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Public Health > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Economics

A

concerned with the production, distribution, and consumption of goods and health services

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2
Q

Health economics

A

Concerned with how scarce resources affect the healthcare industry

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3
Q

Public health economics

A

Focuses on the production, distribution, and consumption of goods and services as related to public health
Greatest good for the greatest number

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4
Q

Public health finance

A

A growing science and process that looks at acquisition, management, and use of money to improve the health of populations
Doing this through disease prevention and health promotion strategies
Evaluates the use of money and impact on public health system
Goal is to be able to provide population-focused preventative health services

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5
Q

General economics of healthcare systems

A

Public funded are paid by taxes, private funded are paid individually (like collective funds or insurance companies)
US uses all four

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6
Q

Beveridge model

A

Healthcare is paid for almost entirely with taxation and delivered through the government.
Healthcare facilities are government-owned, and the government employs healthcare providers.
Deduct from taxes to help fund the healthcare system and the government has control
In addition to the U.K., other countries that follow the Beveridge model include New Zealand, Finland, and Spain.

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7
Q

Bismarck Model

A

Financing and delivery of healthcare are privately funded.
In Germany, employees and employers pay premiums to insurance companies, termed “sickness funds,” through mandatory payroll deductions. Those sickness funds then reimburse the facilities that deliver care.
Government owned agencies and healthcare facilities, we get taxed, and we get deductions from payroll
In the US, we use insurance companies.
Other countries that use this model include Japan, France, the Czech Republic, and South Korea.

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8
Q

National health insurance model

A

Mixture between the Beveridge and the Bismarck model.
In this system, the government funds healthcare services, which are paid for through taxation, like the Beveridge model.
However, healthcare service delivery is provided mainly through private organizations, like the Bismarck model.
Perhaps the most notable country using this model is Canada (National health insurance)
Trying to get as much access and insurance as possible and we need a national health insurance model for this
Long wait lines but that’s what we do anyways!!
Socialized medicine

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9
Q

Uninsured model

A

provides healthcare services to people who can pay for those services out of pocket.
Residents and citizens who can afford to pay receive healthcare, while those who cannot afford care do not receive it.
An exception includes nonprofit institutions that might provide charitable care to the uninsured, or the government might provide vaccines free of charge.
Comprehensive care, however, goes primarily to those who can afford to pay.
This system is found in many low-income countries that lack the resources to fund a robust healthcare system.
Seen in the US
People who can pay get good service, those who can’t pay not as much

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10
Q

Private or personal care

A

Funded through insurance companies, employers, managed care organizations, and individuals paying for care
Primary care system
Those who have insurance get superior care

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11
Q

Public care

A

Includes broad public health system
Financed through public support
Depend on public funds
Large segment of under/uninsured
The working poor: People who make too much for government assistance and their job doesn’t give them health insurance (hope you don’t get sick)

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12
Q

Financing healthcare

A

The US Healthcare system is influenced by federal and private organizations as well as global health organizations.

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13
Q

How is US healthcare funded

A

Public support
Private support
Public health

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14
Q

Federal agencies

A

Veterans Health Administration
US Department of Health & Human Services
It falls under the Secretary of Health and is funded through federal taxes
Have hold on every initiative related to healthcare

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15
Q

11 examples of federal agencies

A

*Centers for Medicare and Medicaid Services (CMS)
*Centers for Disease Control (CDC)
Food and Drug Administration (FDA)
Indian Health Services
National Institutes of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Administration for Children & Families (ACF)
Administration for Community Living (ACL)
Agency for Toxic Substances & Disease Registry (ATSDR)
Health Resources and Service Administration (HRSA)
Substance Abuse & Mental Health Services Administration (SAMHSA)

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16
Q

State agencies

A

Receives funds from the state level to implement community-level programs at the state level
Focused on the health of its citizens
Offers various services and programs
Identify problems and intervene to meet citizens’ health needs
Funded through local taxes with support from federal and state funds

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17
Q

Local agencies

A

Same as state responsibilities but local
Includes local health departments—nassau county dept of aging (commissioner) oversees all senior centers in nassau that fall under local health dept
Receives funds from the state level to implement community-level programs
Their focus is on the health of its citizens
Offers various services and programs
Identify problems and intervene to meet citizens’ health needs
Funded through local taxes with support from federal and state funds
Health departments

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18
Q

International Health

A

World Health Organization (WHO)
Provides daily information regarding the occurrence of internationally important diseases
Establish worldwide standards for antibiotics and vaccines
Focuses on healthcare workforce and education, environment, sanitation, infectious diseases, maternal and child health, and primary care

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19
Q

Public support in financing US healthcare

A

Support funded by the US Federal Government
Dates to 1978 - Marine Hospital Service – considered the “1st national health insurance plan in the US.”
Providing care for sailors at sea ports and protecting borders from internationally infectious disease from coming in
Established what was considered US healthcare plan

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20
Q

What does public support in finance include

A

Public Health Service (PHS)
Department of Defense
Veterans Administration
Medicare & Medicaid
Managed Care

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21
Q

Medicare

A

Federally funded
Covers people 65+ who get social security, people with disabilities receiving services for two years, end-stage renal disease/kidney transplant, maintenance dialysis, ALS
Forms are confusing, help them!

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22
Q

Medicare part A

A

original, emergency care, inpatient services, hospital stays, skilled nursing facilities limited, some home care, hospice, NOT vision and hearing which are common problems in this population

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23
Q

Medicare part B

A

original, doctors services, durable medical equipment, outpatient services, mental health services, preventative services, x rays, lab tests, limited home health and ambulance transportation services, NOT vision and hearing which are common problems in this population

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24
Q

Medicare part C

A

Combination of A and B but provided through private health insurance companies that give advantages of both A and B, more expensive, Medicare Advantage, vision, dental, and hearing

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25
Q

Medicare part D

A

prescription drug plan/coverage, provided only through private insurance companies that have contracts with the government and provide different coverages for different drugs, limitations with A and B if you don’t have this

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26
Q

Medicaid

A

Federally and State Funded (Federal gov says some things are mandatory and state decides the rest)
Income is not just how much you make, it’s also how many people in the household you pay for, income for that amount of people. Not just what they cover, also who meets the criteria.
Covers low socioeconomic status, children, eligibility based on household size and income, priority are children, pregnant women, and disabled
They can also determine income criteria

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27
Q

Advantages of medicaid

A

Inpatient and outpatient, lab stuff, x ray and radiology, home health care, vaccines for children, family planning and pregnancy related care
Copay costs are lower and affordable
Reaches vulnerable populations including low income, elderly, and disabled
Financial protection because many expenses are covered by program
Recipients are entitled to receive care through privately managed care organizations

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28
Q

Disadvantages of medicaid

A

Not all low-income individuals qualify
Each state has its own guidelines for eligibility
Sometimes people receive lower quality care when they have medicaid simply because they can’t always undergo and receive services
Some people face discrimination in terms of sdoh
Not all physicians actually accept medicaid. Tendency to drop medicaid patients due to reimbursements and costs
Doesn’t always pay for certain medical interventions. Usually denied after treatment conducted

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29
Q

Diagnosis related groups (DRGs)

A

patient classification scheme that defines 468 illness categories and the corresponding healthcare services that are reimbursable under Medicare
Directly linked to medicare reimbursement
Classification system, contains 468 illness categories, each with a list of services and treatments that can be done that are reimbursable

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30
Q

Prospective payment system

A

diagnostic-related group payment mechanism for reimbursing hospitals for inpatient health care services through Medicare
How they get paid when they utilize a DRG
Utilize illness category, follow services reimbursable, medicare reimburses through PPS

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31
Q

TRICARE

A

Department of Defense’s health care program for members of the uniformed services

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32
Q

Veterans administration

A

finances health services for active and retired military persons and dependents

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33
Q

Indian health service

A

promotes tribal health for American Indians and Alaskan Natives

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34
Q

Third party payers

A

occur when reimbursement is made to health care providers by an agency other than the client for the care of the client.
Insurance companies, government agencies, managed care organizations, employers
Client is not reimbursing HCP, outside person is

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35
Q

Managed care

A

a type of health insurance designed to control costs by influencing the ways, type, and amount of care clients receive.
Payment by individual
HMOs and PPOs

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36
Q

Medical savings plans

A

tax-exempt accounts available to individuals, enabling individuals to save money for future medical needs and expenses

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37
Q

HMO

A

lower copays, only paying for care that occurs in the network, MUST choose and list on your account a PCP, can’t go to a specialist without referrals from primary care because they’re responsible for coordination of care. Lower monthly payments and smaller copayments each visit. Not a lot of doctors take this, many services denied. Costs employers less so it is offered to employees at lower cost

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38
Q

PPO

A

allows people to choose 2 different ways of care (in network, lower cost and everything covered or out of network, see any doctor, pay more, and not everything is covered)

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39
Q

Financing in private support

A

Funded privately when paying for healthcare services or goods
Insurance
Employers
Managed care (HMOs and PPOs)
Individuals

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40
Q

Financing in public health

A

Seeks to ensure that the health of the community is protected, promoted, and ensured
Overlaps with the primary care system
It is mandated through laws that are developed and organized at the national, state, or local level.

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41
Q

What does public health financing consist of

A

Health insurance
Employee benefits
Managed Care (HMO and PPO)
Medical savings accounts
WIC programs (women and children, medical savings plan)
Health Departments
Public Health Related Organizations
Centers for Disease Control and Prevention (CDC)
World Health Organization (WHO)

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42
Q

CDC

A

Research to enhance disease prevention
Detect and investigate infectious disease problems
Develop and advocate public health policies
Assists in healthcare economics
Look at the economic costs of chronic diseases and health problems and how preventing or managing symptoms can reduce costs.

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43
Q

WHO

A

Provides daily information on disease occurrences
Establishes international standards for antibiotics and vaccines
Assists in healthcare economics
Regarding economics, the World Health Organization’s Economic Evaluation and Analysis (EEA) team assists countries in collecting, evaluating, and introducing economic evidence into health policy

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44
Q

Goals of WHO

A

Increase life expectancy and quality of life
Improve equity in health between and within countries
Access for all to sustainable health services and systems

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45
Q

How are all sectors involved in managed care

A

Managed care can fall under both public and private support and is also related to public health
Public support–Managed care is a key part of Medicaid. It assists millions in gaining access to healthcare
Private support–Managed care plans are a type of health insurance program
Public Health–share an interest in ensuring the health of a defined population. Managed care and public health organizations do this

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46
Q

Primary care

A

Care provided by a healthcare professional
Care is provided on an individual level
Refers to personal health care that provides first contact and continuous, comprehensive, and coordinated care
Managed care (HMOs and PPOs)
-Medicare and Medicaid
-Private insurance

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47
Q

Primary healthcare

A

Care is made universally accessible to individuals and families in a community.
Emphasis is on prevention
Care is provided at the community level
Includes a comprehensive range of services
Encourages self-care and self-management in health and the social welfare of daily life
Declaration of Alma Alta (1978)
Healthy People 2030–want to improve health by focusing on health equity and eliminating disparities

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48
Q

Context of the US healthcare system

A

The U.S. healthcare system is a diverse collection of industries that directly or indirectly provide healthcare services.
Current system is in crisis
No longer affordable and many are left under or uninsured
Full time employees may not have health insurance
Part time is NOT offered but if it is, it’s expensive
Working long hours may cause medical errors, leading to increased cost in healthcare organizations and increased cost of coverage
Can lead to increased cost to hospitals and healthcare organizations and cost of coverage

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49
Q

Demographics in healthcare economics

A

Approximately 12% of the U.S. population was born in a different country.
Hispanics are the largest minority group population.
Mortality for both genders in all age groups declined.
Citizens are appreciating the quality of life enjoyed in the United States.
Massive and unexpected social and economic changes have occurred.
The aging population is expected to have the most significant influence on national healthcare spending.
The government inadvertently encourages low-income persons to use emergency departments as their primary care providers because, legally, EDs must see clients even if clients can’t pay (but where do they follow-up/get meds filled if they don’t see a PCP?)

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50
Q

Forces stimulating change in the US healthcare system

A

Demographic Trends
Social and Economic Trends
Health Workforce Trends
Technological Trends

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51
Q

Demographic trends

A

Population growth of the world
Aging Baby Boomer generation
Change in largest minority group
The U.S. household composition is changing
Declining mortality for both genders in all age groups

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52
Q

Social/economic trends

A

Changing lifestyles
Growing appreciation of the quality of life
Family and living patterns changing
Changing household incomes (slowly going up, don’t meet rapidly increasing living expenses)
Revised definition of quality healthcare
Any economic downturn experienced by the country
Affordable Care Act (will we improve it or take it away?)

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53
Q

Health workforce trends

A

Not enough primary care providers (advanced practice nursing (APN) specialties, rural areas have this problem more)
Move to contain costs and move to community-based care (services out of hospital since hospital is expensive!)
Current nursing shortage (covid made old nurses retire and new nurses quit)
Need to increase the number of minority nurses to help decrease health disparities

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54
Q

Positive technology trends

A

More accessible and efficient, less medication errors
Less costly because more efficient
Telehealth

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55
Q

Negative technology effects

A

Costly! Machines are costly and it takes money to train people to use the machines
Replacing machines even if they’re not outdated because they want the newest, cutting edge technology

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56
Q

Digital divide

A

Some people are great and some really aren’t comfortable with technology

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57
Q

Electronic medical records effects

A

Don’t walk away from open computer!
Doctors from different organizations don’t talk to each other

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58
Q

factors influencing the healthcare system of the future and resource allocation

A

Consumer desires higher quality care for lower cost and ability to choose doctor
Employer wants decent low cost insurance for employees
Health care system needs better balance between consumer desires and employer wants (combination)
Needed policy development and legislation in terms of access and quality

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59
Q

uninsured persons in 2017, 2018, 2023, and 2024

A

1st quarter 2024 - 8.2%.
2023 - 7.7%.
2018 – 8.5%
2017 – 7.9%

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60
Q

Low income and mortality

A

those earning less than $10,000 per year have a mortality rate three times higher than those with incomes of more than $30,000
LINK BETWEEN POOR HEALTH AND SOCIOECONOMIC STATUS
Access to healthcare (we want to improve it)
Healthcare rationing (short on supplies, see who really needs them, less supplies for everyone)

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61
Q

factors affecting health

A
  1. Personal behavior or lifestyle
  2. Environmental factors (including physical, social, and economic environments)
  3. Human biology
  4. Medical services
    Medical services have the least effect and the rest have the greatest effect
    Even though there’s a big impact of behavior and environment on health, estimates show that most healthcare dollars are spend on secondary and tertiary care (medical services)
    We know what it takes to be healthy but our focus of how we treat them/prevent problems are skewed
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62
Q

Trends affecting healthcare spending

A

Population- people living longer
Immigration–affects how we spend healthcare dollars
Change in nuclear family
Technology–costs
Chronic illness
Consumer desire for lower cost and higher quality–how do we get that without increasing cost
Limit excessive and insufficient use of goods and services

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63
Q

Challenges for the 21st century

A

Reemergence of infectious diseases
More extensive foodborne illnesses and outbreaks
Chronic diseases
Acts of terrorism
Electronic medical records
Labor force changes
Affordable Care Act
Nursing education – introduction of DNP

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64
Q

Economics and the future of nursing practice

A

Become aware of nursing service costs
Identify areas for cost savings
Understand how nursing practice affects and is affected by economics
Focus on improving the nation’s health (health for all)
Ensure economic viability within the healthcare marketplace

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65
Q

How have disaster stats changed

A

The number of disasters, both human-made and natural, continues to increase
As does the number of people affected by them (population also increasing)
The cost to recover from a disaster has risen sharply because of the amount of technology and infrastructure that must be restored (most costly part of a disaster)
Nurses are increasingly getting involved in disaster planning, response, and recovery through their local health department or local government and disaster organizations

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66
Q

How does the WHO define a disaster

A

A situation or event, which overwhelms local capacity, necessitating a request to national or international level for external assistance; an unforeseen , unpredictable, and often sudden event that causes great damage, destruction and human suffering

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67
Q

Facts about disasters

A

Range in size
Are expensive
Cause premature deaths, illnesses (communicable infectious disease, and social well-being of the people , those affected directly or disaster workers from recovery efforts)
Destroy the local health care infrastructure and prevent an effective response to the emergency (people went to bathroom in bags and bags were on the street, hospitals were not safe)
Create environmental imbalances, thereby increasing the risk of communicable diseases and environmental hazards
Cause shortages of food and water
Displace populations of people

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68
Q

Why are earthquakes bad

A

kill quickly and lead to many injuries with other long-term effects

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69
Q

Why are volcanoes bad

A

deaths due to mud and ash inhalation

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70
Q

Why are tsunamis bad

A

immediate drowning, few injuries because people just die

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71
Q

Why are floods bad

A

increase in diarrheal disease, respiratory infections (mold), and skin diseases

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72
Q

U.S. Department of Homeland Security

A

through FEMA, directly responsible for emergency response, management, and recovery

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73
Q

National Preparedness Guidelines

A

prepare for threats and hazards that pose the greatest risk to the US

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74
Q

National Response Framework (formally National Response Plan)

A

a national plan to respond to emergencies such as natural disasters or terrorist attacks

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75
Q

National Incident Management System

A

framework or set of guidelines to improve coordination among responders (more communication=better response)

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76
Q

Public Health and Medical Preparedness and the National Health Security Strategy

A

provide a vision for strengthening prevention, detection, assessment, preparation, mitigation, response, and recovery
All levels of disaster management from before to after the disaster (recovery period)

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77
Q

Healthy people 2030 and disasters

A

focuses on making sure individuals, communities, and organizations are prepared for disasters, disease outbreaks, and medical emergencies.

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78
Q

American Red Cross in disasters

A

Implement shelters and work in every stage. Working after a disaster to help people get on their feet. They work at individual and community level

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79
Q

Pan american health organization

A

Stress Management in Disaster program (disaster response workers)

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80
Q

disaster management cycle

A

Prevention/Mitigation (way before the disaster)
Preparedness
Response
Recovery

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81
Q

prevention/mitigation

A

actions towards reducing the severity, seriousness, or painfulness of disasters
Prevent identified risks from causing a disaster
Achieved through risk analysis for a community/population and then helping to offset or mitigate problems

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82
Q

Examples of prevention/mitigation

A

surveillance/monitoring for potential disasters/monitoring disasters as they’re approaching
inspections and security
immunizations, isolation, and quarantine (spread of disease during disasters, know who is immunized and what they have)
strengthening levees/barriers
Teaching methods of prevention

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83
Q

Preparedness

A

Advanced preparation to cope with a disaster.
The first component of the disaster management cycle
Although disasters do not occur with frequency, planning with vulnerability assessment can reduce the impact on the community

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84
Q

How do we assess vulnerability of a community during preparedness stage

A

Identification of hazards - Identify all existing or potential dangers before a disaster occurs
Analysis of vulnerability – predict the most affected & identify resources for a community for disaster response
Assessment of Risk – uses data from hazard identification + vulnerability assessment to determine probability of adverse health effects to a specific disaster. Makes us better prepared

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85
Q

Personal preparedness

A

Checklist (plan for you an family)
Emergency supplies kit
CASH (singles)
Snacks, nonperishable food, chargers
IDs
1 gallon of water per person per day for 3 days
ICE (in case of emergency on phones)
highway emergency local patrol (HELP) roadside assistance

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86
Q

Professional preparedness

A

Know disaster plans
Disaster medical assistance teams (DMAT)-response teams deployed in emergencies/disasters to provide medical assistance to those in need (Field hospitals, can be deployed whenever)
Professional Preparedness Checklist (copy of license nearby, especially if volunteering. Specialized training certificates)

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87
Q

Community preparedness

A

Nurses should be familiar with written disaster plans if they exist for a community (if not then create a realistic and easy one)
be familiar with the disaster history of the community where they work
Having realistic, easy-to-follow plans, enacting community-wide drills, and having an adequate warning system
Disaster and Mass Causality Exercises

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88
Q

iRescU

A

Pinpoints nearest AED

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89
Q

I’m OK

A

Family Locator – location app. It allows you to track the location and send SOS messages

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90
Q

I’m okay

A

allows users to have automatically scheduled texts sent to their phone to check in on them. If they don’t respond, the app alerts a list of cell phones, emails, and Facebook contacts

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91
Q

FEMA

A

advises how to prepare before and what to do after a major catastrophe

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92
Q

Response

A

THINK TRIAGE!!! In terms of mass casualty events
Levels of Disaster and Agency Involvement
Levels determined by number of casualties

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93
Q

3 ways to classify a disaster

A

type: the agent that produced the event
level: anticipated or actual Red Cross disaster response and relief cost
scope: The basic characteristics of the event’s magnitude and the number of Red Cross units affected and responding (family, local, state, major, presidentially declared)

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94
Q

National Incident Management System

A

Structures and flexible framework guiding the response to disasters
Done at all levels of governments, private companies, and nongovernmental organizations

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95
Q

Incident command system

A

Common organizational structure implemented to improve emergency response
Common in hospitals
Different levels of response based on different events

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96
Q

Point of Distribution or Point of Dispensation (POD)

A

Units deployed after disaster occurs to an accessible, central location where the community can obtain specifically determined emergency supplies.
Examples of supplies include food, water, blankets, vaccines, and/or prophylactic medications following a disaster
The type of disaster drives the type of supplies dispensed

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97
Q

Shelter management

A

Local Red Cross Chapter
Can be set up before or after disaster

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98
Q

What do shelter nurses do

A

assessments and referrals (intake and registration when someone comes)
healthcare needs like glasses, meds, first aid, and diet adjustments
Need to know what resources are available in the community and communities outside of the affected area so they can determine what is available, what they can give, pharmacies, what hospitals are open and taking patients
client records
emergency communications
safe environment (physical and from violence)

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99
Q

Stress reactions in the community

A

Heroic (right after impact. Want to help with recovery)
Honeymoon (everyone loves each other and bands together)
Disillusionment (trigger events, people aren’t as helpful)
Reconstruction (new beginning)

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100
Q

Recovery

A

returning to the new normal with the goal of reaching a level of organization that is as near the level prior to the disaster as is possible (will not always return to old normal)
Hardest and most expensive step
occurs as all involved agencies pull together to restore the economic and civic life of the community and its members

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101
Q

role of nurse during preparedness stage

A

initiate or update disaster plan and educate on importance
educational programs regarding disasters (know what disasters you’re prone to based on where you are)
disaster drills (plans)
Updated record of vulnerable populations
Review individual strategies

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102
Q

role of nurse during response stage

A

The role of the nurse in disaster response depends on the nurse’s experience, professional role in a community disaster plan, specialty training, and special interest (MCR is less abrupt of a leave)**
Advocate for members and get response efforts to them quicker
assessment
know what resources are available
First responder (case finding and referring, prevention, health education, surveillance, triage)

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103
Q

Role of the nurse during recovery stage

A

proper hygiene and immunization
referrals to mental health professionals (workers!)
Be alert for environmental hazards
Watch affected animals (can show presence of disease)
case finding and referral

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104
Q

role of nurses in disaster management

A

Public health nurses as first responders
Just in time training
Field triage
Point of distribution plans in responding to disasters
PPE—always have gloves!
Documentation in a disaster (very different, more autonomous and doesn’t need to be done right away)
Skill building for disaster response

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105
Q

evaluation in disaster

A

Foundation for evidence-based disaster response
Following a thorough review of the responses, a final report is prepared with recommendations for improving emergency response in the future

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106
Q

adverse health effects after a disaster

A

Continuing death, chronic illness, and/or disability
Population shift if recovery is prolonged
Contamination of food and water supplies, with an increased risk of infectious diseases
Collapse of local and regional health care access
Increased need to provide mental health services— “psychological first aid” for disaster victims and responders

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107
Q

Passive surveillance system

A

Case reports of symptomatology are sent to local health departments by healthcare providers (nurses usually in ER who see pts with same symptoms and share same characteristics. Exposure to biological, chemical or radiological agents)
Laboratory reports of disease occurrence are sent to local health departments by hcps that find them through patient clientele

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108
Q

Active surveillance system

A

The nurse, as an employee of the health dept, may begin a search for cases through contacts with local healthcare providers and healthcare agencies
Employee of health dept (RN) looks for cases of disease or is sent case report and now want to reach out to others to check for uptick of same symptoms

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109
Q

when is bioterrorism used

A

utilized by countries during war time when they’re studying it for treatments and vaccines because there’s threats of exposure OR they’re studying it to use as a biological weapon

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110
Q

facts about bioterrorism agents

A

Can be easily disseminated or transmitted from person to person
high mortality and illness rates
Have the potential for a significant public health impact
It might cause public panic and require unique action for public health preparedness
Results of a biological attack (symptoms) to be made known several hours or days after the attack

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111
Q

aerosol route of bioterrorism

A

Easiest to disperse
Highest number of people exposed
Most infectious and contagious, causing most dangerous diseases
Undetectable to humans
Most common and most likely
Odorless, colorless

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112
Q

food/waterborne route of bioterrorism

A

less likely
Larger volumes required
More technically difficult
Psychological impact bigger than clinical effects because of filtration and how much is needed to actually infect people

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113
Q

Weapons of bioterrorism

A

Anthrax
Botulism
Smallpox virus
Plague
Tularemia

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114
Q

anthrax

A

Acute disease caused by spore forming bacterium B anthracis
An organism that perpetuates itself by forming spores (very fast rate)
Spread from handling products from infected animals or eating undercooked meat from infected animals
Most people who get sick do so by coming in contact with infected animals or animal products like wool, hide, and hair

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115
Q

four types of anthrax

A

Cutaneous—workers handle contaminated animal products and have broken skin
GI—eating raw or undercooked meat of infected animal
Respiratory/inhalation—from breathing in spores, seen in 9/11 when anthrax was white powder in envelopes
Intravenous—not as common

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116
Q

Prevention of anthrax

A

60-day treatment with antibiotics approved for adults and children (ciprofloxacin, doxycycline, and levofloxacin)
A three dose series of anthrax vaccine
In some cases, treatment with monoclonal antibodies — raxibacumab and obiltoxaximab

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117
Q

treatment for anthrax

A

IV antibiotics, antitoxin
The vaccine isn’t intended for the general public. Instead, it’s reserved for military personnel, scientists working with anthrax, and people in other high-risk professions

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118
Q

cutaneous anthrax

A

Most common form; least dangerous
Usually 1-7 days after exposure
A group of small blisters or bumps that may itch
A painless sore (ulcer) with a black center (looks necrotic) that appears after the small blisters or bumps
Swelling can occur around the sore
Most often the sore will be on the face, neck, arms, or hand

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119
Q

GI anthrax

A

Rarely reported in the US due to FDA investigating food preparation and sources
Usually 1-7 days after exposure
Fever and chills
Swelling of the neck or neck glands
Sore throat
Painful swallowing
Hoarseness
N/V, especially bloody vomiting
Diarrhea or bloody diarrhea
Headache
Flushing (red face) and red eyes
Stomach pain
Fainting
Swelling of abdomen (stomach)

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120
Q

Inhalation anthrax

A

Considered the deadliest form of anthrax
Infection usually develops within a week or two of exposure, but can take up to 2 months
Headache
Fever
Aches
Respiratory symptoms
Drenching sweats

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121
Q

Injection anthrax

A

Never reported in the US
Identified in heroin-injecting drug users in Northern Europe
Spreads through the body faster and may be harder to recognize and treat
Fever and chills
A group of small blisters or bumps that may itch, appearing where the drug was injected (are these symptoms from infection or from anthrax?)
A painless skin sore with a black center that appears after the blisters or bumps
Swelling around the sore
Abscesses deep under the skin or in the muscle where the drug was injected

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122
Q

botulism

A

Serious illness caused by the C. Botulinum toxin that causes paralysis
Very small amount needed, making it optimal for biological attack
A biological attack that releases the toxin into the food supply or air might make many people sick very quickly
Rapid appearance of symptoms (~6h)
Paralysis in face and towards limbs
Resp failure and death possibly

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123
Q

S/S, prevention, and treatment of botulism

A

Blurred or double vision, slurred speech, dry mouth, dysphagia, drooping eyelids, resp and muscle weakness
No prevention
Treatment is airway management and antitoxin when appropriate

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124
Q

Tularemia

A

A rare, infectious disease that affects mammals by attacking the skin, eyes, lymph nodes, and lungs
Developed into aerosol biological weapon
SUPERRR infective
Aerosol Dissemination=abrupt onset in large number of cases of acute nonspecific febrile illness beginning 3-5 days after exposure
Incubation range 1-14 days
Also called rabbit fever or deer fly fever

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125
Q

How is tularemia transmitted?

A

insect bites and direct exposure to an affected animal

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126
Q

manifestations, prevention, and treatment of tularemia

A

Manifestations- fever, headache, aches, dry cough, diarrhea
Prevention- FDA reviewing vaccine
Treatment- Streptomycin, gentamicin

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127
Q

Smallpox

A

VERY infectious and devastating
An infectious disease caused by one of 2 variants, variola major and variola minor
Eradicated! Nobody gets vaccinated anymore
High attack rate (how many people affected by contagious person)=3-4 but can be 10-20 secondary cases
droplet, aerosol, or clothing
Remains a bioterrorism threat

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128
Q

S/S, prevention, and treatment of smallpox

A

S/S: fever, aches, rash from face down
Can look like chickenpox at first. People don’t worry because it’s eradicated. No protocol to make sure it’s not smallpox
Prevention- contact and airborne precautions? Vaccine?
Treatment- no cure, supportive care

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129
Q

Plague

A

The plague bacterium (Yersinia pestis) is transmitted by fleas and cycles naturally among wild rodents (common in western states). It can also infect humans and their pets

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130
Q

Transmission of plague

A

Bites of infected fleas
Touching or skinning infected animals (such as prairie dogs, squirrels, rats, and rabbits)
Inhaling droplets from the cough of an infected person or animal (esp. sick cats)

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131
Q

three types of plague

A

bubonic
septicemic
pneumonic

132
Q

Prevention and treatment of plague

A

Prevention- contact and droplet precautions
Treatment- Gentamicin, fluoroquinolones

133
Q

Bubonic plague

A

Most common
Least deadly
Usually occurs after the bite of infected flea; illness occurs 1-6 days after being infected
Key Feature – swollen, painful lymph node, usually in groin, armpit or neck
Other symptoms – fever, chills, headache, and extreme exhaustion
If not treated early, can spread and cause septicemic or pneumonic plague

134
Q

Septicemic plague

A

100% death
Occurs when plague bacteria multiply in bloodstream
Symptoms: high fever, exhaustion, light-headedness, and abdominal pain
Quickly causes shock and organ failure
No treatment

135
Q

Pneumonic plague

A

Occurs when plague bacteria infects lungs
High fever, chills, cough, difficulty breathing, and coughing up bloody mucus
Almost always fatal if not treated rapidly

136
Q

Least to most serious forms of plague

A

Bubonic
Septicemic
Pneumonic

137
Q

Chemical disaster presence

A

Presence is known immediately through observation (explosion), self-admission, or the occurrence of rapidly emerging symptoms (burns, convulsions, SOB).
Chem-agents may be solid, liquid, or gas

138
Q

Health effects of chemical disasters

A

Disorientation
Dizziness
Nausea
Blindness
Serious injury
Immobilization
Death

139
Q

2 steps of mitigation of chemical disaster

A
  1. Minimize exposure: avoid chemical cloud and filter breathing
  2. Get medical assistance (skin decontamination and antidote if applicable and available
140
Q

Nerve agents

A

disrupt the nervous system (convulsions), cause paralysis, and are fatal quickly. Reactions occur minutes after inhalation or hours if through skin
MOST LETHAL AND REQUIRE SMALLEST QUANTITIES

141
Q

Sarin and VX

A

Sarin: used by cult in Tokyo subway bombing, non persistent nerve agent
VX (persistent)
Vary in persistence from hours to weeks

142
Q

Blister agents

A

Can be felt within minutes depending on what was used
Felt as oily droplets that can penetrate clothes.
Eye contact: blindness
Inhalation: respiratory damage/failure
Example - Mustard gas (liquid, common in chemical warfare stockpiles)
2nd smallest quantity needed

143
Q

Choking agents

A

not persistent, lung fills with fluid, causing choking and quick or delayed fatality (up to 3 hours). Irritation can give warning
Example - Chlorine gas (transported in bulk)

144
Q

Blood agents

A

not persistent interfere with oxygen at the cellular level, which can become fatal quickly. Causes headache, nausea, and vertigo. Example - Hydrogen cyanide
3rd smallest quantity needed

145
Q

Riot controlled agents

A

not persistent skin and breathing irritations, rarely fatal. Example – pepper spray/tear gas

146
Q

factors of a chemical disaster

A

The hazardous material involved
The population threatened
The time span involved from chemical release to symptoms or people coming in with them
The current and predicted weather conditions (aerosol + wind is bad)
The ability to communicate emergency information

147
Q

shelter-in

A

used for short-duration incidents when moving would result in a greater hazard or evacuation is impractical
Example is covid. Stay inside small place and cover entrances to outside

148
Q

Evacuation

A

occurs when there is potential for massive explosions, fire, and long–duration events
People need to leave homes and communities

149
Q

Radiological disasters effects

A

Skin reddening
Headaches
Nausea & vomiting
Hair loss
Weakened immune system

150
Q

Health outcome after radiological disaster depends on

A

The amount or dose of radiation absorbed
The type of radiation
The route of exposure
The length of time exposed to the dose

151
Q

radiological attack

A

Explosions and symptoms of high radiation doses indicate a radiological attack.
Explosive release of fine powder or solid material

152
Q

3 rules of protection from radiation

A

Minimize time
Maximize Distance
Maximize Shielding

153
Q

chemical agent detection

A

Some can be seen
Some can be smelled
Some can be tasted
Most can be felt (e.g. burning sensation, choking)
Instruments and paper tests can detect these
In chemical attack, agents r usually vapor, solid aerosol, or liquid drops. Can be inhaled and come into contact with skin or eyes. Many agents have antidotes but some don’t and treatment options are limited

154
Q

Radiation detection

A

Can not be seen
Can not be smelled
Can not be tasted
Can not be felt
Can be rapidly detected by instruments!

155
Q

Clues of epidemiologic attack

A

Won’t know something happened until patients access the medical system
ER or Family Practice Clinic/Office-
Unusual trend in patient population
Pharmacy-
Intuition or “hunch” that something is not right
Increase in abx prescriptions

156
Q

Large epidemics of acutely ill patients or multiple, simultaneous epidemics

A

Unusual or impossible pathogen
The prior or current threat of bioterrorism
Unexplained numbers of dead animals
Increased and severe morbidity and mortality especially in previously healthy population
Increase in severe respiratory illnesses
Look for change or trend in your population baseline!!

157
Q

Levels of prevention in disaster management

A

Primary- Planning, drills, vaccines, develop protocols
Secondary- Early recognition, screenings, monitor mortality and morbidity
Tertiary- Rehabilitation of survivors, monitor meds, evaluate effectiveness of plan

158
Q

Initial response to bioterrorism

A

Early detection through surveillance/rapid assessment of reports
Mobilize laboratory
Rapid confirmation of agent, site, initial at-risk population, prophylaxis and/or treatment
Alert medical community, ERs, labs, tell them to watch for big influx of patients with same symptoms
Implement disease specific plans (e.g. Smallpox)
Determine resource needs and possible quarantine
Coordinate with partner agencies (local/state/national)
Provide immunizations as required

159
Q

Army Surgeon Dominique Jean Larrey

A

Triage system

160
Q

MPI

A

multiple person incident = <25 victims

161
Q

MCI

A

multiple casualty incident = 25-100 victims

162
Q

Disaster (victims)

A

> 100

163
Q

MOI

A

mechanism of injury (cause/how?)

164
Q

MVC

A

Motor vehicle collision

165
Q

START SMART triage

A

START – Simple Triage and Rapid Treatment
SMART – triage tag system used with the START process

166
Q

Why use SMART START and how was it developed

A

It is fast, simple, easy to use, easy to remember, consistent
Developed by the Newport Beach (CA.) Fire and Marine Department to quickly identify and sort patients during a multiple patient incident

167
Q

What to assess with start

A

Initial victim assessment and treatment should take less than 30 seconds for each patient
Assess airway, respiration, pulse, and LOC
SHOULD TAKE LESS THAN 30 SECONDS

168
Q

SMART triage system: green

A

Minor injury (fractures, wounds, or burns)
Walking wounded
direct them to gathering place
Think: “If you can walk, move to green”

169
Q

SMART triage system: yellow

A

Delayed
Most victims in this category
Includes significant MOI but whose RPM is intact
Shock risk (e.g., heart attack, abdominal trauma)
Open fractures
Femur or pelvis fracture
Burns (recommended 5-50% TBSA)
Head trauma but responsive to verbal or painful stimuli
Uncertain diagnoses

170
Q

SMART triage system: red

A

Immediate stabilization required
Patients whose RPM is altered
Shock due to any cause
Breathing difficulty with possible respiratory failure
Profuse external bleeding
Burns (50-90% TBSA)
Head trauma with signs of altered consciousness
Disorientation (cannot obey simple commands)
Unconsciousness (cannot respond to verbal and/or painful stimuli)
Asymmetrical pupils (sign of cerebral hernia)

171
Q

SMART triage system: black

A

deceased/expectant
Respirations = absent -> reposition airway -> still absent
Perfusion = absent
Mental status = unconscious
Injuries too severe to live
Mortally wounded, will probably die
Burns 95% TBSA
Resources are wasted here, hard decision

172
Q

Triage process

A

Clear walking wounded with verbal instructions (speak loud, may be hearing impaired from incident)
Direct them to treatment areas for assessment and treatment
Check RPMs (respirations, pulse, mental status)

173
Q

Mnemonic for RPM

A

R-30
P-+2
M-Can do

174
Q

RPM: respirations

A

Absent? Open the air way
If still none, black tag. If restored, red tag
Above 30: red tag
Below 30: check perfusion

175
Q

RPM: pulse/perfusion

A

Radial pulse absent or cap refill over 2 seconds: red tag
Radial pulse present or cap refill under or equal to 2 seconds: check mental status

176
Q

RPM: mental status

A

Can’t follow simple commands (unconscious or altered MS): red tag
Can follow simple directions: yellow tag

177
Q

3 treatments in triage

A

open airway
stop bleeding
elevate extremities

178
Q

triage priorities

A

find and transport red tag
Reassess yellow ASAP and see if they deteriorate to red tag (serious MOI, age, or history)
Don’t move green tag
FOCUS ON RED TAG! EVERYONE ELSE CAN WAIT

179
Q

ped triage vs adult

A

Apneic child more likely to have a primary respiratory problem than an adult. Perfusion may be maintained for a short time and the child may be salvageable
RR +/- 30 may over or under triage a child depending on age
Cap refill not accurate when it is cold
Obeying commands not appropriate for small children

180
Q

why do kids need a different triage system

A

Pediatric multi-casualty triage may be affected by the emotional state of triage officers.
To optimize triage effectiveness to benefit all victims, not just children
Introducing JUMPSTART

181
Q

JumpSTART triage

A

For ages 1-8, could be less but not really since babies can’t walk
Pediatric physiology (specifically, the airway) approaches that of adults by approximately eight years of age
If the child is over 8, we use jumpstart, if they’re a young adult, use START

182
Q

JumpSTART respirations

A

Not breathing: open airway, if they breath it’s red
If apneic AND no pulse, black tag
Apneic with pulse, 5 rescue breaths. Still apneic, black. Breathing again, red

183
Q

Pulse in JumpSTART

A

No distal pulse: red
Present: mental step

184
Q

Mental status in JumpSTART

A

AVPU
Alert, responds to verbal or pain (yellow)
Inappropriate response, posturing, or unresponsive, red

185
Q

JumpSTART for babies under 1

A

Either yellow or red (JumpSTART to determine)
NO GREEN BABIES

186
Q

JumpSTART for ambulatory minor

A

Get them to green area
Assess non-ambulatory patients
Children carried to green area by walking victims need to be assessed first

187
Q

Secondary triage

A

uses refined physiological scoring systems and anatomical examination.
It is carried out as and when resources become available. This normally is at the casualty clearing station.
Evaluates GCS, respiratory rate, and SBP
Again, can be done within 30 – 60 seconds

188
Q

Epidemiology

A

Factors that influence health and disease
The study of disease, causes, distribution/spread, incidence, prevalence, etc
The study of Health Phenomena (disease, condition, etc)
distribution and determinants of health and diseases, morbidity, injuries, disability, and mortality in populations/aggregates, health phenomena
Study characteristics of those who have disease and compare to those who don’t have the disease
Why does disease affect one group more than another?
Helps determine what’s occurring, cause of illness, possible treatments, cures, preventative efforts
A tool for examining the “signs and symptoms” of the community’s health
Population medicine

189
Q

What kinds of health outcomes are studied by epidemiology

A

Infectious diseases
Chronic diseases (patterns)
Disability, injury, limitation of activity
Mortality (leading causes of death in a population)
Active life expectancy (infant mortality, increasing lifespan)
Mental illness, suicide, drug addiction

190
Q

3 assumptions of epidemiology

A
  1. Disease doesn’t occur at random, and we need to look for root causes and how to prevent it from occurring
  2. Disease has causal and preventive factors
  3. Disease is not randomly distributed throughout a population
191
Q

Purpose of epidemiology

A

Control and prevention

192
Q

How do epidemiologists use information

A

To control health problems
Interdisciplinary team works in collaboration and uses data collected to evaluate local health problems and act to promote health and prevent disease

193
Q

Epidemiology uses data to

A

Monitor Disease Trends & The Health of the population (where diseases occur, who they occur in, symptomatology, how we can prevent it)
Identify the determinants of health and disease in communities
Investigate and evaluate interventions to prevent disease and maintain health

194
Q

Determinants

A

Also referred to as the how and why of health events
Factors or events that can bring about a change in health
Cause and how it occurs
Genes and biology, behaviors, access to and quality of medical services, ecology, social/societal characteristics
Closely related to sdoh
Demonstrate how disease occurs and why some people are more affected than others

195
Q

Distribution in epidemiology

A

Frequency or number of cases of disease occurrence.
These may vary from one population group to another
Disease mapping, where is disease more frequent and where does it occur most

196
Q

John Snow

A

father of epidemiology
Utilized door-to-door investigation and disease mapping to determine the origins and characteristics of the Cholera outbreak in London in 1854

197
Q

Florence Nightingale in epidemiology

A

Focused on Soldiers and the environment & carefully tracked and reported rates of illness
Demonstrated that a safer environment resulted in decreased mortality rate during the mid-1800’s
Pick up careful records of what was done and what were the results
She focused on soldiers and their environment.
Thus, nursing’s roots in epidemiology started with Florence’s efforts during the Crimean War

198
Q

Epidemiologic description

A

indicates variation by age groups, time, geographic location, and other variables

199
Q

Health phenomena

A

Health outcome of interest (looking at cancer, diabetes, etc)
Epidemiology investigates many kinds of health outcomes:
Infectious diseases
Chronic diseases
Disability, injury, limitation of activity
Mortality
Active life expectancy
Mental illness, suicide, drug addiction

200
Q

Epidemiology has contributed to

A

Understanding the factors that contribute to health and disease;
The development of health promotion and disease prevention measures;
The detection and characterization of emerging infectious agents;
The evaluation of health services and policies;
The practice of community and public nursing

201
Q

How do nurses use epidemiology

A

Nurses working in the community look at health and disease causation and ways they prevent and treat illness, we are case finders.
Surveillance and monitoring of disease trends
Nursing documentation is a source of data for epidemiologic reviews
School Nursing–autonomous, reporting and finding diseases
Communicable Disease
Environmental Health
Infection Control
Community Oriented nursing (keep well population well)
Occupational and school nurses
Analyze, interpret, report

202
Q

Epidemic

A

Increase in disease rate in a certain population in a certain timeframe
Communicable or infectious disease
Outbreak

203
Q

Endemic

A

Constant presence of a disease (usually in smaller numbers) in a certain population or area.
HIV, bubonic plague, flu when it’s not flu season, ebola

204
Q

Pandemic

A

Worldwide epidemic, only classified as pandemic when WHO says so
Swine flu was worldwide but never declared a pandemic. COVID is a pandemic
MMWR weekly report, morbidity and mortality, different cases, world health system saying if this is sporadic, epidemic, endemic, or pandemic

205
Q

Sporadic disease

A

No discernable pattern, infrequent with occasional pop-up cases. No population at risk because not many cases at a time

206
Q

Acute vs chronic

A

Acute: usually revolves by itself or with treatment in about 3-4 weeks
Chronic: lifelong, has fluctuations

207
Q

Sources of data in epidemiology

A

Surveillance data put out by CDC
Routinely collected data (census data, vital records)
Data collected for other purposes (medical records, insurance records)
Original data collected for specific epidemiologic studies

208
Q

Comparison groups

A

To decide if the rate of disease is the result of a suspected risk factor, compare the exposed group with a group of comparable unexposed persons
Ex. Black and white ppl with breast cancer

209
Q

Descriptive epidemiology

A

What is occurring, who is affected, where it’s occurring, when is it occurring?
Provides a way of organizing and analyzing these data in order to understand variations in disease frequency geographically and over time, and how disease (or health) varies among people based on a host of personal characteristics (person, place, and time (seasonal).

210
Q

Person in epidemiology

A

characteristics that affect susceptibility to a disease: age, gender, ethnicity

211
Q

Analytic epidemiology

A

How is it occurring, differences and relationships
Why are certain people more affected/at risk than others
Investigate potential causes or relationships between health conditions and other factors or events
Examines the how and why of observed patterns of health and disease
Rates and calculations to describe severity
Research approaches to analytic epidemiology (the 4 studies)

212
Q

The epidemiological triangle

A

Interrelationships between host, agent, and environment

213
Q

Host in epidemiological triangle

A

living species capable of being infected/affected by an agent
Susceptible by age, comorbidities, etc.

214
Q

Agent in epidemiological triangle

A

infectious microorganism capable of bringing about disease
Has to be present for disease to occur but its presence isn’t the only thing to diagnose a disease (other factors like environment and how severe/how many numbers of pathogen involved to create disease)
Just because we have an agent and somebody’s exposed to it, doesn’t mean they’re gonna come down with disease. But to have disease you need an agent

215
Q

Environment in epidemiological triangle

A

characteristics of an environment that precede an infectious disease process leading up to disease (physical like geology/climate that influence risk and disease, also biological environment like insects, rodents, also socioeconomic environment like overcrowding with TB or sanitation or availability of healthcare services and goods

216
Q

Web of causation

A

Also called web of causality
Demonstrates the complex interrelationships of many factors interacting with each other to influence the risk for or distribution of health outcomes
Identifies causal relationships
Associations can be mutual with lines of causation going in both directions
Simple to complex

217
Q

Ecological model of public health

A

New paradigm that goes beyond the two-dimensional causal web and considers multiple levels of factors that affect health and disease
Treats the multiple determinants of health as interrelated and acting synergistically (or antagonistically) with onset of a disease or illness, rather than as discrete factors
Encompasses determinants at many levels
Includes policy enactment, legislation, culture, and economic environments
Includes lifespan perspective (young to old)
Epidemiology looks at the distribution of health states and events (rates, proportions, and risk)

218
Q

Epidemiological measures

A

Think numbers and calculations!!
Counts or ratios
Proportion- Ratio
Rate- Frequency
Risk – probability
Incidence- new cases
Prevalence- all cases
Attack Rate (morbidity)
Mortality Rate (deaths)

219
Q

best indicators of the probability that a specific state of health will occur

A

Rate

220
Q

Ratio

A

Simple to calculate but very important
The value obtained by dividing one quantity by another
Consists of a numerator and a denominator
Rates, proportions, and percentages are also ratios
Compares two amounts to each other
In epidemiology, ratios are often used to determine priority in terms of needs and resource allocation

221
Q

Proportions

A

Primary measurement used to describe the occurrence of a state of health in a specific group
In proportion a subpopulation is divided by the total population
May be expressed as a percentage
Ex. 50 students in dorm and 20 have mono, what % is contagious
Can demonstrate the magnitude of a problem, how serious is the problem

222
Q

Rate

A

Think frequency
Most common statistic used in epidemiology, expresses probability/risk of disease or other events in a defined population over a specified period.
Rates deal with change*
Use rates in gaining attention for problems, to obtain funding if problem is serious, to assess for intervention impact (did interventions help decrease rate)

223
Q

Attack rate

A

exposed & get sick (most prominent)
Specifically linked to people who get exposed to a problem (usually foodborne) and how many people get sick

224
Q

Crude rate

A

All causes of death

225
Q

Case fatality rate

A

% of people who die from a disease, among all with the dx in a specific period of time

226
Q

Adjusted rates

A

used when we want to try to control for differences such as age, or known conditions

227
Q

Fertility rate

A

Live births

228
Q

Infant mortality rate

A

Die at <1 year
The infant mortality rate is commonly referred to as a general indicator of overall health because they’re vulnerable but also don’t have a bunch of comorbidities and stuff
Rate most often used to determine quality of healthcare systems
Least viable healthcare systems have greatest risk of infant mortality
Looking at this, then age of <5 (usually die from various diseases [infectious or diarrheal])
This is a crude rate- because it is not CAUSE-specific (all deaths)

229
Q

Perinatal mortality rate

A

stillbirths and deaths <7 days

230
Q

Neonatal mortality rate

A

<28 days

231
Q

Incidence

A

the number or proportion of individuals developing (new cases) the disease during a specific time
Assesses whether health condition is getting better or worse
Compares frequency of diseases in diff communities when populations are different
Useful when determining if a nursing intervention worked**

232
Q

Prevalence

A

Think ALL
the number of existing cases of a disease or health condition in a population at some designated time.
Prevalence- time can be calendar date, age, life event
Prevalence measures disease status, not disease onset
It is used to present a ‘snapshot’ view of the disease or health condition of interest.
We frequently obtain prevalence data from surveys or surveillance databases.
Prevalence is a proportion (or percentage).
at a given point in time.
This is of particular use when planning health services
Not useful in determining cause/determinants

233
Q

Incidence and prevalence with acute vs chronic

A

Chronic: High Prevalence compared to Incidence (keeps getting added to total number)
Acute: High Incidence compared to prevalence
Due because of recovery or death (no longer part of prevalence, now they’re part of mortality stat)

234
Q

Attack rate

A

A form of incidence that measures the proportion of persons in a population who experience an acute health event during a limited period (i.e., during an outbreak)

235
Q

Attack rate equation

A

The total number of new cases (number of ill people exposed to a specific agent) / the total population (total number of people exposed whether they get diagnosis or not).

236
Q

Risk

A

Probability that an event will occur within a specified period
There are some outcomes for which certain people would never be at risk (i.e., men can’t be at risk of ovarian cancer; women can’t be at risk of testicular cancer)
Men can be at risk for breast cancer though so include them!
A high-risk population would include those persons who, because of exposure, lifestyle, family history, or other factors, are at a greater risk for disease than the population at large

237
Q

What do we do with epidemiologic information

A

Find relationships
Look for differences in diseases and outcomes
Share what is learned with providers and general public (education)

238
Q

Primary prevention in epidemiology

A

Health Promotion and Education
Improving Host, Agent, and Environment conditions
Adequate provision for basic needs
Anticipatory action = Health Protection
Classic epidemiological model

239
Q

Secondary prevention in epidemiology

A

Screening and Monitoring
Detection = Early Diagnosis
Screening programs- regular exams and screening tests to detect disease in its earliest stages (e.g. mammograms to detect breast cancer)
Prompt treatment, arrest progression
daily aspirin, modified work so ill workers can return

240
Q

Tertiary prevention in epidemiology

A

Functional Adaptation & Rehabilitation
Reducing degree of disability/damage from crisis
Reducing risk of future crisis
Cardiac or stroke rehabilitation programs, chronic disease management programs (e.g. for diabetes, arthritis, depression, etc.)
Support groups that allow members to share strategies for living well
Vocational rehabilitation programs to retrain workers for new jobs when they have recovered as much as possible

241
Q

Florence Nightingale in environmental health

A

“Mother of Biostatistics”

242
Q

Lilian Wald in environmental health

A

worked to improve the environment of the Henry Street Settlement neighborhood

243
Q

When did environmental health become a discussion

A

Quality of the environment became a popular topic in the mid- to late 20th century.
Environmental Health is one of priority areas of Healthy People 2010/2020//2030

244
Q

Why should nurses know about environmental health?

A

Environmental factors have an impact on health (examples)
Nurses are good about teaching about health (supports work in protecting individuals, families, and communities from environmental hazards)
Nurses are largest professional group in healthcare (we can be powerful together in improving environment)

245
Q

Toxicology

A

The basic science that studies the health effects associated with chemical exposures

246
Q

Epidemiology

A

the science that helps us understand the strength of the association between exposure and health effects in human populations

247
Q

Biomonitoring

A

the process of using medical tests such as blood or urine collection to determine if a person has been exposed to a contaminant and how much exposure he or she has received

248
Q

Bioavailability

A

the amount of a contaminant that ends up in the systemic circulation

249
Q

Environmental health

A

the branch of public health science that focuses on how the environment influences human health

250
Q

Exposure

A

occurs when there is contact between people and an environmental contaminant

251
Q

Environmental justice

A

The belief that no group of people should bear a disproportionate burden of the negative effects of pollution regardless of race, culture, or income

252
Q

How is environment and its effect on human health often considered

A

How do environmental contaminants, such as asbestos, lead, or radon, influence human health?
How does the entire environment surrounding the community, such as neighborhood safety, climate, access to grocery stores, and community design, affect health?

253
Q

Questions about environmental health

A

How do specific contaminants affect human health?
How do we assess exposure to contaminants?
How does the environment influence health?
How do we live as a population while maintaining a healthy environment?

254
Q

Environmental health assessments

A

Assess home, school, workplace, and community
Key questions should cover past as well as present conditions
Determine whether an exposure is in the air, water, soil, or food

255
Q

Methods of environmental health assessments

A

Windshield survey
Environmental databases
Environmental assessment forms
Exposure Pathways - A method by which people are exposed to an environmental containment that originated from a specific source

256
Q

Exposure assessments

A

Exposure pathway and history

257
Q

Exposure pathway

A

method by which people are exposed to an environmental contaminant that originates from a specific source (skin, oral, inhalation)

258
Q

Exposure history

A

the process to help determine whether an individual has been exposed to environmental contaminants (amount of exposure [dose]); duration of exposure; to whom (animals, humans, environment)

259
Q

What should exposure history aim to do

A

Identify current or past exposures.
Eliminate exposures
Try to mitigate or reduce a client’s adverse health effects from exposures.
“I PREPARE” Mnemonic
Precautionary principle - Maintains that if something has the potential to cause harm to the environment or humans, then precautionary measures should be taken if there is a lack of scientific evidence concerning cause and effect

260
Q

Assessing for and constructing an exposure pathway

A

Source of contamination
Environmental media and transport
Point of Exposure
Route of exposure
Receptor population
Knowing if there is a completed exposure pathway
Interrupting the exposure pathway before it is complete is key

261
Q

Determining the Health Impact of a Completed Exposure Pathway

A

An exposure estimate determines a person’s level of exposure to a contaminant.
How much exposure to a chemical or agent will cause what effect?
Dose-Response

262
Q

iPrepare mnemonic

A

Investigate potential exposure
Present work
Residence (homes before 1978=lead risk)
Environmental concerns
Past work
Activities
Referrals and resources
Educate

263
Q

Evaluation exposure/exposure risk questions to consider

A

Has the exposure pathway been interrupted?
What does the community think about the intervention— are people satisfied?
How has people’s health improved?
How many people did the intervention affect?
Can the intervention demonstrate any cost savings?
Is the evaluation sustainable?

264
Q

Major Challenges to Environmental Epidemiology

A

Limited availability of data on many contaminants and their effect on health
Limited understanding about how exposures to multiple contaminants may sicken people
Latency between exposure and illness can be very long
Time consuming to perform
Resource intensive in terms of personnel and money
Inconclusive in determining if X contaminant caused Y illness

265
Q

Where can environmental hazards be found

A

Air
Water
Land
Food

266
Q

Biological agents

A

bacteria, protozoa, viruses, fungi. Algae, dust mites, pollen, molds

267
Q

Chemical contaminants

A

Organic and inorganic

268
Q

Organic chemical contaminants

A

fluorine, chlorine, bromine, iodine, nitrogen, sulfur, phosphorus, Polychlorinated Biphenyls (PCBs), DDT, dioxins, benzene, malathion, toluene

269
Q

Inorganic chemical contaminants

A

ozone, nitrogen oxides, sulfur dioxide, lead, mercury, cadmium, arsenic, etc.

270
Q

Radiation

A

microwaves, UV rays, noise

271
Q

Particulate matter

A

dust, smoke, asbestos, ETS (Environmental tobacco smoke)

272
Q

Air as an environmental hazard

A

Significant contributor to health problems
Point source and nonpoint source

273
Q

Major culprits contributing to poor indoor air quality

A

Carbon monoxide
Dusts
Molds
Dust mites
Cockroaches
Pests and pets
Cleaning and personal care products (particularly aerosols)
Lead
Environmental Tobacco Smoke (ETS)

274
Q

Examples of water hazards and why it’s so bad

A

Water is necessary for all life forms
People’s lives are tied to a safe and adequate water supply
Water-borne diseases such has giardia, cryptosporidium, cholera, dysentery, Hepatitis A
Wastewater and sewage
Agricultural and storm runoff
Oil pollution and radioactive substances
Lead

275
Q

Land in environmental hazards

A

Local governments determine land use through their zoning laws
“Urban sprawl and the built community” - uncontrolled development around the edges of a city, can have many negative effects on the built community,

276
Q

Sources of land environmental hazards

A

Manufacturing, mineral extraction, abandonment of mines, national defense activities, waste disposal, accidental spills, illegal dumping, leaking underground storage tanks, hurricanes, floods, pesticide use, and fertilizer application

277
Q

Examples of land environmental hazard

A

Lead in the soil
Pesticide poisoning
Community configuration and obesity

278
Q

Food environmental hazard

A

Usually E.coli or salmonella (bacteria)
Food-borne illness is defined as 2 or more cases of similar illness resulting from ingestion of a common food
Prevented by health department inspections of restaurants and supermarkets

279
Q

Early 1900s with food

A

Contaminated food, milk, and water caused many foodborne illnesses

280
Q

Sanitary revolution

A

Sewage and water treatment
Hand-washing, sanitation
Pasteurization of milk - 1908
Refrigeration in homes – 1913

281
Q

Where can transmission/contamination occur

A

On the farm or in the field
At the slaughter plant
During processing
At the point of sale
In the home

282
Q

Irradiation and why it’s done

A

Prevention of foodborne illness
Preservation
Control of insects
Delay sprouting and ripening
Sterilization
Controversial topic

283
Q

Food safety in the home

A

Drink pasteurized milk and juices
Wash hands carefully
Wash raw fruits and vegetables before eating
Defrost meats in the refrigerator
Cook meats thoroughly
Beef – internal temp 160 F
Poultry and eggs – internal temp 170-180 F
Eat cooked food promptly
Refrigerate leftovers within 2 hours after cooking
Store leftovers in shallow containers
Don’t always use antidiarrhea

284
Q

Malaria

A

serious and sometimes fatal disease caused by a parasite that commonly infects a certain type of mosquito which feeds on humans.
People get malaria by being bitten by an infective female Anopheles mosquito.

285
Q

Symptoms of malaria

A

People who get malaria are typically very sick with high fevers, shaking chills, and flu-like illness.
For most people, symptoms begin 10 days to 4 weeks after infection, although a person may feel ill as early as 7 days or as late as 1 year later

286
Q

2 special types of malaria

A

P. vivax and P. ovale
can occur again (relapsing malaria),
Remains dormant in the liver for several months up to about 4 years after being bitten by infected mosquito

287
Q

West Nile Virus

A

Leading cause of mosquito-borne disease in the continental United States
Most commonly spread to people by the bite of an infected mosquito
Cases occur during mosquito season, (starts in the summer and continues through fall)

288
Q

Symptoms of WNV

A

Most people infected with WNV do not feel sick.
About 1 in 5 people who are infected develop a fever, swollen lymph nodes, nausea/vomiting, muscle aches, joint pain and rash
About 1 out of 150 infected people develop a serious, sometimes fatal, illness

289
Q

Treatment of WNV

A

No vaccine or specific medicines are available for West Nile virus infection
Over-the-counter pain relievers can be used to reduce fever and relieve some symptoms

290
Q

Chikungunya

A

A viral infection transmitted by mosquitoes.
Extremely rare
Chikungunya is found worldwide, particularly in Africa, Asia, and India

291
Q

Symptoms of chikungunya

A

Symptoms usually appear within a week of infection. Fever and joint pain come on suddenly. Muscle pain, headache, fatigue, and rash also may occur.
Treatment is aimed at relieving symptoms. Most people feel better within a week or so, after the virus runs its course.
Pain medications and fluids

292
Q

Preventing mosquito diseases

A

Repellants
-DEET (up to 50% concentration; 10% in children)
-Permethrin on clothing and fabrics
Reduce mosquito breeding sites
Long sleeves and pants
Stay indoors when mosquitoes are biting
Mosquito nets
Bug zappers, sonic devices, CO2 devices (mosquito magnet); no proven efficacy

293
Q

Before going to endemic areas of malaria

A

Prophylactic use of chloroquine (Aralen hydrochloride)***

294
Q

Tick bites

A

Not poisonous but can transmit disease
Rocky Mountain spotted fever
Lyme diseaseBite into skin, embed mouth parts
If not detected, may remain for days

295
Q

What to do if you see a tick

A

Remove tick by grasping close to skin with tweezers, pull gently until tick lets go.
Wash area with soap and water.
Put antiseptic on site and apply antibiotic cream if not allergic.
Seek medical attention if rash appears or flu-like symptoms

296
Q

Lyme Disease and incubation period

A

A bacterial infection you get from the bite of an infected tick
Incubation Period: 3-30 days

297
Q

Early localized stage of lyme

A

Erythema migrans (EM) – bullseye rash

298
Q

Early disseminated stage of lyme

A

Multiple secondary annular rashes
Flu-like symptoms - malaise, headache, fever, myalgia, arthralgia
Swollen lymph nodes

299
Q

Late disseminated stage of lyme

A

Rheumatologic Manifestations, Cardiac Manifestations, and Neurologic Manifestations

300
Q

Prevention of lyme

A

Wear light-colored clothes (easier to spot tick), long pants, long sleeves
Use tick repellent: Permethrin on clothes; DEET on skin
Check for ticks after being outside
Remove ticks immediately by the head

301
Q

Treatment for lyme

A

for adults and children includes Doxycycline, Cefuroxime Axetil, and Amoxicillin

302
Q

Rocky Mountain Spotted Fever

A

American dog tick in the Eastern, Central and Western United States
Rocky Mountain wood tick in the Rocky Mountain states
Brown dog tick in the Southwestern United States, along the U.S.-Mexico border
Can be rapidly fatal if not treated within the first 5 days of symptoms

303
Q

Incubation, early, and late periods of rocky mountain

A

Incubation Period: 3–12 days
Early (1–4 Days)
Late (5 Days and Beyond)

304
Q

Rocky mountain rash

A

Typically appears 2–5 days after onset of symptoms; approximately 10% of RMSF patients never develop a rash.
Decision to treat should not be based on presence of rash

305
Q

Rocky mountain treatment

A

doxycycline for all ages

306
Q

4 types of poisonous snakes

A

Rattlesnakes
Copperheads
Water moccasins (cottonmouths)
Coral snakes

307
Q

What to do about snake bites

A

Have the victim lie down and stay calm.
Keep the bitten area immobile and below the level of the heart.
Call 9-1-1.
Wrap extremities with a clean cloth.
DO NOT apply a tourniquet.
**DO NOT follow the movies and suck the venom out

308
Q

Spider/scorpion bites (where are they found and what to do)

A

In the U.S., black widow and brown recluse spider bites are serious and sometimes fatal
Spiders are commonly found in woodpiles, sheds, and debris piles. Closets, rarely used cabinets, attics, crawl spaces
If the victim has difficulty breathing – call 9-1-1. Call 9-1-1 immediately for a brown recluse bite.
Keep the bite area below the level of the heart.
Wash the area with soap and water

309
Q

Insect stings

A

Not poisonous but can cause anaphylaxis in those allergic
Bees of all types and fire ants
Someone allergic may carry EpiPen or other emergency epinephrine auto-injector
Remove stinger from skin.
Call 9-1-1 if known allergy.
Wash area with soap and water.
Watch victim for 30 minutes for signs or symptoms of anaphylaxis

310
Q

Examples of chemical hazards

A

Pesticides
Environmental Tobacco Smoke (ETS)
Lead
Mercury

311
Q

Physical hazards

A

includes airborne particles, humidity, equipment design and radiation (including radon)

312
Q

Health risks of pesticides

A

Skin, eye, and lung irritation
Hormone disruption
Brain, nervous toxicity, and nerve disorders
Cancer
Blood disorders
Birth defects
Reproductive effects

313
Q

Effects to children in heavy pesticide areas

A

impaired hand-eye coordination, decreased physical stamina, short-term memory impairment, and trouble drawing

314
Q

environmental tobacco smoke (ETS)

A

From someone else’s smoking
also described as the material in indoor air that originates from tobacco smoke

315
Q

S/S of ETS in children

A

Brain tumors, middle ear infections, lymphoma, respiratory symptoms, impaired lung function, asthma, lower respiratory illness, leukemia, SIDS

316
Q

S/S of ETS in adults

A

Stroke, nasal sinus cancer, nasal irritation, coronary heart disease, breast cancer (women), lung cancer, COPD, asthma, chronic respiratory symptoms, impaired lung function, atherosclerosis, reproductive effects in women, including low birth weight and pre-term delivery

317
Q

Lead exposure

A

Health problems associated with overexposure to lead are anemia, birth defects, bone damage, neurological damage, kidney damage, and others
Exposure is by ingestion and inhalation
Children are particularly at risk from eating peeling lead paint

318
Q

Lead poisoning effects

A

lower IQ, growth problems, kidney damage, hyperactivity, reading problems, anemia, hearing loss

319
Q

Sources of lead poisoning and who’s at risk

A

exposure to lead-based paint or dust, drinking water, hobbies, foods, cosmetics
children under the age of 6, children living in older housing

320
Q

Treatment for lead poisoning

A

Chelation therapy.
In this treatment, a medication given by mouth binds with the lead so that it’s excreted in urine.
Chelation therapy might be recommended for children with a blood level of 45 mcg/dL or greater and adults with high blood levels of lead or symptoms of lead poisoning

321
Q

Mercury exposure

A

A toxic metal that comes in different forms within the environment
The most common cause of mercury poisoning is from consuming too much methylmercury or organic mercury, which is linked to eating seafood
There is no cure, stop exposure and start chelation therapy if certain levels

322
Q

Mercury poisoning s/s in adults

A

anxiety, depression, irritability, memory problems, numbness, tremors, pathologic shyness
If advanced: hearing and speech difficulties, lack of coordination, muscle weakness, nerve loss in hands and face, trouble walking and vision changes

323
Q

Mercury poisoning s/s in children

A

problems in cognition, fine motor skills, speech and language development, visual-spatial awareness

324
Q

Mercurialism

A

acrodynia (pink disease – pain and pink skin); Minamata disease (ataxia, impairment of hearing and speech)

325
Q

Radon exposure

A

Naturally occurring radioactive gas produced when uranium, thorium, and radium break down in soil, rock, and water and is then released in the air
High amounts of radon can be found in the workplace, school, or any building
Most likely to be exposed in your home (spending most time in house)
Radon comes up through the ground and into the home through cracks in the foundation
Tasteless, odorless, and invisible

326
Q

Global Environmental Health Challenges

A

Clean water and sanitation
Air quality
Climate change

327
Q

Why are children vulnerable to environmental risk

A

Body systems are still rapidly developing
Eat more, drink more, and breathe more in proportion to their body size than adults
The breathing zone is closer to the ground than adults
Bodies may be less able to break down and excrete contaminants
Behaviors can expose them to more contaminants

Public Health (6 decks)

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