Community Exam 2 Flashcards by malarie carroll

Environmental Factors

WHO, 1993

Physical
	Chemical
	Biological
	Social
	Psychosocial

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Environmental Exposures

Herbicides
Pesticides
Other chemical carcinogens
Lead
Radiation

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Healthy People 2020 Objectives for Environmental Health

Eliminate elevated lead blood levels in children.

Minimize risks posed by hazardous sites.

Reduce significant pesticide exposures.

Reduce the amount of toxic pollutants.

Reduce indoor allergen levels.

Decrease lead-based paint or related hazards.

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clean water and sanitation

nightingale

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Henry Street neighborhood

Lillian Wald

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Testing of human fluids and tissues for presence of potentially toxic chemicals

biomonitoring

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Sometimes called the study of poisons

Negative effects of chemicals

toxicology

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Studies the strength of association between exposures and health effects

Epidemiology

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Epidemiologic triangle

Agent
Host
Environment

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Relates it to a place on Earth (“mapping”)

coding data

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GIS (geographic information systems) community-based maps can be used to:

Educate communities and local policy makers

Provide graphic depictions of public health (PH) problems

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example of GIS

Hill and Butterfield’s model of environmental risks

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Earth sciences that show how pollutants travel

Geologists
Meteorologists
Physicist
Chemists

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Key public health (PH) professionals:

¬ Food safety specialist
¬ Sanitarians
¬ Radiation specialists
¬ Industrial hygienists

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WHO: “____ ____ is a significant and emerging threat to public health, and changes the way we must look at protecting vulnerable populations.”

Climate change

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nurses main role in climate change

mitigation and response

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working at individual, community, institutional, and governmental level to ensure energy-conserving policies and practices

Mitigation:

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Response: public health nurses must be prepared for increased____ and ____ related disasters

fire- and storm-

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Risks can be categorized as follows:

medium
type
setting
functional location

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ex of medium

air
water
soil
food

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ex of type

chemical
biological
radiological

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ex of setting

urban
rural
suburban

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ex of functional location

home
school
workplace
community

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information sources

national library of medicine (NLM)

safe cosmetics database

“right to know”

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Household Products page Environmental pages

ToxTown

is an American Nurses Association (ANA) environmental health principle that recommends access to all information necessary to make informed decisions to protect our health.

“Right to Know”

Use of the “I PREPARE”mnemonic device

``` Investigate potential exposures Present work Residence Environmental concerns Past work Activities Referrals and resources Educate ```

Features that can positively contribute to a community’s health

Green space, bike paths, walkable communities

point sources of pollution in the air

identifiable (smokestacks)

non-point sources of pollution in the air

mobile (cars and trucks)

sources of pollution in the water

Waste from industry, pharmaceuticals Storm runoff, erosion, especially due to loss of 80% of the world’s forests leading to massive erosion

contaminated land designations

superfund site | brownfield site

pathogenic causes of food contamination:

e. coli salmonella pesticides genetically modified organisms (GMOs)

68-page final decision from EPA about levels of dioxins in area—May 2011

mossville

Calcasieu Estuary—

Bayou Verdine

Several environmental statutes give the public the ____ __ ___ about the hazardous chemicals in the environment.

right to know

Process to determine the probability of a health threat associated with an exposure

risk assessment

four phases of the risk assessment

Assess toxicology and epidemiologic data. Has the chemical been released? How much and by which route of entry of the chemical? Risk assessment process

: lower-income clients are at increased risk for _____ _____

health problems

why are lower-income clients are at increased risk for health problems

Live in substandard housing Live in close proximity to pollution sources Employed in more dangerous occupations Have less access to healthy food options

Very ____ and very ___ are more vulnerable

young and old

Children’s bodies operate differently than adults, putting them at potentially increased risk for ____ _____.

toxic exposure.

reasons children are increased risk for toxic exposure?

increased RR immature BBB kidneys are less effective

A "______ ______" advised when animal research and other indicators demonstrate a possible toxic relationship between a chemical and health effect

“precautionary approach”

______ is a core goal in PHN.

Prevention

Every nurse’s role in risk reduction

``` Shift to e-records to avoid paper Recycle Promote minimal packaging and green wrappers Go fragrance free Turn off equipment not used Report dysfunctional plumbing Promote local sustainable foods (organic) Start a Green Team Create community ```

Three Rs to reduce environmental pollution

Reduce Reuse Recycle

includes all the principles of good communication in general.

Risk communication

Risk communication is a combination of the following:

the right information to the right people at the right time

Created to coalesce nurses and nursing organizations around relevant issues

2008—Alliance of Nurses for Healthy Environments

Certain environmental health risks disproportionately affect poor people and people of color in the United States.

1993: Environmental Justice Act was passed 1994: Executive Order 12898, “Federal Actions to Address Environmental Justice in Minority Populations”

Chemicals that do not decompose Also referred to as persistent organic pollutants (POPs)

Persistent Bioaccumulative toxins (PBTs)

Pollutant created by health care industry Created by incineration of chlorine

Dioxin

ANA was a founding member of this campaign.

Health care without harm

υ Goals of Epidemiology

υ Monitor the health of the population υ Understand the determinants of health and disease in communities υ Investigate and evaluate interventions to prevent disease and maintain health.

υ So WHAT kind of Diseases are we talking about?

υ COMMUNICABLE DISEASES

, “father of epidemiology”

υ John Snow

How to measure mortality rate

υ Proportionate mortality ratio (PMR)

υ A two-dimensional causal web that considers multiple levels of factors that affect health and disease

υ Web of Causality

Ð Determining the relationships between the different causes of disease is important to PH practitioners who seek to prevent, diagnose, and treat disease.

¥ Establishing causality:

what two ways to establish causality

screening and surveillance

screening tests a group of individuals who are

υ At risk for a certain condition υ As yet asymptomatic

screening is not a _____ test.

diagnostic

reflects the more complex interrelationships among the numerous factors interacting, sometimes in subtle ways, to increase risk of disease.

web of causality

precision its consistency or repeatability

reliability

accuracy whether it really measures what we think it is measuring and how exact the measurement is

validity

validity is measured by?

sensitivity and specificity

quantifies how accurately the test identifies those with the condition or trait

sensitivity | true positives

indicates how accurately the test identifies those without the condition or trait.

specificity | true negatives

descries the distribution of disease, death, and other health outcomes in the population according to PERSON, PLACE, AND TIME providing a picture of how things are or have been--the who, where, and when of disease patterns.

descriptive epidemiology

searches for the determinants of the patterns observed--the HOW AND WHY

Analytic Epidemiology

person with descriptive?

``` race ethnicity sex age education occupation income socioeconomic status marital status ```

place with descriptive?

does the rate of disease differ from place to place?

time with descriptive?

is there an increase or decrease in frequency of the disease over time?

Investigating a link between exposure and disease Think of the maps you pull up on Google when you are trying to find something.

cluster investigations

examples of analytic epidemiology

cohort studies case-control studies cross-sectional studies ecologic studies

a group of persons who are born at about the same time

cohort

is the standard for observational epidemiological studies, coming closest to the ideal of a natural experiment

cohort study

participants are enrolled because they are known to have the outcome of interest (cases) or they are know not to have the outcome of interest (controls) prone to bias

case-control studies

provides a snapshot or a population or a group. very FAST

Cross sectional study

both descriptive and analytic looks at disease rates by person, place, and time (descriptive) relationship between disease rates and risk or protective factors (analytic)

ecologic (correlational) studies

associations observed at the group level may not hold true for the individuals who make up the groups, or associations that actually exist may be masked in the grouped data

ecologic fallacy

uses an intervention

experimental studies

ex of experimental studies

clinical trials community trials

in ____ _____ the research issue is generally the efficacy of a medical treatment for disease, such as a new drug or an existing drug used in a new or different way.

clinical trials

♣ Health promotion and disease prevention ♣ Large scale trials ♣ Mainly Pharmaceutical (Fluoridation of water), but usually involves: ♣ educational, programmatic, or policy interventions.

community trials

Phocomelia from thalidomide was what?

prescribed for morning sickness for PG women

Phocomelia means?

sealed limbs NO legs or arms

The relationship between an event (the cause) and a second event (the effect), where the second event is a consequence of the first.

causality of disease

υ Establishing Causality υ Seven criteria establish the existence of a cause and effect relationship:

1. Strength of association 2. Consistency with other studies 3. Biological plausibility 4. Demonstration of correct temporal sequence 5. Dose-response relationship 6. Specificity of the association 7. Experimental evidence

Navajo man comes into ER with SOB and tells you his wife died 2 days earlier. what's the agent?

Hantavirus

host for hantavirus?

Deer mice (zoonosis)

environment for deer mice?

new Mexico

what type of study was used for hantavirus?

case control study

10 confirmed cases—3 deaths! mousses were getting into cabins that weren't being occupied for long periods of time people on vacation stayed in these cabins, spreading the disease further

yosemite national park | 2012

υ Involves observation, data collection, consultation, and interpretation υ Lillian Mood example

υ Community-oriented epidemiology

υ Example: toxic waste activists

υ Popular epidemiology

a disease of human or animal origin caused by an infectious agent and resulting from transmission of that agent from an infected person, animal, or inanimate source to a susceptible host

communicable disease

host

reservoir

to remove a disease from a larger geographic area such as a country or region of the world

elimination

irreversible termination of all transmission of infection be exterminating of that infections agent world wide small pox in 1970!!!

eradication

in the early 20th century the leading causes of death were?

infectious diseases

which diseases WERE major killers?

TB and diarheal diseases

what are concerns now?

``` HIV pneumonia influencza VRSA and MRSA SARA ```

transmission of communicable diseases

agent host evironment

agent??

bacteria fungi parasites viruses

host??

human or animal that can harbor ann infectious agent

environment??

anything external to the human host

species-determined innate resistance to an infectious agent what your body was born with

natural immunity

resistance acquired by a host as a result of previous infection natural exposure to an infectious agent vaccinations

acquired immunity

immunity of a group or community

herd immunity | 70-80%

modes of transportation

vertical | horizontal

passing of the infection from parent to offspring via sperm, placenta, milk or contact in the vaginal canal at birth

vertical

person to person spread of infection

horizontal

horizontal transportation can be through what 4 modes:

direct/indirect contact common vehicle airborne vector-borne

◦ Infected host to susceptible host | ◦ Via food, water, body fluids

common vehicle

ex of vector-borne transmission

arthropods such as ticks and mosquitos

entry, development, and multiplication of an agent in a susceptible host

infection

possible outcomes of infection. may indicate a physiological dysfunction or pathological reaction

disease

o : time interval between invasion by an infectious agent and the first appearance of signs and symptoms of the disease ♣ Variable from between 2-4 hours for staphylococcal food poisoning to between 10-15 years for AIDS

incubation period

o : interval during which an infectious agent may be transferred directly or indirectly from an infected person to another person

communicable period

o May range from subclinical infection to severe and fatal disease o At community level, may occur in endemic, epidemic, or pandemic proportion

ϖ Disease spectrum

Constant presence of a disease within a geographic area or a population

o Endemic:

Occurrence of disease in a community or region in excess of normal expectancy

o Epidemic:

Epidemic that is worldwide and affecting large populations

o Pandemic:

Surveillance for agents of bioterrorism

◦ Syndromic surveillance systems | ◦ Early Aberration Reporting System (EARS)

National Notifiable Disease Surveillance System (NNDSS) includes the national notifiable diseases such as the louisiana ____ ____.

sanitary code

ϖ Part of a comprehensive system that serves to limit the introduction and spread of contagious diseases in the U.S.

CDC Quarantine Stations

Located at 20 points of entry & land border crossings where international travelers arrive

ϖ Quarantine Station:

Quarantine Stations are staffed with?

medical and public health officers from CDC

what rights do the staff have at the quarantine stations?

◦ They decide whether ill persons can enter the U.S. and what measures should be taken to prevent the spread of contagious diseases. ◦ They have the legal authority to detain anyone who needs to be quarantined, can deny ill persons entry to the U.S., & can have ill persons admitted to a hospital or confined to a home for a certain amount of time.

Nathan Wolfe—___ Hunter

virus

♣ A new infection ♣ People died from non-pulmonary cardiac genetic • Lungs fill up but has nothing to do with the heart • Has nothing to do with health

o Hantavirus Pulmonary Syndrome

♣ Symptoms: bull’s eye rash and arthritis ♣ Where do you live? ♣ Have you been out in the woods/tall grass ♣ What’s your occupation?

o Lyme disease

♣ Genetic material from swine/pigs, birds & humans

swine flu

♣ Cervical cancer ♣ Cancer of the penis ♣ Warts & lesions

HPV

can't assume someone with cervical/penis cancer has ___

HPV

ϖ Not contagious until signs and symptoms appear o If you begin with symptoms, call ER first and let them know o Do not immediately go to ER without notifying them (do not want to contaminate everyone)

ebola hemorrhagic fever

with ebola there are __-__ incubation days, but up to ___days

8-10; 21

sx of ebola

o Fever great than 101.5 o Severe headache o Muscle pain o Weakness o Diarrhea and vomiting o Abdominal pain

A person with Ebola is NOT contagious until

symptoms appear.

treatment for ebola

IV fluids maintaining O2 and BP treating other infections

mortality rate of ebola

70%

isolation for ebola:

standard contact droplet respirators

PPE for ebola

``` face mask fluid resistant gown N-95 nask double gloves disposable shoe covers leg coverings ```

role of nurses

``` immunizations surveillance teaching controls prevention screening and treatment ```

There is an Imbalance between ____ _____ and ____

human host and environment

vaccine preventable diseases:

measles rubella pertussis influenza

highly contagious, | airborne

measles

worst condition concerned with PG women

Rubella | german measles

whooping cough

pertussis

H1N1--

novel (swine flu) (2009)

H5N1

avian flu (1997)

bacteria in food that is ingested and multiplied in the gut

o Food Infection:

ex of food infection

salmonella e. coli listeria campylobacter

toxin produced by bacteria that is in food and is released in gut

o Food Intoxication:

o Food Intoxication example:

staph aureus | botulism

CDC sentinel surveillance system targeting 10 sites across the country

ϖ Food net

◦ Collects information from laboratories on disease caused by enteric pathogens transmitted commonly through food.

food net

ϖ Much foodborne illness can easily be prevented through simple changes in ???

food preparation, handling, and storage

ex of waterborne illnesses?

o Viruses, bacteria, protozoans cause: Hepatitis A, Cholera, Typhoid, Dysentery o Shigella, Vibrio, Campylobacter, E. coli can be transmitted via water o Legionnaire’s disease

in mexico waterborne illnesses cause?

montezuma's revenge!!!!

ϖ Refers to illness for which the infectious agent is transmitted by a carrier, or vector, which is usually an arthropod (mosquito, tick, fly)

vector borne diseases

o Usually occurs in the summer in rural and suburban areas of the northeast, mid-Atlantic and north-central states, particularly Wisconsin and Minnesota o Most common vector borne disease in the US

lyme disease

lyme disease is transmitted by?

ixodid ticks

o Most common occurs in the southeast, Oklahoma, Kansas, and Missouri o Tick vector that is not transmitted from person to person

ϖ Rocky Mountain Spotted Fever

ϖ Prevention and control of tick-borne disease

o Prevent exposure to ticks o Landscape modifications o Prompt tick discovery and removal o Remove with steady, gentle traction on tweezers applied to head parts of the tick (twist the tick) o Permethrin sprays on the body and clothing

diseases of tranvelers

malaria foodborne and waterborne diseases diarrheal diseases

ϖ – potentially fatal disease characterized by regular cycles of fever and chills o Transmission is through bite of infected mosquito o Fifth leading cause of infectious disease death o Prevention: protection against mosquitos

malaria

ϖ can usually be avoided if the traveler eats thoroughly cooked foods prepared with reasonable hygiene o Eating foods from street vendors may not be a good idea o Water is many areas of the world is not safe to drink o Ice should be avoided o Only drink water that has been boiled

Foodborne and waterborne diseases

ϖ An infection transmitted from a vertebrate animal to a human under natural conditions ϖ Do not need humans to maintain their life cycles

zoonoses

zoonoses are transmitted via

``` o Animal bites o Inhalation o Ingestion o Direct contact o Arthropods ```

Common Zoonoses in the U.S

``` o Toxoplasmosis o Cat-scratch disease o Brucellosis o Listeriosis o Salmonella o Rabies o Avian flu o Monkey pox o Creutzfeldt-Jakob disease (mad cow) o Anthrax ```

is a Zoonotic virus (member of the corona virus, responsible for the common cold)

SARS

transmission of Zika virus

vector and sexual

sx of zika

◦ Fever, rash, joint pain, conjunctivitis (most common); other S&S include muscle pain and headache ◦ Very mild illness—most people don’t even realize they have it.

prevention of pika

◦ Stay inside, wear long-sleeved shirts and long pants, use repellents, use mosquito netting

◦ Pinworm most common helminthic infection in United States, usually in schools, institutions or overcrowding

Intestinal parasitic infections

◦ More frequent or severe in immunocompromised

Parasitic opportunistic infections

ϖ If you have a needle stick injury in the hospital

o Patient does not have to get tested for HIV o You have to have a consent to test for HIV o Prophylactic measures for a needle stick injury

o : within about 1 month of contracting HIV

primary infection

when body shows no symptoms

incubation period

♣ CD4 T-lymphocyte count less than ____/ml with documented HIV infection

200

ϖ Transmission of HIV

blood, semen, transplanted organs, vaginal secretions, breast milk

HIV began in?

monkeys in 1981

largest group of AIDS contractors in??

homo men

o Accounts for nearly all HIV infection in children | o Can occur during pregnancy, labor and delivery, or breastfeeding

perinatal transmission of HIV/AIDS

υ Screens blood and other donor products υ Does not reveal whether individual has symptomatic AIDS, nor does it isolate the virus

υ Enzyme-linked immunosorbent assay (EIA)

υ Confirmatory test minimizes false-positive results

υ Western blot

υ Despite having an HIV-infected mother, many children do not acquire ____

HIV/AIDS.

adherance to ___ therapy is critical for HIV patients

HAART

υ Sexually Transmitted Diseases

``` υ Gonorrhea υ Syphilis υ Zika Virus υ Chlamydia υ Genital herpes υ Human papillomavirus infection ```

o Second most common STD o Bacterium that infects the mucous membranes of the genitourinary tract, rectum, and pharynx o Transmitted through genital-genital contact, oral genital contact, and anal genital contact o Treated with antibiotics

gonorrhea

o Infects moist mucous or cutaneous membranes | o Spread through direct contact, usually by sexual contact or from mother to fetus

syphillis

syphillis is cured by?

penicillin

o Newly emerging o Can be transmitted sexually by men to partners o In one case, virus was transmitted before the host developed symptoms o The virus is present in semen longer than blood

zika

o Most common and reportable STD in the U.S. | o Infects the genitourinary tract and rectum of adults and causes conjunctivitis and pneumonia in neonates

chlamydia

o Transmitted through direct exposure and infects the genitalia and surrounding skin NO CURE

ϖ Herpes Simplex Virus 2 (Genital Herpes)

HAV route

fecal-oral

sources of HAV

water food feces sexual contact

high risk groups for HAV

``` ♣ Travel to countires to high incidents ♣ Children living in areas of high incidents ♣ Chronic liver disease ♣ Clotting disorders ♣ Drug usage ♣ Homosexual men ```

HBV is spread ?

through blood and bodily fluids

HBV remains outside of the body for at least ___ week.

high risk for HBV

``` ♣ People who use injeciton drugs ♣ People with STDS ♣ Multiple sex partners ♣ Blood and body fluids ♣ Immigrants that come for an high epidemic rate coutry ♣ Hemodialysis patients ♣ Inmates of long term correctional institionals ♣ Health care workers ```

HCV is transmitted?

blood or bodily fluids enter an uninfected person

high risk for HCV

♣ Injection drug users who share needs ♣ Infants born to infected mother ♣ Health care workers ♣ Emergecy personal

____ ____ ___ from HCV is twelfth leading cuase of death in adults in United States and most common reason for a liver transplant

o Chronic liver disease

ϖ Transmission usually occurs through exposure to the tubercle bacilli in airborne droplets from persons with pulmonary tuberculosis who talk, cough, or sneeze

transmission for TB

airborne droplets

common sx of TB

``` cough fever fatigue hemoptysis chest pains weight loss ```

υ WHO reports 12 million cases in 2012 and 1.3 million deaths due to TB (WHO, 2013)

υ Previously, purified protein derivative (PPD) test υ Used for initial screening υ Followed by chest x-ray for persons with positive skin reaction and pulmonary symptoms

υ Tuberculin skin test (TST)

υ Primary prevention for TB

υ Education on how to avoid infection

υ Secondary prevention for TB

υ Testing and counseling for HIV υ Posttest counseling υ Partner notification and contact tracing

υ Tertiary prevention

DOT therapy

ϖ Any natural or man-made incident that causes disruption, destruction, and/or devastation requiring external assistance

disaster

ϖ The disaster event ____ and ___ predict subsequent injuries and illnesses

type and timing

ϖ Any event or force of nature that has catastrophic consequences o Avalanche, earthquake, tsunamis

Natural disasters:

ϖ Anything that a human has done to cause disaster | o Hi-jacking, terrorism, bombing, war

Man-made disasters:

ϖ : Involves 100+ individuals Either dead, dying, injured

Mass Casualty

ϖ Incident is 2-99 individuals

Multiple Casualty

Individual immediately affected by disaster event

ϖ Direct Victim:

Family or friend or first responder of victim

ϖ Indirect Victim:

Those who have evacuate their home, school, or business because of the disaster o Evacuated for awhile but go back

ϖ Displaced Persons:

Group of people who have fled their home/country as a result of famine, drought, natural disaster, war or civil unrest

ϖ Refugees: