exam 3 Flashcards
Characteristics of each three factors in the epidemiological triangle
a way of identifying causative factors, transmission, and risk related to infectious diseases.
Host: Age, sex, Race, genetic profile, previous diseases, immune status, religion customs, occupation, marital status, family background
(Causative factor leading to health problem)
Agent: biologic (bact, viral), Chemical (poison alcohol smoke), physical (trauma radiation fire), and Nutritional (lack excess)
(Ext factors that surround the host and influence vulnerability and resistance)
Environment: temperature, humidity, altitude, crowding, housing, neighborhood, water, milk, food, radiation, pollution, noise.
How the epi triangle has evolved
The Web of Causality-interacting factors: reflects the more complex interrelationships among the numerous factors interacting, sometimes in subtle ways, to increase (or decrease) risk of disease.
4 W’s of descriptive epidemiology
*Looks at the distribution of health outcomes.
What: Health Issue of Concern what happened?
Who: Person who is it happening too?
Where: Place where was it happening?
When: Time when was it happening?
2 factors of analytical epi
*looks at the determinants of outcomes
Why/How: Causes Risk Factors Modes of transmission.
How does nursing apply epidemiological methods?
*understand factors that contribute to health and disease
*develop health promotion and disease prevention
*identify the presence of infectious agaents in individuals and groups
*design, implement and evaluate community health programs and PH policies
Hx of epidemiology
*Hippocrates (Greek) 4th century BC
*Idea of diverse causes of health/disease in a community (ecological model)
*Not until 19th century Basic epidemiology created by John Snow father of epidemiology.
20th century when it became a distinct discipline.
proportions
Type of ratio, denominator includes the numerator (expressed as a %)
rates
*ratio, measured by frequency of a health event in a defined population, usually within a specific period of time.
Numerator= # of events
Denominators= population over a period of time
risk
*probability that an event will occur during a specified period of time. (Even if it’s a small possibility… ex men and breast cancer)
*High Risk: based on genetics, behaviors, and other factors. Incidence
*No Risk: ex. Men with ovarian cancer & women with testicular cancer
Difference between incidence and prevalence
*Prevalence: amount of disease in a population. Usually expressed in %. Denominator includes the numerator . (Ex: death d/t heart disease over the number of deaths total)
*Incidence: number of new cases/ the number of people at risk. Usually expressed as so many cases per 100,000 annually.
Mortality rate is good for what?
They reflect changes in social behavior or health practices. For example, the increased lung cancer mortality rates among men and women in recent years reflect a delayed effect of increased smoking in prior years
Importance of IMR
indicator of overall population health around the world and availability of healthcare. # of infant deaths within a year versus the total number of live births
Purpose of screening and characteristics of successful screening program.
*aim is early detection and treatment, NOT a diagnostic test.
*Ask: Ethical? Justified?
reliability and validity
*validity: accuracy- measuring what is intended.
a. Sensitivity: test identifies those with condition
b. Specificity: test identifies those without condition
*Reliability: repeatability/consistency of the measure
a. Sources of error
b. Variation in what’s being measured.
c. Observer variation
d. Instrument inconsistency
sensitivity vs specificity
a. Sensitivity: test identifies those with condition
b. Specificity: test identifies those without condition
What is surveillance and how is it useful to Epidemiology?
systematic collection, analysis, and interpretation of data r/t occurrence of disease and health status of the population
What is Sentinel Surveillance?
systems and providers. representative population selected and sampled. used when it is not feasible to survey larger groups or larger geographical areas or the disease is rare.
Active and passive surveillance difference?
a. Passive: more common, less expensive (health care providers report to PH dept. standardized reports)
b. Active: uses personal contact, limited to special specific purposes. Personal/phone contact or review of lab reports
Sources of Data major types
*Secondary sources: routinely collected data (census vital records CDS data)
*Primary sources: original data collected for specific epidemiology studies
a. National center health stats
b. National hospital d/c summary and many others
Value of Comparison Groups
Key feature. Control group who does not have disease compared with those with disease
When – trends in time useful for Epidemiology: Time patterns of death/disease secular trends, Point epidemic, Sharp peaks, Cyclical patterns, Event related clusters
*Time patterns of death/disease secular trends: changes in social behavior
*Point epidemic: most clearly seen when frequently in cases is plotted against time
*Sharp peaks: concentration of cases in short time intervals
*Cyclical patterns: seasonal fluctuations (time change)
*Event related clusters = natural disaster exp by many people at the same time.
Different types of Epidemiological studies
*Cohort studies: group of people sharing some characteristics of interest. They are watched for development of a disease
a. Prospective cohort: follow over time
b. Retrospective cohort: use already available data from the past
Causality criteria
*Strength of association
*consistency of findings
*biological plausibility
*demonstration of correct temporal sequence
*Dose-response relationship
*specificity of the association
*experimental evidence
How do nurses use Epidemiology?
understand factors that contribute health and disease, develop health promotion and disease prevention interventions, identify the presence of inf agents in individuals and groups, design implement and evaluate community health programs and PH Policies.
What triggers an investigation of a disease?
the severity of the disease, the potential for spread, the availability of resources, and sometimes by political considerations or the level of concern among the general public.
Steps in the outbreak investigation of disease
- What is the problem
- what is the cause of the problem
- How do we stop the spread of the problem
Know the difference between endemic and epidemic.
*endemic: (no end) the constant presence of a disease within a geographic area or a population. Pertussis is endemic in the United States.
*epidemic: refers to the occurrence of disease in a community or region in excess of normal expectancy.
Where have nursing intervention efforts been focused regarding STDs?
PREVENTION: Behavior Modification, vaccination early detection, and education
*primary:
HIV is becoming a young person’s disease. Cost/burden of disease
*Lifetime care: costly
*Huge impact on society, blame, discrimination
*Magnified by the fact that groups with HIV tend to be ostracized ex: Homosexual men or IV drug users.
*2016 21% new HIV cases are 13–24-year old’s
Name 2 sources of financial assistance for HIV treatment
Medicare, medicaid, Ryan White HIV/AIDS treatment extension Act, ADAP (AIDS Drug Assistance Program)
Know the 3 stages of HIV. What are the characteristics of each?
*Stage 1 primary infection within 1 month of contracting virus
- Mononucleosis- lasts few weeks
- DC4 WBC decreased when virus most plentiful
- Antibody tests usually negative at this time
*Stage 2 3wks-6months (varies) after infection antibodies appear in blood but not protective
*Stage 3 symptomatic disease AIDS
- after several years last stage develops immune system declines
- Opportunistic disease develops because of low CD4 T lymphocyte count <200/ml
- TB, Pneumocystis carinii
AIDs is dx based on what White blood cell count?
CD4 WBC decreased when virus most plentiful
Be aware of the 5 HIV infection states.
0,1,2,3, unknown
What is HAART?
Highly active antiretroviral therapy
* has greatly increased the survival time of persons with HIV/AIDS.
*adherence is imperative
What testing is different about newborns from HIV Pos. mothers?
*newborns of infected mothers must be tested using DNA or RNA bc their antibodies are not their own
* it is recommended that HIV testing be a routine part of prenatal care and that all pregnant women be tested for HIV
* The EIA test is not valid because it tests for antibodies, which in the infant reflect passively acquired maternal antibodies.
Modes of transmission HIV
blood, semen, transplanted organs, vaginal secretions, breast milk, needle sharing, mother to baby at birth
What area of the US has the highest HIV prevalence rate?
the southern United States and the U.S. territories of the Virgin Islands and Puerto Rico report the highest rates
Note the ethnic distribution of HIV
HIV has disproportionately affected minority groups. African Americans have the largest HIV disease burden
Is HIV reportable and how it is reported?
*Confidential reporting is required in all states
* Anonymous
Name the 2 tests used to check for HIV?
*CD4 T lymphocyte count
*EIA enzyme linked immunosorbent assay and Western blot
Home testing is available and accurate but needs what else?
Needs confirmed by physician
What is the difference between confidential testing and anonymous testing?
*Confidential testing involves reporting by identifying the person’s name and other identifying information; this information is considered protected by confidentiality.
*anonymous testing, the client is given an identification code number that is attached to all records of the test results and is not linked to the person’s name and address
CDC Voluntary yearly screening is recommended for what age group?
15-65 years old
What are the advantage/disadvantage of anonymous testing?
*Advantage: The anonymity eliminates their concern about the possibility of arrest or discrimination.
*Disadvantage: anonymous testing does not allow for follow-up if the test is positive because the client’s name and address are not available.
What accounts for nearly all the HIV in children?
Perinatal transmission accounts for nearly all HIV infection in children and can occur during pregnancy, labor and delivery, or breastfeeding.
What happens that impoverishes many families dealing with HIV?
Cost of treatment for chronic disease
Chronic AIDS. What is the legal protection against discrimination in housing, work and school in the US?
American’s with Disabilities Act
What are the important issues in living with AIDS?
*Bouts of illness interspersed with periods of wellness
*Nurses need to teach family how to care and support client w/ personal care
*adherence to HAART is imperative
*Mental health issues such as bipolar and depression are common
*use of variety of resources
*children should attend school
What are the bacterial STDs?
*bacterial infections include gonorrhea, syphilis, and chlamydia. (GCS)
*Most of these are curable with antibiotics, with the exception of the newly emerging antibiotic-resistant strains of gonorrhea.
Viral STD?
*STDs caused by viruses cannot be cured.
*These are chronic diseases resulting in a lifetime of symptom management and infection control.
*The viral infections include herpes simplex, HPV, and hepatitis
How many new STDs since 1980?
8
The tx for which STD has been particularly affected by ABX resistance?
Gonorrhea
What is the danger with PID?
*Most common complication of gonorrhea
*RF: multiple sex partners
*outcomes: stillbirth and premature labor, infertility, ectopic pregnancy
PID caused by chlamydia exhibit what S&S
fever, abnormal menses, and lower abdominal pain, but PID may not be recognized because the symptoms vary among women.
What 2 STDs are frequently co infections?
Gonorrhea and chlamydia
Gonorrhea and Chlamydia are currently treated with similar ABX therapy. What are the ABX of choice for each?
ceftriaxone combined with either doxycycline or azithromycin
Most common reportable disease in the US?
Chlamydia
Most common non reportable disease in the US?
HPV
Most commonly affected age group/sex for Chlamydia?
Women under 25 years old
3 Key risk factors for Chlamydia?
inconsistent use of barrier contraceptives, multiple sex partners, and hx of other STIs
What are the stages of syphilis?
*Primary syphilis: chancre forms at site of infection, painless, heals spontaneously.
*Secondary syphilis: low grade fever, malaise, sore throat, headache, lymphadenopathy, muscle and joint pain, rash
*Tertiary syphilis: CNS and CV involvement, can lead to blindness, rare in the US.
When is the latency period of syphilis?
*Asymptomatic infection after secondary period passes.
*Serologic testing remains positive
Is it possible to infect others after the HSV vesicles have crusted over?
yes
Usual locations of HSV1 and HSV2 vesicles
*1: in and around the mouth
*2: genitalia
Is there a cure for viral STDs?
No
lab test for gonorrhea
Nucleic acid amplification test (NAAT)
lab test for chlamydia
NAAT
lab test for syphilis
Blood serological testing
lab test for HSV
Blood test PCR or viral culture
What testing is useful for HPV discovery?
PAP testing
What is the main danger of HPV infection?
cervical cancer
Mode of transmission for each Hepatitis A,B,C
Fecal/oral: A
blood/genital fluids: B and C
In developing countries why is Hepatitis A not epidemic?
epidemics are not common because most adults are immune from childhood infection.
S/S of Hepatitis
fever, fatigue, loss of appetite, nausea, abd pain, joint pain, jaundice
Which Hepatitis(es) can be treated with Immunoglobulin?
Hep B
most common CHRONIC bloodborne infection in the US
Hep C
What groups have the highest prevalence of Hep B?
healthcare workers, correctional institutions, IV drug users
What obligations does OHSA put on employers who have at risk employees for Hep B?
must offer HBV vaccine at employer’s expense and HBV exposure prevention education
Which Hepatitis is responsible for most Liver transplants?
Hep C
Main danger of Hep C infection outcome?
s/s are mild so can go unnoticed, it is chronic
TB TST testing issues
*false neg in immunosuppressed clients
*false pos in those w/ the bCG vaccine
Sexual and IDU assessment: 5P’s
5 Ps:
*Partners
*Prev preg
*Protection of STI’s
*Practices
*Past Hx STI
Sexual and IDU assessment 3 area to cover with your assessment questions
- types of relationships (who do you have sex with)
- number of sexual partners and encounters
- Types of sexual behaviors practiced
What is the best way to prevent STDs?
abstinence
primary prevention of STDs
*community education about prevention of communicable diseases
*vaccinate for Hep A and B
*Provide barrier contraceptives
secondary prevention of STDs
*administer TST screening
*test and counsel for HIV
*notify partners and trace contacts
Tertiary prevention of STDs
*management of s/s
*psych support
*Referrals to long term care
*infection control in home
*standard precautions
Definition of Family
2 or more individuals who depend on one another for emotional, physical, and/or financial support. Members are self-defined.
Types of family structures:
*Married family: traditional nuclear family
*Single-parent family
*Multi-adult household
Why is the family important for CH nursing?
family health is often used interchangeably with the concepts of family functioning, healthy families, and familial health
What benefits has the ACA had on families?
the coverage of pre-existing conditions, mental health coverage, the disparity in the cost of insurance for women and men, the more than three million young adults on their parents’ insurance policies, and not receiving medical care simply because one does not have insurance
Why does the US need a cohesive family policy?
the United States could benefit from a cohesive family policy designed to enhance the well- being of all families. Such a policy would go a long way toward preventing future crises in vulnerable family populations
What is meant by family policy?
Family policy means anything that is done by the government that directly or indirectly affects families.
Recognize 4 approaches to Family nursing
Family as context
Family as client
Family as a system
Family as component of society
Name 2 influential studies of Lifestyle behaviors that reduce morbidity and mortality
*Health of Families
*health of the nation
What is key in the Newman systems model about family and energy? What are the 5 interacting variables
*question: can the family withstand stressors and remain stable?
*5 interacting factors:
-physiological,
-psychological,
-sociocultural,
-developmental
-spiritual.
What are the 3 categories of health risks?
*biological and age-related: genetics or transitions and life event risks (genogram)
*environmental: social and economic risk (ecomap)
*behavioral/lifestyle: personal health habits
What is health risk appraisal?
process of accessing for the presence of specific factors in each category that have been identified as being associated with an increased likelihood of illness or accident.
What is the assumption that health risk reduction is based on?
that decreasing the number of risks or the magnitude of risk will result in a lower probability of an undesired event occurring.
What is a family crisis?
family not able to cope with an event or multiple events and becomes disorganized or dysfunctional.
Family coping strategies
- Cognitive:
1. Be accepting of the situation and others.
2. Gain useful knowledge. Use of Internet helpful.
3. Collaborate in problem solving (reframe the situation).
*Relationships
4. Increase cohesion (togetherness).
5. Increase flexibility.
6. Share feelings and thoughts.
7. Increase family structure.
*Communication
9. Listen to one another.
10. Be sensitive to nonverbal
communication.
11. Use humor when appropriate.
8 major stages of Family Development and relationship to life-event
risks
*it provides a useful framework for identifying normative events and preparing families to cope successfully with related demands.
Stage 1 married without children
Stage 2 child bearing
Stage 3 preschool
Stage 4 school age
Stage 5 adolescence
Stage 6 launching
Stage 7 middle age
Stage 8 aging
Normative events.
The kinds of normative events families experience are usually related to the addition or loss of a family member, such as the birth or adoption of a child, the death of a grandparent, a child moving out of the home to go to school or take a job, or the marriage of a child. There are health-related responsibilities associated with each of these tasks.
non normative events
Non-normative events present different kinds of issues for families. Unexpected events can be either positive or negative. Getting a job promotion or inheriting a substantial sum of money may be unexpected but are usually positive events. More often, non-normative events are unpleasant, such as a major illness, divorce, death of a child, or loss of the main family income.
Biological Health Risk and genogram
genetics or transitions and life event risks (genograms)
*genogram: a way of recording and interpreting your family’s history so you can better understand the genetic, medical, social, and cultural aspects of your family
Lifestyle Risk
personal health habits
What are critical dimensions for understanding/assessing family lifestyle Health Risk?
There is no good family lifestyle assessment tool yet
Advantages and disadvantages of home visits?
*advantages:
1) opportunity for cultural knowledge/understanding
2) see the family environment
3) encourage family participation
*disadvantages:
1) cost-so who would benefit most?
2) personal safety of nurse
3) hard to schedule/interruptions
4) family may refuse
Recognize steps in home visit.
1) initiation phase: clarify, make sure you know the why of the visit.
2) Pre-visit phase: set up visit contact family, share perceptions
3) in-home phase: introduction, establishing relationship
4) termination phase: review visit w/ family, plan future visits
5) post-visit: record and plan for next visit
What is important to develop during a home visit?
trust
How can trust be developed.
sensitivity, clarity, positive regard, empowering families
What can be done if the family refuses a home visit?
It is voluntary
What is the purpose of contracting with a family?
formally involving the family in the nursing process and jointly defining the roles of both family members and health professionals
What are advantages to Telehealth?
*allows clients to communicate with and transfer health information to providers from home.
*useful in the case of frequent monitoring being necessary
What is the role of the nurse in community resources?
to provide options and give support for the family to begin to reach out for resources
What is FMLA and how can it help families?
Family Medical Leave Act: allows covered employees to take up to 12 weeks of leave each year for certain family and medical reasons.
*employees still receive their medical benefits
*their job is secured for them when they return
*paid leave is not part of the act
What is the first provision for vulnerable populations to have culturally competent care?
*Nurses are under an ethical obligation to provide culturally competent care
*safe environment is the first concern for these clients
