exam 3: ATI CHPT.7 Flashcards
factors that threaten health
-low income
-difficulty accessing healthcare (uninsured)
-poor self-esteem
-young/advanced age
-chronic stress
-environmental factors
-presence of communicable disease
-racial/ethnic minority
-discrimination
health disparities
significant differences in health status and access to health services across varied groups
health disparities can be linked to
preferred sexual orientation, ethnicity, race, education, and income differences
national health goals: increases in
-number of people who have a routine PCP
-number of people who have health insurance
national health goals: decreases in
-the number of people who are unable to access, or have a delay in accessing, health care services and prescribed medications
-the number of people w/disabilities who report physical barriers to accessing health and wellness programs in the community
nursing actions for vulnerable populations
-advocate for social justice and the elimination of health disparities
-create rapport and provide a safe environment
-be knowledgeable about population characteristics (investigate an individual’s preferences that may differ from population trends)
-facilitate care coordination among providers, facilities, and community resources
-Advocate for the needs of the population, with focus on preventive services.
-Assist the client in obtaining as much control over personal health and health care as possible.
-Develop an interprofessional network to assist with improving the health of the population.
homicide
-often related to substance use
-most homicides are committed by someone known to the victim and occur during an argument
-violence often precedes homicide among families
-increasing among adolescents
assault
-males higher risk
-youth higher risk
rape
-often unreported
-most incidences are marital or date rape
-females higher risk
-risk is increases in cities, between 8pm-2am, weekends, and summer
human trafficking
-It affects all races, ages, and genders
-women and children under the age of 18 are at an increased risk.
Suicide according to the CDC
-Rates of suicide are highest among individuals 35 to 64 years of age.
-Females are more likely to attempt suicide; however, males are more likely to complete suicide.
-Caucasians are more likely than other ethnic groups to commit suicide.
risk factors of suicide
-depression or other mental health disorders
-substance use
-having access to a firearm
-partner violence or neglect issues.
physical violence
occurs when pain or harm results
physical violence toward infant/child
shaken baby syndrome
physical violence toward spouse/partner
striking/strangling
physical violence toward an older adult
pushing older adult in their home, causing them to fall
sexual violence
occurs when sexual contact take place w/o consent
emotional violence
includes behavior that minimizes an individual’s feelings of self-worth or humiliates, threatens, or intimidates a family member.
neglect
includes the failure to provide the following.
-Physical care, such as food shelter, and hygiene
-Emotional care and/or stimulation necessary to achieve developmental milestones, such as speaking and interacting with a child
-Education for a child
-Needed health or dental care
individual risk factors for violence
-History of being abused or exposure to violence
-Low self-esteem
-Fear and distrust of others
-Poor self-control
-Inadequate social skills
-Minimal social support/isolation
-Immature motivation for marriage or childbearing
-Weak coping skills
recognizing potential child maltreatment
-Unexplained injury
-Unusual fear of the nurse and others
-Injuries/wounds not mentioned in history
-Fractures, including older healed fractures
-Presence of injuries/wounds/fractures in various stages of healing
-Subdural hematomas
-Trauma to genitalia
-Malnourishment or dehydration
-General poor hygiene or inappropriate dress for weather conditions
-Parent considers the child to be a “bad child, worthless, or burdensome.”
economic maltreatment
-Failure to provide for the needs of a person in need when adequate funds are available
-Unpaid bills when another person is managing the finances
-Theft of or misuse of money or property
recognizing potential older adult abuse
-Unexplained or repeated physical injuries
-Physical neglect and unmet basic needs
-Rejection of assistance by caregiver
-Financial mismanagement
-Withdrawal and passivity
-Depression
-Mental anguish and fear
social and community violence risk factors
-Work stress
-Unemployment
-Media exposure to violence
-Crowded living conditions
-Poverty
-Feelings of powerlessness
-Social isolation
-Lack of community resources (playgrounds, parks, theaters)
primary prevention strategies to reduce societal violence
-teach conflict resolution, anger management, and coping strategies
-parenting classes (to teach appropriate discipline)
-community resources to protect from violence
-promote public understanding about aging process and safety for older adults
-assist in removing/reducing factors that contribute to stress
-encourage older adults to safeguard their funds
-teach that no one has the right to touch or hurt another person
-teach how to report cases of abuse
-advocate for legislation designed to assist support adult independence, assist caregivers, and increase funding for programs that supply services to low-income, at-risk individuals.
secondary prevention for reducing societal violence
-Identify and screen those at risk for abuse and individuals who are potential abusers. (especially pregnant women)
-Assess and evaluate any unexplained bruises or injuries of any individual.
-Refer sexual assault or rape survivors to a local emergency department for assessment by a sexual assault abuse team. (no bathing to keep evidence)
-Assess and counsel anyone contemplating suicide or homicide and refer the individual to the appropriate services.
-Assess and help offenders address and deal with the stressors that can be causing or contributing to the abuse (mental illness, substance use).
-Alert all involved about available resources within the community
tertiary prevention for reducing societal violence
-Establish parameters for long-term follow-up and supervision.
-Make resources in the community available to survivors of violence (telephone numbers of crisis lines and shelters).
-foster care
-Refer all involved to mental health professionals for long-term assistance.
-Provide grief counseling to families
-Develop support groups for caregivers and survivors of violence.
-Support and educate the offender, even though a report must be made.
caring for clients who experience violence
-Build trust and confidence with a client.
-Focus on the client rather than the situation.
-Assess for immediate danger.
-Provide emergency care as needed.
-Work with the client to develop a plan for safety.
-Make needed referrals for community services and legal options.
-If abuse is suspected or has occurred, complete mandatory reporting, following state and agency guidelines.
substance use disorders
involved the maladaptive use of substances resulting in threats to an individual’s health or social/economic funding
SUD affects
-family dynamics leading to codependency
-cause more disability, death and illness than any other health condition
recovery from SUD
-occurs over years and usually involves relapse
-strong support system (family, 12-step programs, and self-help groups) are necessary
dependence
a pattern of pathological, compulsive use of substances, and involves physiological and psychological dependence
indications of dependence
Cardinal indicators of dependence include manifestations of tolerance and withdrawal.
Denial is also a primary indication of dependence and can include the following.
-Defensiveness
-Lying about use
-Minimizing use
-Blaming or rationalizing use
-Intellectualizing
-“Going with the flow” (agreeing there is a problem, vowing to make a change, but the change doesn’t occur)
health problems of SUD
-Low birth weight
-Congenital abnormalities
-Accidents
-Homicides
-Suicides
-Chronic diseases
-Violence
-Disability
alcohol use
-most commonly used substance
-is easily accessible and socially acceptable
-depressant: dulls the sense to outside stimulation and sedates the inhibitory center of brain
-tolerance: frequent drinkers; increased requirement for alcohol to achieve desired affect
effect of alcohol
is determined by BAC
processing is dependent on
-size/weight
-sex (metabolism)
-carbonation (increases absorption)
-time elapsed during consumption
-food in stomach
-emotional state
-type of alcohol
Excess alcohol
that is not metabolized circulates in the blood and affects the CNS and brain
withdrawal
-Following prolonged use, manifestations of alcohol withdrawal appear within 4 to 12 hr.
-It is important to determine the time of the last drink the client ingested in order to accurately monitor for manifestations of withdrawal.
manifestations of withdrawal
-Irritability
-Tremors
-Nausea
-Vomiting
-Headaches
-Diaphoresis
-Anxiety
-Sleep disturbances
-Tachycardia
-Elevated blood pressure
physical assessment findings of SUD
-Vital signs: Vary depending on the substance being used.
-Appearance: Individual can appear disheveled with an unsteady gait.
-Eyes: Pupils can appear dilated or pinpoint; eyes may be red, with poor eye contact.
-Skin: Can be diaphoretic, cool, and/or clammy. Needle track marks or spider angiomas may be visible.
-Nose: Can be runny, congested, red, and/or cauliflower-shaped.
-Tremors: Fine or coarse tremors can be present.
primary prevention to reduce SUD
-Increase public awareness, particularly among young people, regarding the hazards and risks of dependence associated with substance use (public education campaigns, school education programs).
-Encourage development of life skills.
-Assist in the formation of parental action and awareness groups, such as Mothers Against Drunk Driving (MADD).
Secondary prevention to reduce SUD
-Identify at-risk individuals and assist them with reducing sources of stress, including possible referral to social services to eliminate financial difficulties or other sources of stress.
-Screen individuals for substance use disorders.
tertiary prevention to reduce SUD
-Assist the client with developing a plan to avoid high-risk situations and to enhance coping and lifestyle changes.
-Refer the client to community groups, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA).
-Monitor pharmacological management (nicotine replacement therapy, methadone programs).
-Provide emotional support to recovering substance users and their families, including positive reinforcement.
NAMI
National Alliance for the Mentally Ill: an advocacy group that works to reduce stigma and provde services for clients who have MHD and for their families
characteristics of MHD
-Occur across the lifespan
-High risk of substance use disorders
-High suicide risk
-Increased occurrence of chronic disease
factors affecting MH
-Individual coping abilities
-Stressful life events (exposure to violence, disasters)
-Social events (recent divorce, separation, unemployment, bereavement)
-Chronic health problems
-Stigma associated with seeking mental health services
primary prevention to improve MH
-Provide education to populations regarding mental health issues.
-Teach stress-reduction techniques.
-Implement parenting classes.
-Organize bereavement support groups.
-Promote protective factors (coping abilities) and risk factor reduction.
secondary prevention to improve MH
-Screen to detect mental health disorders.
-Work directly with at-risk individuals, families, and groups through formation of therapeutic relationships.
-Conduct crisis intervention.
tertiary prevention to improve MH
-Perform medication monitoring.
-Provide mental health interventions.
-Make referrals to various groups of professionals, including support groups and rehabilitation services. QTC
-Maintain the client’s level of function to prevent relapse or frequent rehospitalization.
-Identify behavioral, environmental, and biological triggers that can lead to relapse.
-Assist the client in planning a regular lifestyle and minimizing sources of stress.
-Educate the client and family regarding medication adverse effects and potential interactions
migrant employment
-farming: caring/harvesting crops
-temporary home during employment
-Ag workers are not covered under common labor laws
-Minors >/=12 are not covered under the Child Labor Act
-oftentimes, english is not 1st language
-may face discrimination or ineligibility of services (undocumented fear deportation)
health problems for migrant workers
-Dental disease
-Tuberculosis
-Chronic conditions
-Stress, anxiety, and other mental health concerns
-Leukemia
-Iron deficiency anemia
-Stomach, uterine, and cervical cancers
-Lack of prenatal care
-Higher infant mortality rates
-STIs, including HIV/AIDS
pesticide exposure
significant problem among farm workers
subjective findings of pesticide exposure
Headache, dizziness, dyspnea, nausea, abdominal cramps, poor concentration, eye irritation
objective findings of pesticide exposure
Confusion, irritability, muscle weakness and twitching, nasopharyngeal irritation, vomiting, rash, shortness of breath
complications of pesticide exposure
long-term exposure
-cancer
-reproductive problems
-Parkinson’s
-liver damage
-behavioral issues
-impaired fetal development can occur from primary (working in fields) or secondary exposure (contaminated clothing from family member)
primary prevention for Migrant Health Care
-Educate clients regarding measures to reduce exposure to pesticides (hand washing after working, washing food picked from fields before consumption, changing clothes after work).
-Teach clients about accident prevention measures.
-Provide prenatal care.
-Mobilize preventive services (dental, immunizations).
secondary prevention for Migrant Health care
-Create testing programs for tuberculosis and prenatal diagnostic testing.
-Implement screening programs. (Pesticide exposure, skin cancer, chronic preventable diseases, communicable diseases, anemia (children))
-Mobilize primary care and emergency services.
tertiary prevention for Migrant health care
-Treat for manifestations of pesticide exposure.
-Promote rehabilitation after work-related musculoskeletal injuries.
-Educate clients who have diabetes mellitus or anemia regarding appropriate nutrition.
How many veterans are in the US
21.8 mil
2mil=women
9.9mil are >65yrs
Veterans’ Health Administration
-part of VA
-responsible for purchasing coverage and delivering health care to veterans and dependents
-nation’s largest integrated health system
-inpatient and outpatient services
veteran health issues
-MH (PTSD, depression, anger)
-SUD
-suicide
-infectious diseases
-exposures to herbicides, chemical, radiation
-TBI/spinal cord injuries
-amputations
-cold injury
-military sexual trauma
-hearing/visual impairments
strategies for veteran health care
-Coordinate referrals to available veteran resources.
-Advocate for continued strengthening of the Veterans Health Administration health care system.
-Assist clients with transitioning from active duty to veteran status.
-Ensure continuity of care between acute and outpatient settings.
-Develop partnerships with local agencies to strengthen resources and achieve mutual goals.
disability
indicates a factor in the body, senses, or mind that affects the way a person interacts in the daily environment
causes of disability
-Individual or group living environments (unsanitary conditions, poor nutrition, stress)
-aging
-chronic illness
-injury
-substance use
-genetics
different terminology for disability
-disabled
-challenged
-compromised
how many people in US report having a disability
-1/5 of population
-globally: 650 mil
Acts to promote rights for individuals w/disability
-Americans w/Disabilities Act
-Individuals w/Disabilities Education Act: ensures free public education and accommodations to prepare the child for independent living, assists w/funding, and evaluates effectiveness
effects of disability
-Cost of chronic management
-Decreased employment rates
-Decreased household income and increased poverty rates
-Decreased opportunity for physical activity (physical impairment)
-Isolation and possible self-image issues
-Possible altered roles of family members
-Increased risk for abuse
-Possible inability to live independently
-Presence of comorbidities
nursing actions for diabilities
-Implement primary prevention measures to prevent disability (such as responsible alcohol use to prevent liver damage).
-Identify disability and chronic disease as early as possible.
-Connect clients with appropriate resources to promote maximum self-care ability.
-Connect families with respite care and counseling.
-Advocate for the rights of individuals, families, and groups dealing with disabilities.
-Ensure public buildings are accessible to individuals who have physical disabilities.
-Implement programs to improve quality of life.
immigrants and healthcare
-often have a waiting period to receive financial assistance for medical care
-Unauthorized immigrants are only eligible for immunizations, school lunches, treatment for communicable diseases, and emergency care.
nursing actions for immigrant care
-cultural competence when planning care
-identify risk factors specific to culture/race
refugees
-Refugees are those who have been forced to leave their place of origin due to disaster, war, or threatening environment.
-Refugees are eligible for Temporary Assistance for Needy Families, Medicaid, and Supplemental Security Income.
Nursing actions and refugees
-Assess mental health status and coping following crisis.
-Help individuals apply for assistance programs.
pregnant adolescents
-Limited education and job opportunities
-Increased risk for poverty and homelessness
-Increased risk for school problems
-Increased incidence of violence
-Increased risk of malnutrition
-Increased risk for low birth weight or premature infants
pregnant adolescents nursing actions
-Assist with early identification of pregnant adolescents, including early initiation of prenatal care.
-Provide pregnancy counseling, including alternative courses of action.
-Provide instruction and encouragement in the parenting role in home and peer group settings.
-Assist in applying for assistance programs (prenatal services; Women, Infants, and Children [WIC]).
-Promote education about self-care during pregnancy.
incarcerated populations
-Increased rates of mental health disorders (The presence of major mental health disorders increases the risk for multiple incarcerations.)
-Increased incidence of rape and assault in the prison system
-Health care regulated through the Federal Bureau of Prisons (Department of Justice) to promote rights of inmates
-Increased rates of chronic disease compared with the general population
incarcerated populations nursing actions
-Implement health promotion and counseling during routine care.
-Assist with the design of programs to re-integrate individuals into society.
-Foster follow-up with community mental health centers.
-Provide transitional care to reduce the risk of future violent behavior.
LGBTQIA
-Can face barriers to adequate health care
-State variations in rights for benefits and adoptions
-Can face social stigma and discrimination
-Health disparities, including poorer mental health, increased risk for disability, and increased risk for substance use disorder
national health goals for LGBTQIA: increase
-survey/monitoring systems that include standardized questions to allow individuals to identify sexual orientation, gender, and pronouns
-health insurance coverage
-increase number of individuals who have a routine health care provider
national health goals for LGBTQIA: decrease
-adolescent bullying
-proportion of persons who experience major depressive episodes
-adult tobacco and illicit drug use
nursing actions for LGBTQIA
-advocate increasing access to care
-support the development or maintenance of healthy families
-provide opportunities and safe environments for clients to discuss care concerns
