. C/PHNs should be familiar with and share with their clients local support services that may provide housing, food, and utilities for older people in need, which can do much to help relieve the source of that stress and anxiety

Question 42

What are the psychosocial and spiritual needs of the elderly?

Answer 42

-All human beings have psychosocial needs that must be met for their lives to be rich and fulfilling

-Typically, aging is seen as a time of loss and decline, and much research focuses on the physiological and psychological impact of multiple losses and decline
1. However, some research indicates that older adults actually pay attention to and remember positive information and memories more than younger people do

-There may be biological and psychological reasons for this:
1. The amygdala in the brain reacts to emotions, and biological research indicates that older adults may not react at a brain level to negative information in the way the younger adults do, meaning that they may be more likely to gather and hold onto only their good memories
2. For many, old age may be a time of life reflection, review, and reevaluation of what gives meaning and satisfaction in life
*Knowing that they have limited time, older adults may choose to focus on positive emotions

-However, with a lack of healthy relationships with other people, life can be very lonely and diminished in quality for older people

-Holistic nursing is a hallmark of community and public health nursing
1. This means a focus on the body, mind, and spirit

-Although related, religion and spirituality are distinct concepts:
1. A spiritual component exists in all people but not everyone is religious
2. Religion is generally recognized to be the practical expression of spirituality or the organization, rituals, and practice of one’s beliefs
3. Religion includes specific beliefs and practices, whereas spirituality is far broader

-According to the Pew Forum, belief in God continues to be very important to older adults, including the younger baby boomers, even though religious practices vary
1. Whereas other sources of well-being decline, religion may become more important over time
2. Individuals within different cultures have varying philosophies and practices of spirituality but derive similar positive outcomes

-Faith-based nursing is one of the community nursing roles that epitomizes this holistic approach of caring for one’s clients, many of whom are older adults

Question 43

How do the elderly cope with multiple losses and suicide?

Answer 43

-Older adults may experience multiple losses, including loss of income and purpose from a career once practiced, loss of the economic stability of employment, and loss of space due to replacement of a larger residence, where the older adult may have raised a family

-The loss of a spouse after 50 years of marriage may have a huge impact on the remaining partner
1. Short- or long-term declines in health may result in pain or limited mobility and may necessitate multiple moves, such as a move to a child’s home, a move to an assisted living facility, and a move to a skilled living facility
2. Repetitive losses occur as significant others, relatives, friends, and acquaintances die
3. There is no right or wrong way to grieve, but there are healthy and unhealthy ways to cope with the pain
4. Assisting older adults with handling these losses is an important role of the public health nurse

-Inadequate coping with the compounding losses can make an older person believe that life holds no meaning

-Depression may be a difficult problem for older adults

-Social and emotional withdrawal can often occur, as can suicide
1. Among the risk factors for suicidal behavior in older adults are the loss of a spouse; having other mental disorders, such as dementia and depression; physical illnesses or decline; and social isolation
2. Although older populations have a much lower rate of suicide attempts than younger age groups do, the rate of completed suicide is high

-Community health nurses should be observant of risk factors and be prepared to ask questions, including whether the client is suicidal, as older adults are not likely to talk about the subject
1. If you think someone is suicidal, do not let them be left alone; seek further services for the older adult

-Older adults who have maintained good health and developed a supportive system of family and friends have more fulfilled lives
1. Churches, universities, and senior service programs often have volunteers who regularly meet with isolated seniors either in their homes or long-term care facilities, increasing social support for those who have no family members nearby
1. Good examples are the local Area Agency on Aging (AAA), the local health department, senior community centers, and the YMCA
2. Some counties have a senior resources guide

Question 44

How do the elderly maintain their independence?

Answer 44

-The need for autonomy—to be able to assert oneself as a separate individual—is important for all people

-Independence helps to meet the need for self-respect and dignity

-Older adults need to have their ideas and suggestions heard and acted upon, and they ought to be addressed by their preferred names in a respectful tone of voice

-Respect for the older adult is not a strong value in American society, but it is highly valued in Asian, Italian, Hispanic, and Native American cultures

-Older people represent a rich resource of wisdom, experience, and patience that is often unacknowledged in the United States

-Older adults who are in poverty, minorities, or veterans and who experience poorer health need support at home to remain independent

-Communities work with local, state, and federal agencies to create programs to provide support to older adults who need assistance but want to remain in their home communities
1. A good example of a program supporting older veterans at home is the Veteran in Charge program in Colorado Springs, Colorado
2. This program allows veterans to receive community-based services to continue living in their homes as long as possible and gives them control of the who, what, when, and how much related to the care

Question 45

What is involved with the interaction, companionship, and purpose for the elderly?

Answer 45

-Baby boomers, who started to reach the retirement age of 65 in 2011, have changed the face of aging

-Nearly 75% of boomers feel that full-time retirement is not for them
1. This may be, in part, because they are not financially prepared to live another 20 years past retirement
2. As the largest and healthiest aging cohort, they may also be the most engaged

-However, not everyone will be employed after the age of 65
1. Some may be challenged with physical or mental impairments or caring for spouses or parents

-A new phrase in our language is “Grand families”
1. It is possible that grandparents and even great grandparents may be cutting into their own finances to care for grandchildren whose parents may have been deployed or are struggling with substance abuse

-Programs exist to support older adult caregivers
1. Examples include the federally supported Foster Grandparents and Senior Companions programs, which engage millions of Americans in service
2. These older adults work part-time offering companionship and guidance to handicapped children, the terminally ill, and other people in need

-In cases where family and social networks have weakened, C/PHNs and others can help to improve their psychosocial health by working at individual, family, and community levels
1. The problem is of greatest significance for women, who outnumber men considerably in the later years and who more frequently live alone
2. Take time to explore skills that older adults can do from home: letter writing, volunteer phone calling, or crafting for others who are ill

Question 46

What are the safety and health needs of the elderly?

Answer 46

-Safety issues are a major concern for older adults and the C/PHNs who work with them
1. Personal health and safety, home safety, and community safety

-Personal health and safety includes three major areas: immunizations, home safety and prevention of falls, and drug safety

Question 47

What is involved with immunizations for the elderly?

Answer 47

-Older adults are at increased risk for many vaccine-preventable diseases

-Preventable illnesses cause substantial morbidity and mortality in older patients, who tend to have more medical comorbidities and are at higher risk for complications

-Acute respiratory infections, including pneumonia and influenza, are the eighth leading cause of death in the United States, accounting for 56,000 deaths annually

-Nonetheless, vaccination rates in the United States do not meet targets for vaccination against flu and pneumonia, such as the Healthy People 2020 target of 90%
1. Healthy People 2030 objectives target a reduction in hospital admissions due to pneumonia by older adults
2. Although influenza does kill an estimated 36,000 people per year, in older adults, it is the exacerbating effect it has on other conditions (e.g., pneumonia, congestive heart failure, or chronic obstructive pulmonary disease [COPD]) that is of greatest concern

-Racial and ethnic disparities exist among older adults receiving influenza and pneumonia vaccines; therefore, it is important to engage in outreach efforts to these populations, such as culturally targeting communication, reaching out to those providers serving this population, and offering vaccination clinics in underserved sections of the community

-Attempts to improve immunization coverage involve changing provider knowledge, attitudes, and behavior through reminders and standing orders, so that “missed opportunities” when seeing clients are prevented

-Additional opportunities for vaccinating people exist beyond the primary care setting, as C/PHNs are well aware

-Regardless of the site, a method for tracking and communicating vaccinations is needed so that vaccination information may be documented and shared with the elder’s primary care provider

-Shingles is caused by the varicella–zoster virus (VZV); this is the same virus that causes chickenpox
1. Anyone who has had chickenpox can develop shingles because VZV remains in the nerve cells of the body after the chickenpox infection clears, and VZV can reappear many years later causing shingles
2. Shingles is a very painful localized skin rash, often with blisters
3. The disease most commonly occurs in people 50 years or older, people who have medical conditions that keep the immune system from working properly, or people who receive immunosuppressive drugs
4. A new shingles vaccine called Shingrix (recombinant zoster vaccine) was licensed by the U.S. Food and Drug Administration (FDA) in 2017
5. The CDC recommends that healthy adults aged 50 years or older get two doses of Shingrix, 2 to 6 months apart
6. Shingrix provides strong protection against shingles, and C/PHNs should advise clients about this vaccine

Question 48

What is involved with fall prevention for the elderly?

Answer 48

-According to the CDC STEADI fact sheet, every 20 minutes an older adult dies from a fall, and one in five falls causes a serious injury, such as a head trauma or a fracture
1. Furthermore, fewer than half of fallers talked to the primary provider about the fall

-Although not all falls cause serious injuries, effects from falls, such as decreased mobility and excessive bleeding due to taking medications such as blood thinners, lead to additional concerns

-Environmental hazards (e.g., lack of nonslip surfaces and handrails) and host conditions (e.g., poor vision, problems with balance) are often the causative factors in falls
1. Falls are a preventable problem

-Today, more than in any other time, older adults can be safer and more comfortable at home or in a facility as the result of smart home technology and wearable monitoring
1. Smart homes may include environmental, activity, and physiological sensors, with more affordable systems being developed in a rapidly expanding market
2. Smart homes have been purported as a method to safeguard senior safety through alerts and notification related to falls, first aid, and detection of unattended cooking

Question 49

What is involved with mediations for the elderly?

Answer 49

-Medications are often prescribed to control the effects of chronic conditions

-A significant safety issue for the older adult arises from the use of prescription and over-the-counter (OTC) drugs

-Problems can arise from a single difficulty or a combination of issues such as:
1. Number of medications taken daily
2. Absorption rate of medications
3. Drug interactions
4. Side effects

-In addition, the more medications taken daily, the higher the rate of nonadherence to the schedule
1. This problem is compounded when older adults have visual or cognitive impairments

-Older adults often have multiple chronic diseases for which they take prescription medications
1. It is not unusual for older people to be taking four to six medications daily
2. The use of multiple drugs, called polypharmacy, is defined as using from 5 to 10 prescription drugs

-Older adults often receive multiple prescriptions from multiple providers and sometimes from multiple pharmacies, including mail-order pharmacies
1. They are less likely to see the pharmacist in person, and these circumstances put older adults at risk of receiving the same or similar medications in error

-Medication side effects or drug interactions can lead to falls and further disability
1. Older adults need education about the drugs they take and their possible effects
2. They also need proper supervision of their overall medication intake, including complementary and alternative therapies (e.g., herbal treatments) and OTC drugs
3. It is also important for all seniors to keep a list of their current medications and doses and to have this available in the event of an emergency

-Research evidence indicates that polypharmacy in older adults is being addressed by the use of appropriate screening tools such as the Beer’s criteria and STOPP Screening tool
1. C/PHNs can help by doing a thorough medication review with older adults

Question 50

What is involved with safety in the community for the elderly?

Answer 50

-Safety can involve many things, such as pedestrian and driving issues, crime and fear of crime against older adults, and environmental factors such as sun exposure, pollution, heat, and cold

-Because of age-related changes in vision, hearing, and mobility and the effects of polypharmacy, older adults are at risk in the community as pedestrians and as drivers

-Automobile crashes and pedestrian injuries can be life-threatening events when elders are involved
1. As pedestrians, older adults must be increasingly vigilant to traffic patterns, sidewalk irregularities, and the possibility of being a victim of street crime

-Often out of necessity and pride, older people may drive longer than their abilities permit
1. The C/PHN may recommend resources for families who need to talk about driving safety

-Although many older adults are fearful of being victims of crime, rates of nonfatal violent crime and property crime against the elderly are lower than in all younger age groups

Question 51

What are the secondary preventions for the elderly?

Answer 51

-Secondary prevention focuses on early detection of disease and prompt intervention

-Much of the C/PHN’s time is spent in educating the community on preventive measures and positive health behaviors
1. This includes encouraging individuals to obtain routine screening for diseases such as hypertension, diabetes, or cancer, which, if identified early, can be treated successfully

-Many nurses, working in collaboration with community agencies, are in positions to establish screening programs based on the desires and demographics of the community and agency focus, making them accessible to the population being served

-Older adults need to be encouraged to follow the routine health screening schedule prescribed by their clinic or health care provider

Question 52

What diseases and conditions are common in old age?

Answer 52

-Four of five older adults experience at least one chronic condition, and many suffer multiple chronic conditions as they progress into older age

-Cardiovascular disease, cancer, diabetes, and obesity are common to all adults

-Common chronic conditions seen in older adults are as follows:
1. Alzheimer’s disease
2. Arthritis
3. Cardiovascular disease
4. Depression
5. Diabetes
6. Hearing loss
7. Obesity
8. Osteoporosis

-The prevalence of chronic disease and resulting disability in older adults require health promotion behaviors and guidance

Question 53

What are the tertiary preventions for the elderly?

Answer 53

-Tertiary prevention involves follow-up and rehabilitation after a disease or condition has occurred or been diagnosed and initial treatment has begun

-Chronic diseases that are common among older adults, such as heart failure, stroke, diabetes, cognitive impairment, or arthritis, cannot always be prevented but can frequently be postponed into the later years of life through a lifetime of positive health behaviors
1. However, when they occur, the debilitating symptoms and damaging effects can be controlled through healthy choices encouraged by the C/PHN and recommended by the primary care practitioner

-Although many older adults are considered generally healthy, 80% have at least one chronic condition and 50% have at least two

-A small proportion suffer more disabling forms of disease, such as COPD, cerebral vascular accidents (CVAs), cancer, or DM, with some requiring extensive care and ongoing medical management

-Heart disease and cancer pose their greatest risks as people age, as do other chronic diseases and conditions, such as stroke, chronic lower respiratory diseases, AD, and diabetes

-Influenza and pneumonia also continue to contribute to older adult deaths among older adults, despite the availability of effective vaccines

-While the risk for disability from disease clearly increases with advancing age, poor health is not the inevitable outcome of aging
1. Many older adults manage chronic conditions well throughout the remainder of their lives

Question 54

What are the changes occurring in the older population globally?

Answer 54

-The unprecedented growth in the number of older adults is not limited to the United States but is happening worldwide

-In 2010, an estimated 524 million people were aged 65 years or older—8% of the world’s population
1. By 2050, this number is expected to nearly triple, to about 1.5 billion, representing 16% of the world’s population

-Life expectancy at birth around the world now is 67
1. A child born in Myanmar or in Brazil can expect to live 20 years longer than one born 50 years ago
2. And in Iran, only 1 person in 10 is currently older than 60 years, but in 35 years’ time, this will change to 1 in 3

-Although more developed countries have the oldest population profiles, the vast majority of older people—and the most rapidly aging populations—are in less developed countries
1. Between 2010 and 2050, the number of older people in less developed countries is projected to increase more than 250%, compared with a 71% increase in developed countries

-As a result of demographic transitions, including declining infant and childhood mortality, lower fertility rates, and improvements in adult health, the shape of the global age distribution is changing
1. The age distribution in developed countries, such as the United States, includes a larger proportion of older adults than does the age distribution in less developed countries

-Because of this demographic shift, along with altered societal expectations, changes in attitudes and social policies worldwide are needed
1. Many countries have few or no social programs, pensions, or health care services available for their older adult populations

Question 55

What is the history of nursing in the correctional setting?

Answer 55

-In the past, the correctional system of prisons and jails has provided minimal, if any, health care to inmates

-Historically, nurses involved with prisoner and mentally ill populations included Dorothea Dix, who visited prisons around the country in the 19th century and found prisoners in chains, without proper sanitation, living conditions, nutrition, or clothing

-Prison was viewed as a punishment, and the inmates were seen as not deserving of care that was being paid for through public dollars

-The historic Supreme Court ruling Estelle v. Gamble stated that not providing medical services inflicted pain and denied inmates their Eighth Amendment rights and led to major reforms in the correctional health system
1. Medical providers were hired, and inmates’ rights were established

-Although the correctional health system is a relatively new specialty, it is under intense pressure from the courts to ensure that adequate and humane care is provided

-Specific issues include the provision of ethically appropriate and timely patient care for inmates, the provision of adequate mental health treatment, prevention of prisoner-on-prisoner violence, maintenance of sanitary and safe conditions, and ending inmate neglect and abuse

-Ensuring that inmates’ health needs are met amidst the growing number of inmates and their increasing complex health concerns has imposed a huge financial burden on correctional systems
1. Funding for correctional health care derives from public tax dollars and many are contesting that care and expense should be given to incarcerated persons
2. This is an ethical dilemma nurses working in correctional facilities must face every day
3. In an attempt to decrease costs and save money, several states utilize managed care organizations to provide some services for inmates and are increasingly relying on private prison health care providers and managed care organizations

-Correctional nurses must demonstrate nonjudgmental attitudes while at the same time ensuring self-protection from assault

-Correctional nurses work in on-site medical units, clinics, or infirmaries housed in criminal justice facilities
1. These facilities can be local jails or state and federal prison

-The care is focused on the individual, immediate, and ambulatory care, emergency needs, and management of chronic conditions, screenings and preventive services

-Larger facilities offer ambulatory and inpatient mental health services, and subacute care units for short-term therapies (e.g., IV medications)

-In addition, the increased female incarceration rates highlight that women’s health care concerns must be addressed

-As prisoners age, long-term care and end-of-life care must also be provided; correctional systems are further challenged with these additional specialty care needs

Question 56

What are the functions of the public health nurse?

Answer 56

-Public health nursing practice consists of many areas of expertise, including:
1. Focusing on the health of populations
2. Reflecting the needs and priorities of the community
3. Establishing caring relationships with individuals, families, communities, and systems
4. Being grounded in cultural sensitivity, compassion, social justice, and a belief in the worth of all people (e.g., vulnerable populations)
5. Having a basic understanding of all aspects of health (e.g., physical, emotional, mental, social, spiritual, and environmental)
6. Using strategies to promote health that are motivated by epidemiologic evidence
7. Using individual, as well as collaborative, strategies to achieve results

Question 57

What are the differences between hospital nurses and public health nurses?

Answer 57

-The role of the C/PHN is to focus on the health of the public

-C/PHNs combine their nursing and clinical knowledge of disease and the human response to it, along with public health skills, to accomplish their goals

-They apply the nursing process, not only with individuals but also with populations

-C/PHNs are a critical link between data tracking (e.g., epidemiology) and developing a clinical understanding of a disease or condition and use the data to prioritize their interventions to stop the spread of diseases, such as measles, and also to intercede

-A key emphasis of the C/PHN is prevention, and a key focus is educating and empowering the community

-C/PHNs may focus on a population that is a geographic community (e.g., a state or municipality) or a focus group (e.g., adolescents or older persons) spanning all socioeconomic levels
1. To accomplish this, C/PHNs often work with individuals or families at highest risk, and their motive is to improve, protect, and promote the health of the entire population

-A distinctive goal of C/PHNs relative to the goals of other nursing disciplines is achieving the greatest good for the majority of people
1. This requires priority planning and a basic knowledge of the community
2. It can also create ethical dilemmas for C/PHNs when they have personal and passionate issues that they would like to pursue but which are not the top priority for the majority of community members

-The C/PHNs in the community must prioritize which issue to address first by deciding which issue impacts the most people and what interventions will help the population thrive
1. Because each community is different, once all factors are taken into account, the priorities will vary among communities
2. Hence, assessment is a critical component of public health and a key tool for the nurses who work in the public sector

-Another way Community/public health nursing differs from other areas in nursing is that C/PHNs must actively seek out and identify potential problems and situations
1. Nurses who work in a hospital setting address the issues that come to them
2. A nurse in the intensive care unit of a hospital works with an assigned patient load
3. C/PHNs, on the other hand, are out in the community identifying the problems, not waiting for problems to come to them
4. For example, C/PHNs may participate in visits to childcare centers to note any safety hazards and ensure that rules and regulations are being followed and that children are properly immunized
5. These visits are part of the priority of assurance

-C/PHNs cannot perform all these activities alone
1. They need to collaborate with other partners and optimally use often limited resources

-C/PHNs are in a unique situation because they work with their populations (i.e., clients) and with others to find the best solutions for a situation or problem
1. For instance, C/PHNs may notice an increase in the number of measles cases in their community
2. They may then work with families to identify where and how the children were exposed to the disease and with local health care providers to provide treatment and vaccinations for those at highest risk of exposure to and damage from measles
3. C/PHNs also work with school nurses and other school personnel to exclude from school attendance those children who are not adequately immunized against measles
4. This helps decrease the spread and potential harm because of measles
5. C/PHNs educate a variety of groups, such as parent–teacher associations and city or school officials, as to how measles spreads, what can be done to treat the disease, and the importance of herd immunity in protecting the public
6. Education thus empowers each group to be part of the solution
7. Finally, C/PHNs can work with public health officials to develop a policy for all new school entrants to receive a second booster of measles vaccine
8. Policy development is the third critical component of public health

Question 58

What are the qualifications for a nurse to be a member of the U.S. Public Health Service Commissioned Corps?

Answer 58

-U.S. citizenship

-A degree in the Bachelor Science of Nursing

-An active nursing license

Question 59

What agency is used by the C/PHN to obtain information about disease prevention and bioterrorism prevention?

Answer 59

CDC

Question 60

What are the Expected Outcomes of the School-Based Health Centers?

Answer 60

-Evaluation research has demonstrated that SBHCs are effective in increasing student access to health care
1. This is especially true for adolescents, who often are difficult to reach and do not willingly access health care
2. Onsite SBHC services are more appealing for adolescents, who have been shown to utilize substance abuse and mental health counseling services, as well as STD and family planning services

-SBHCs provide ready access to health care for large numbers of children and adolescents during school hours, reducing absences from school due to health care appointments

-Many SBHCs in middle schools and high schools offer abstinence counseling, pregnancy testing, sexually transmitted infection diagnosis and testing, and pap tests

-Many hospitals, HMOs, and health departments are sponsors of these school clinics, because it is a cost-effective way to decrease visits to the emergency department and promote health, especially to underserved groups such as adolescents

Question 61

What are the most prevalent health conditions among inmates?

Answer 61

-Mental illness, substance abuse, and communicable diseases (TB and Hepatitis C)

-Manage chronic conditions of hypertension, diabetes, pulmonary disorders, and mental health

-In addition to women’s reproductive health issues, females tend to have higher rates of major mental illness, dental problems, insomnia, and chronic medical conditions

Question 62

What are the key roles of the School Nurse in promoting a healthy school environment?

Answer 62

-A third function of school nursing practice includes maintaining and promoting a healthful school environment

-Promotion of healthful school living emphasizes planning a daily schedule for monitoring healthy classroom experiences, extracurricular activities, school breakfasts and lunches, emotional climate, discipline programs, and teaching methods

-It also includes screening, observing, and assessing students to identify needs early and to report illegal drug use, bullying, suspected child abuse, and violations of environmental health standards

-Cyberbullying is another area where school nurses can provide education to students, parents, teachers, and school staff, as well as response to warning signs among school-age children and youth

-Health promotion also involves the nurse in supporting the physical, mental, and emotional health of school personnel by being an accessible resource to teachers and staff regarding their own health and safety

Question 63

What is the primary responsibility of the school nurse?

Answer 63

-School nurses play a critical role in promoting the academic success of these and other children in school

-Depending on the state of residence, a school nurse is usually an RN that has primary responsibility for the health care of school-age children and school personnel in an educational setting

-School nurses address the social determinants of health such as environment, access to health insurance, housing, and income as most health issues are associated with social determinants of health

-They bridge health and education preventing illness and promoting and maintaining the health of the school community

-The school nurse serves not only individuals, families, and groups within the context of school health but also the school as an organization and its membership (students and staff) as aggregates

-The school nurse identifies health-related barriers to learning, serves as a health advocate for children and families, and promotes health while preventing illness and disability

-School nursing activities are varied and is composed of nursing care of children with special health needs, including nasogastric tube feedings, catheterization, insulin pumps, and suctioning; general and emergency first aid; vision, hearing, scoliosis, and TB screenings; height, weight, and blood pressure monitoring; oral health and dental education; immunization assessment and monitoring; medication administration; assessment of acute health problems; health examinations (athletic participation or school entry); and referrals

-School nurses also assess and are the frontline providers for identifying communicable diseases, such as outbreaks of influenza or meningitis

-Medication administration is another common school nurse duty and includes giving a wide range of medications for acute and chronic issues, as well as delegation of medication tasks

-In addition, school nurses perform first aid, help students with inhalers and nebulizer treatments, and some may do gastric tube feedings and ventilator/tracheostomy care

-Other duties of a school nurse may include training school staff in cardiopulmonary resuscitation (CPR), universal precautions and first aid, as well as overseeing the health and wellness of school staff members

Question 64

What are the conditions that make a student eligible for Individualized Education Plans (IEPs)?

Answer 64

-Autism

-Deaf-blindness

-Deafness

-Emotional disturbance

-Hearing impairment

-Intellectual disability

-Multiple disabilities

-Orthopedic impairment

-Other health impairment

-Specific learning disability

-Speech or language impairment

-Traumatic brain injury

-Visual impairment, including blindness

Question 65

How do caregivers often describe themselves?

Answer 65

-Caregivers often describe themselves as emotionally and physically drained and may need information about resources to assist them

-Frail older caregivers are especially vulnerable to deterioration of their own health because of their caregiving burden

-Likewise, the economic cost of providing home care places a significant burden on informal caregivers
1. Out-of-pocket expenditures include medications, transportation, home medical equipment, supplies, and respite services
2. These costs may be non reimbursable and are often invisible, but they are very real to families struggling to provide care on a fixed income

-Home health nurses must continually assess the strain on caregivers as they seek to develop a realistic plan of care

Question 66

What is involved with the reimbursement for home health care: Medicare criteria and reimbursement?

Answer 66

-Corporate and governmental third-party payers, as well as individual clients and their families, pay for home health care services

-Corporate payers include insurance companies, health maintenance organizations, preferred provider organizations, and case management programs

-Government payers include Medicare, Medicaid, the military health system (TRICARE), and the Veterans Administration system
1. These governmental programs have specific conditions for coverage of services, which are often less flexible than those of corporate payers

-The Medicare policies for home health programs set the precedent for all other reimbursement sources

-Medicare is the largest single payer for home care services in the United States and has set the standard in establishing reimbursement criteria for other payers
1. Therefore, it is essential that home care nurses seek to understand the complex Medicare home health requirements and rules for determining eligibility for home care services
2. It is important to acknowledge that a person may be in dire need of care at home, yet not meet eligibility standards for home health care under Medicare
3. There are five criteria that must all be met to be eligible for reimbursement by Medicare

The following steps are implemented while the patient is under Medicare-reimbursed home health care:
1. The Medicare prospective payment system pays an agency for a 60-day “episode of care.” All services and many medical supplies must be provided under the payment amount adjusted to geographic location and determined by the patient’s clinical and functional status at the start of care, as well as the projected need for services over the anticipated 60-day period
2. When the patient is admitted, the patient is comprehensively assessed using an assessment tool called OASIS. OASIS is used to measure home health quality measures and is the basis for measuring patient outcomes and adherence to best practice for quality improvement
3. The nurse also completes the Medicare plan of care at admission, and the physician must sign this. It is then used to assess agency compliance with Medicare and state requirements. All follow-up services must match the plan of care
4. It is a Medicare requirement that patients receiving home health care must be recertified every 60 days. A determination of continued visits is then made based on the objective data obtained

Question 67

What is the Medicare home health eligibility criteria?

Answer 67

1. The patient must be confined to the home or homebound
2. The patient must need skilled services (from a nurse or therapist)
3. The patient must be under the care of a physician
4. The patient must receive services under a home health plan of care (POC) that is established and periodically reviewed by a physician
5. The patient must have had a face-to-face encounter that is related to the primary reason the patient requires home health services with a physician or an allowed NPP (this must be done 90 days prior to the home health start-of-care date or within 30 days of the start of the home health care)

Question 68

What are the government sources for reimbursement for home health care?

Answer 68

Government payers include:
-Medicare

-Medicaid

-The military health system (TRICARE)

-The Veterans Administration system

Question 69

What is involved with locating the client and getting through the door?

Answer 69

-The first step in making a home visit is finding where the person lives
1. Directions and household identification can be unclear
2. In rural areas, tracking down clients can involve vague instructions involving barns, bridges, trees, and other colorful local landmarks
3. When families are unstable, clients may not be staying in households designated on the nurse’s paperwork
4. They may have moved in with relatives or friends or be back home alone despite major care needs

-Even when the wheels stop at the correct household, there is the challenge of getting through the closed door and making the connection
1. Always remember that you are a guest in the home
2. Respect and attentive listening are the foundation for establishment of trust between the client and nurse
3. Agendas must be laid aside initially as the nurse focuses on the concerns and realities of both the client and family
4. Assumptions and stereotypes are overturned in the process of discovering how clients live, what they believe, and who comprises their family and community
5. The nurse must take into account the spiritual, cultural, and developmental, as well as environmental, realms of the client in order to be able to develop individualized plans of care to promote health

-The home health nurse is aware that the client is the driver of the plan of care
1. To have effective outcomes, the nurse must develop a therapeutic relationship in which the client identifies the desired outcomes
2. Autonomy should be respected, and the family should be empowered by actions recognizing that they are in charge of their lives
3. The nurse, the patient, and family must work together to establish mutually agreed-upon goals

Question 70

What is important for the nurse to remember when visiting a client’s home for the first time?

Answer 70

-Always remember that you are a guest in the home

-Respect and attentive listening are the foundation for establishment of trust between the client and nurse

-Agendas must be laid aside initially as the nurse focuses on the concerns and realities of both the client and family

-Assumptions and stereotypes are overturned in the process of discovering how clients live, what they believe, and who comprises their family and community

-The nurse must take into account the spiritual, cultural, and developmental, as well as environmental, realms of the client in order to be able to develop individualized plans of care to promote health

Question 71

What are the most common conditions managed at home?

Answer 71

-COPD

-Diabetes

-Dementia

-Cardiovascular disease

-Cancer

-Lung conditions

Question 72

What measures does the nurse make to ensure medication safety in the home?

Answer 72

-The home presents a risk of medication errors that are different from those found in hospital or nursing home

-Every visiting nurse has stories of finding drawers and cupboards filled with multiple prescriptions from various physicians, some current and some outdated for many years
1. Polypharmacy becomes obvious in the home setting
2. Clients often have received prescriptions from multiple sources for similar drugs
3. Also, well-meaning friends often share their prescriptions with the attitude that it “helped them”
4. Even if the client is well organized and taking every drug prescribed, those prescriptions may have originated from several providers over time and may have contradictory side effects

-Sometimes, medication errors at home include failure to clearly reconcile hospital or nursing home orders with home discharge orders
1. Although weekly medication organizers can helpfully put medications in order, they can also confuse new or impaired users
2. Distraction, visual impairment, forgetfulness, depression, and cognitive impairment are common causes of unintentional medication noncompliance

-The home health nurse investigates how the medication is taken by reviewing and reconciling the current list of medications and having the patient explain and demonstrate the process he or she goes through

-Intervention requires clear and repeated instruction, updating the medication list, charting or diagramming the schedule for medication taking, and assuring that the client or caregiver knows how to use the medication box

Question 73

What is custodial care?

Answer 73

-Unskilled care

-Involves unskilled or nonprofessional services, such as cleaning and assistance with daily living, and DME includes wheelchairs, commodes, beds, or oxygen

-Agencies that provide such services are not held to the same standards as those that offer skilled care

Question 74

What is involved with spokes of the home health caregiving wheel: collaborating, mobilizing, strengthening, teaching, & solving problems?

Answer 74

-Home health nursing competencies that radiate from the hub and contribute to promotion of self-care and family care include collaborating with multiple team members and mobilizing resources in the community that can sustain the client after discharge

-The home health care nurse usually is the coordinator of all other home health team members

-Working with the social worker, the nurse proposes needed connections with community services

-Likewise, strengthening involves development of self-management or family caregiving ability

-The home health nurse is constantly teaching clients and/or family caregivers through concrete explanation, discussion, and modeling behavior

-Concerns and relevant feelings must be validated, and the nurse leads the person to consider options for change
1. The solution develops through a mutual, participatory process
2. Ultimately, people are responsible for their own health decisions

-Finally, home health nursing competency requires flexibility and creativity in solving health care problems and the challenges of everyday living

-All outcomes of care can be achieved only by adapting to the skills and resources available in the home

-Although people of all socioeconomic backgrounds present with severe health problems requiring home health nursing, many families live on the margins

-The home health nurse must often be creative in obtaining supplies and adjusting to conditions in the home

-For example, how do patients and families with no running water wash their hands before providing care, such as dressing changes?
1. This may lead the home health nurse to contact social agencies in order to provide services or teach the patient and family the use of alcohol-based gels to clean their hands
2. The home health nurse must be nonjudgmental but work with the patient and family to help them understand the need to keep areas clean

Question 75

What is the goal of receiving home health care?

Answer 75

-As the population ages, and particularly now that the baby boomers are entering their elder years, home health nursing is challenged to respond

-Professional home health care agencies seek to maximize the client’s level of independence and to uphold the right to access high- quality health care and supportive services

-Those most in need of home care services are older adults and those with chronic illnesses
1. As the number of multiple chronic conditions rises, specifically for older beneficiaries, the need for health care in the home is critical

-Today, C/PHNs provide home health care much like their early predecessors, where the focus of care is on maximum independence

-The nurse’s role in the home can be extensive
1. The nurse may be the coordinator of care, managing and providing a plan of care for the patient
2. The nurse monitors the progress of the patient, makes referrals as necessary, assesses for home safety, provides care such as dressing changes or blood pressure, coordinates communication with the health care team and family members, reviews the medication regime, and educates and advocates for the patient and family

-Today’s health care system requires nurses to employ a greater understanding of health care cost and reimbursement, a population focus for improving health, and inclusion of quality and satisfaction in the care provided