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community health nursing > Exam 02 > Flashcards

Exam 02 Flashcards

need to add vaccine info but otherwise complete

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1
Q

Three factors in the epidemiological triangle

A

Agent, Host, Environment

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2
Q

Agent types

A

Infectious agents
Chemical agents
Physical agents

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3
Q

Host characteristics

A

genetic susceptibility
immutable characteristics (age, sex)
acquired characteristics
lifestyle factors

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4
Q

Environment characteristics

A

Climate
Plant and animal life
Human population distribution
Socioeconomic factors
Working conditions

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5
Q

The 5 Ws of Epidemiology, separated into descriptive and analytic

A

DESCRIPTIVE:
- what is the outcome?
- who is affected
- where are they
- when do events occur

ANALYTIC:
- how does it occur
- why are some affected more than others

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6
Q

What is the difference between descriptive and analytic epidemiology

A

descriptive looks at the distribution of health outcomes

analytic looks at the determinants of outcomes

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7
Q

epidemic

A

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

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8
Q

two key historical figures of epidemiology

A

Hippocrates: ecological model
John Snow: father of epidemiology

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9
Q

Proportion

A

type of ratio in which denominator includes the numerator. e.g. x amount of sick people / x total people

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10
Q

rates

A

measure of frequency of a health event in a defined population, in a specific period of time. rates usually expressed per 100k population per year

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11
Q

risk

A

probability that an event will occur within a specified period of time

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12
Q

prevalence

A

number of existing cases, expressed in a percent; proportion!

e.g. deaths d/t heart disease over total number of deaths

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13
Q

incidence

A

number of new cases over number of people at risk; usually expressed as x cases/100k pop at risk annually; RATE!

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14
Q

attack rate

A

proportion of people who are exposed to an agent and develop the disease

e.g. ill people after exposure/total exposed

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15
Q

mortality rate limitations

A

can provide info about fatal diseases or events, but not info about level of existing disease in population.

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16
Q

Mortality vs Morbidity

A

Mortality: rate of deaths
Morbidity: disease prevalence, can be harder to attain

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17
Q

Primary sources of epidemiology data

A

collected directly through interaction with community members, + OG info for specific epidemiologic studies; NCHS, NHDS

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18
Q

Secondary sources of epidemiology data

A

Collected through existing reports on the community, including routinely collected data. Includes census, vital statistics/records, CDC data, data collected for other purposes, etc

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19
Q

Annual population estimate number

A

estimate of population at midyear as the denominator for annual rates, since pop. changes during the course of a year

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20
Q

Reliability

A

repeatability or consistency of a measure

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21
Q

Validity

A

accuracy measuring what is intended.
Includes sensitivity and specificity

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22
Q

Sensitivity

A

test ID those with the condition (true positive)

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23
Q

Specificity

A

test ID those w/o condition (true negative)

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24
Q

Bioterrorism

A

intentional release/dissemination of biological agents

common agents: anthrax, smallpox, plague

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25
Q

Signs of bioterrorism

A
  • temporal or geographic clustering of illness
  • unusual age distribution for a common disease
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26
Q

Surveillance

A

systematic collection, analysis, interpretation of data r/t occurrence of disease and health status of a given pop.

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27
Q

Passive surveillance

A

used more commonly by local and state health department and by providers who reports cases of notifiable disease; inexpensive

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28
Q

Active surveillance

A

purposeful, ongoing search for new cases of disease by PH personnel, via contacts, review of lab reports, hospital/clinic records
limited to special specific purposes, more expensive

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29
Q

Purpose of surveillance

A

assess public health status

define PH priorities
plan PH programs
evaluate programs
stimulate research
improve health

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30
Q

Types of epidemiological analytical studies

A

Cohort studies
Case control studies
Cross-sectional studies
Ecological studies
Clinical trial
Community trial

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31
Q

Cohort study

A

group of people sharing some characteristic or interest. watched for development of disease

Prospective: follow over time
Retrospective: past data

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32
Q

Case control study

A

sample from cohort rather than following entire cohort

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33
Q

Cross-sectional study

A

snap shot

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34
Q

Ecological study

A

bridge between descriptive and analytic study

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35
Q

Clinical trial

A

how effective is the new treatment? randomizing/blinding, with contrived/controlled environment

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36
Q

Community trial

A

large-scale community based
tests mass interventions, health promotion and disease prevention

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37
Q

Objectives of an investigation

A
  • control and prevent disease or death
  • ID factors that contribute to the outbreak of the disease and occurrence of event
  • implement measures to prevent occurrences
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38
Q

What triggers an investigation of a disease

A

unusual increase in disease incidence
unusual event in the community

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39
Q

Different types of immunity

A

Active
- natural: infection
- acquired: vaccination

Passive
- natural: breast milk to child
- acquired: immunoglobulin

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40
Q

6 characteristics of an infectious agent

A

Infectivity, Pathogenicity, Virulence, Toxicity, Invasiveness, Antigenicity

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41
Q

Infectivity

A

ability to enter and multiply

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42
Q

Pathogenicity

A

producing a specific clinical reaction

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43
Q

Virulence

A

producing a severe pathological reaction

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44
Q

Toxicity

A

producing a poisonous reaction

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45
Q

Invasiveness

A

penetrate and spread through tissue

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46
Q

Antigenicity

A

stimulate an immunological response

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47
Q

Endemic

A

constant presence of a disease within a geographic area or population

48
Q

Epidemic

A

disease in community or region in excess of normal expectancy

49
Q

Pandemic

A

epidemic occurring worldwide and affecting large populations

50
Q

Vertical transmission

A

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

51
Q

Horizontal transmission

A

person-to-person spread of infection via…

  • direct/indirect contact
  • common vehicle
  • airborne
  • fomite
  • vector borne
52
Q

Emerging disease factors

A

Societalevents
Health care
Food production
Human behaviour
Environmental
Public health
Microbial adaptation

53
Q

Lyme Disease - Stage 1

A

bullseye rash; fever, fatigue, malaise, HA, muscle pains, stiff neck, enlarged lymph nodes

54
Q

Lyme Disease - Stage 2

A

additional leasions, HA, neurological abnorm, cardiac abnorm

55
Q

Lyme Disease - Stage 3

A

recurrent attacks of arthritis and arthralgia

56
Q

Lyme Disease location and dx

A

most commonly reported vector-borne disease in the US, usually in the summer during tick season.

Located in NE, mid Atlantic, north central states

with absence of lesion, Lyme is harder to dx, serological tests more accurate in stages 2 + 3

57
Q

Rocky Mountain Spotted Fever s/sx

A

sudden onset of mod-high fever
severe HA
chills
deep muscle pain
malaise
rash on extremities, spreads to most of body

58
Q

RMSF- transmission, immunity, dx, tx

A

not transmitted person to person
one attack = lifelong immunity
wood ticks
dx w serum titers
EARLY TREATMENT IS KEY! doxycycline

59
Q

Main difference b/t Lymes and RMSF?

A

Lyme = bullseye
RMSF = rash on wrists and ankles, no bullseye

60
Q

Vaccine hesitancy spectrum

A

People in the middle may refuse or delay vaccines, accept vaccines but uncertainly, or only get certain vaccines.

61
Q

Primary vaccine concerns

A
  • safety
  • lack of confidence in effectiveness
  • do not think they are at risk
  • distrust

most people just need more information!

62
Q

Levels of disease prevention: primary

A

reduce incidence of disease by preventing occurrence.

ex: responsible sexual behaviour, prophylaxis, vaccines, safe food handling, repellants for vectors, water inspection, BBP regulations, restaurant inspections

63
Q

Levels of disease prevention: secondary

A

prevent spread of infection and/or disease once it occurs; focuses on rapid ID of potential contacts to a reported case

ex: immunoglobulin post-exposure, post-exposure rabies vaccine, TB screening for HCW, STD partner notification, HIV testing and treatment, quarantine

64
Q

Levels of disease prevention: tertiary

A

Works to reduce complications and disabilities through treatment and rehabilitation

ex: PCP prophylaxis for AIDS, regular inspection of hands and feet for leprosy or DM pts with neuropathy

65
Q

Foodborne disease transmission + examples

A

infection from eating food contminated with disease

ex: salmonella, e. coli

66
Q

Differences between salmonella and e. coli

A

Salm: sudden HA, diarrhea, N, sometimes vomiting, almost always fever

E. coli: bloody diarrhea, abd cramps, rarely fever

67
Q

Water-borne disease transmission + examples

A

animal or human fecal contamination in the form of viruses, bacteria, protozoa

ex: Hep A; typhoid, giardia, legionella, cryptosporidium; cholera

68
Q

Vector-borne disease transmission + exmaples

A

transmitted by a vector - tick, mosquito, animal (zoonoses), etc

ex: lymes, RMSF, rabies, malaria

69
Q

Parasitic infections

A

intestinal: tapeworms, flukes, roundworms
opportunistic: toxoplasmosis

70
Q

2 sources of financial assistance for HIV tx

A

Ryan White HIV/AIDS treatment extension act of 2009

AIDS Drug Assistance Program (ADAP)

71
Q

Malaria caused by…

A

Plasmodium (bloodborne parasite)
Potentially fatal disease, transmitted through bite of infected Anopheles mosquito

72
Q

What is the most prevalent vector-borne disease in the world?

A

Malaria; 1/2 world is at risk!

eliminated from US, but can happen as Anopheles mosquito is in Southern US, Report to DOH

73
Q

MalariaPrevention

A

No vaccine; some partial prot for young children
Protect against mosquitos
Best: antimalarial meds, started 1-2 wks before leaving country and continued 4-6 wks after returning

74
Q

S/sx of malaria

A

Cyclical fever and chills up to one year after returning home

75
Q

3 stages of HIV: Primary Infection

A

W/in about 1 month of contracting the virus.
Mononucleosis-like. WBC drops for brief time, self-limiting illness

S/sx: lymphadenopathy, myalgia, sore throat, lethargy, rash, fever

Antibody test at this point usually appears negative

76
Q

3 stages of HIV: Clinical Latency

A

period when body shows no symptom.
gradual deterioration of the immune system during incubation period
can transmit virus to others

77
Q

3 stages of HIV: Symptomatic disease

A

final stage of HIV, becomes AIDS

78
Q

What is AIDS dx measurement?

A

CD4 T-lymphocyte count <200 with documented HIV infection

79
Q

Modes of transmission of HIV

A

Sexual contact involving exchange of body fluids w/ an infected person
Sharing needles
Perinatal transmission during pregnancy or delivery, breastfeeding
Exposure to HIV-contam blood, organs, semen

80
Q

How is HIV reported?

A

CDC

81
Q

Tests for HIV (2)

A

HIV antibody test – indicates presence of antibody to HIV

EIA (enzyme linked immunosorbent assay) – Western blot; screens blood and other donor products

82
Q

S/sx of HIV in children

A

failure to thrive, unexplained persistent diarrhea, dev. delays, bacterial infections

83
Q

Employers and workers with AIDS

A

Increase PPE as they are immunocompromised
Adherence to HAART
Chronicity of AIDS
ADA protects clients against discrimination
Teach family how to care and support client with personal care
NO EVIDENCE OF TRANSMISSION OF AIDS AT A SCHOOL/WORK

84
Q

Viral STDs

A

HSV (oral or genital, more like pimples or blisters), HIV, HPV (genital warts)

85
Q

Bacterial STDs

A

gonorrhea, syphillis, chlamydia!

86
Q

What is the risk for HSV in pregnancy

A

Increased risk of fatal newborn infection during vaginal delivery; concern; C-sections are recommended if active lesions are present.
If there is no clinical evidence of herpes lesions, deliver vaginally.

NOTE: a small amount of infants are infected in utero and infection can present as liver disease, encephalitis, or infection limited to the skin, eyes, or mouth

87
Q

STD with highest risk factor for PID?

A

Gonorrhea - s/sx are asymptomatic in women, treatment may not be sought. Can spread to others through sexual activity and may not be recognized until someone has PID

88
Q

S/sx of Chlamydia in adult women

A

dysuria, urinary frequency, purulent vaginal discharge

89
Q

S/sx of Chlamydia in neonates

A

conjunctivitis, pneumonia

90
Q

Which 2 STDs are frequently coinfections?

A

gonorrhea and chlamydia

tx with ceftriaxone and azithromycin

91
Q

most common reportable disease in US

A

chlamydia

92
Q

Stages of Syphillis: Primary

A

when syphillis is acquired sexually, bacterial infection forms as a lesion called a chancre at site of entry. Lesion starts out as a macula, progresses to a papule, and later ulcerates.

If untreated, chancre persists for 3-6 wks, then disappears.

93
Q

Stages of Syphillis: Secondary

A

occurs when the organism enters the lymph system and spreads throughout the body

s/sx: rash, lymphadenopathy, mucosal ulceration

94
Q

Stages of Syphillis: Tertiary

A

1/3 of untreated syphillis patient will show the following s/sx pf tertoaru syphillis:

  • blindness, congenital damage, cardiovascular damage or syphilitic psychoses
  • gummatous lesions of bones, skin, mucous membranes
  • usually occurs several years after initial infection; rare in US d/t being cured w ABX, major problem in developing countries
95
Q

Stages of Syphillis: latency period

A

when individual is free of s/sx but has serological evidence, may occur early or late in the infection

96
Q

Is it possible to infect others in HSV if you are asymptomatic?

A

YES

97
Q

Difference between HSV1 and HSV2?

A

Location!

HSV1: sores, saliva, mucous membranes in or around mouth

HSV2: vulva, vagina, upper thighs, buttocks, penis;

98
Q

Is there a cure for viral STDs?

A

NO

99
Q

What is the main danger of HPV infection?

A

cervical cancer, screen with pap smear

100
Q

Hepatitis transmissions

A

Hep A: fecal-oral, contaminated food/water, sexual
Hep B: bloodborne, sexual, perinatal
Hep C: primarily bloodborne, also sexual and perinatal

101
Q

Hep B prevalence in US;

A

steadily declined since HBV vaccination became available!

102
Q

Hep B vaccine

A

3 IM injections; 2nd and 3rd doses are given 1 and 6 months after first

103
Q

Hep C prevalence in US;

A

In 1980s, HCV spread rapidly, and 3.5 million people in US were chronically infected. # is decreasing d/t treatment and mortality.

104
Q

Who is at greatest risk for Hep C?

A

past or current IV Drug User with Hep C prevalence rate of 50%

105
Q

What level of prevention is blood product screening?

A

Primary

106
Q

What level of prevention is patient-delivered partner therapy?

A

Providing patient with extra meds to give to partner and prevent reinfection; secondary prevention

107
Q

What is the incubation period for TB?

A

4-12 wks

Many infected people turn latent and can reactive later

108
Q

TST/PPD - Mantoux test

A

Intradermal injection
Read induration after 48-72 hours

POSITIVE: >5 immunosuppressed
>10 for DM, IV users, foreign-born, kids, HCW
> 15 for everyone over 4 yo

109
Q

What are the three other tests for TB?

A

Chest xray, Sputum smear, quantiferon blood test

110
Q

Best way to prevent STDs

A

Abstinence
Safe sexual behaviour
Masturbation, dry kissing, touching, fantasy, vag/oral sex w condom

111
Q

Nurses attitudes re: sexual behaviour

A

should be comfortable discussing topics of sexual behaviour to properly assess pts; remain supportive and open

112
Q

primary prevention for STDs

A

getting client to change bx and reduce risk
education early in life
vaccination for HPV, Hep A, Hep B

113
Q

secondary prevention for STDs

A

annual screening for HIV
contact tracing
teaching and counselling - how to avoid self-reinfeciton, managing symptoms and preventing infection of others

114
Q

teritary prevention for STDs

A

management of symptoms for chronic STDs
support groups
DOT
referrals to long-term care
infection control
standard precautions at home

115
Q

mnmemonic for non IM vaccines

A

ORSMYV
Our Rude Sister Made You Vomit
Oral: Rotavirus
SQ: Measles, Yellow fever, Varicella

community health nursing (4 decks)

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