Final Exam Review Flashcards
care vs case management
care population
case = single
criteria for medicare for home visit
Homebound, must require taxing effort to leave home and how frequent.
Plan of care, written doc guided by lengthy assessment.
Skilled needs, what professional services es are needed, Skilled nursing vs
nonskilled nursing needs.
Intermittent care, skilled care provided over several hours during the day/week.
Medicare requires 60 days with renewals if needed.
HPSA
health professional shortage area
MUA
medically underserved area
MUP
medically underserved population
advocacy
Being a voice for the patient. Understanding their needs and wants and
implementing them in the care.
TRICARE
Insurance for military
Medicare
old
medicaid
low income
5 phases to home visit
initaiton
preparation
in home visit
termination
post vist planing
in home visit what to assess
risk of meds, risk for falls and risk for abuse and neglect
Who needs special attention and creative solutions to overcome health disparities?
LGTBQ, military, homeless
Included questions on intake form.
High risk mothers, chronically ill and disabled people, mentally ill, substance
abusers. Immigrants and refugees.
social determinants of health
live work play
medically underserved
LGBTQ
homeless
military
natural disaster
tornado
accidental disaster
chemical spill
terrosim
acts of violence to cause terror and hurt people
diaster assessment
surveillance, community vulnerabilities, who is most at risk
disaster preparedness
Although disasters don’t occur with frequency, planning with
vulnerability assessments can reduce the impact on the
community.
mitgation
Take measures to limit damage, disability, and loss of life.
Cost effective primary prevention.
Creation or removal of structures or alteration of the environment to
remove or modify risk.
PPE
prevent the transfer of the hazardous agent from the victim or the
environment to healthcare professionals.
Incident command System (ICS)
on-site, flexible, all-hazards system. Set of personnel, policies,
procedures, facilities, and equipment integrated into common
organizations structure.
recovery begins when
disaster ends
Formal report after action report (AAR)
Detail report of list strengths and weaknesses and even failure
with suggestions for future
all disaster response begins
at local level
risk assessment =
hazard + exposure
Point of distribution OR Emergency dispensing sites
is a centralized location where the public picks up emergency supplies,
including food, water, and medications (if necessary), following a disaster.
The plan details the staffing required and procedures to be followed in the
setup and deactivation of a POD/EDS
not just food
Infectious agents, contaminated body fluids, poisonous plants, insects,
spiders, and poisonous snakes
biologic
Hazardous drug and toxin exposures, diesel exhaust, aerosols and cleaning
solutions, floor strippers, disinfection
chemical
Electric and magnetic fields, UV rays, cold and heat stress, noise, lighting,
falls, fires, unsafe machinery, abrasive workstations, and transportation
accidents
physical
Sexual harassment, interpersonal probs, assaults and violent acts, bodily
reaction, and exertion
psychosocial
school nursing
Specialized practice, a bridge of EBP to healthcare, families, and kids.
school nursing is guided by
MI school code and MI public health code
MI school code
(legislates what must be done in school)
MI public health code
(legislates how medical professional may
practice in MI)
ratio of school nurse
1 nurse to 750 students
OSHA
enforces
NIOSH
conducts research
Sufficient experience to recognize a range of practice issues and functions
as clinical, occupational health services. Coordination and case
management relies on checklists and clinical protocols.
competent
Has increased ability to perceive situations as a whole- able to predict the
events to be expected and can recognize protocols sometimes need to be
adjusted to meet needs of situation.
proficient
Has extensive experience- broad knowledge base-grasps situations quickly
and initiate action, leadership roles, policy, servs upper executive or
management roles.
expert
epidemiology triad
Host: all suspectable people and their families in the workplace
Agent: workplace hazards, biologic, chemical or psychosocial
Environment: All external factors, physical and emotional
source
what’s the contaminate and where did it originate from
environmental media.transport
ground water, surface water (lakes, rivers)
air, soil, plants, or animals. The environmental medium that the contaminant is in
helps determine who is exposed and how they are exposed.
point of exposure
the place where people encounter the contaminated medium,
which may includefood or another item. An exposure point can be a home, a
playground, a lake, a business, a cloud of diesel fumes, an abandoned lot, a fish to
be eaten, or a park.
route of exposure
how the contaminant enters the body via ingestion,
inhalation, or skin contact.
receptor population
population of people who are likely to be exposed
Since experimental designs can’t be used for most environmental studies,
cohort
studies, case-control studies, or cluster investigations are generally used for
environmental epidemiology.
children more vulnerable
Body systems are still rapidly developing.
o Eat, drink, and breathe more in proportion to their body size than do adults.
o Breathing zone is closer to the ground compared with adults.
o Bodies may be less able to break down and excrete contaminants.
o Behaviors can expose them to more contaminants.
o Spending time outside home where environmental hazards may be present.
Environmental injustice, be able to define it and give an example of some type of
environmental injustice and how that impacts health outcomes.
Environmental justice is the belief that no group of people should bear a
disproportionate share of negative environmental health consequences regardless
of race, culture, or income.
o Most farmers are Hispanic. The pesticides from the farm exposes them to health
risks. They also tend to live on the farm. This exposes their families to illness.
Being ill can then take away from their job leaving them financially unstable.
Health belief model
perceived seriousness- what will happen to me.
Perceived susceptibility- will this happen to me.
Perceived benefits of treatment will i not get the condition.
Perceived barriers to treatment- what is preventing me from making this
change.
Cues to action- what is happening to me.
Self-efficacy- can I do it.
rate
the best indicator of the risk that a specific disease, condition or event will
occur
incidence
new
prevalece
all
sensitivity
positive
specificity
negative
crude rate
The entire population. Bias! Don’t want to include the people who don’t have the
disease. Entire population for birth rates when men can conceive.
o Use adjusted rate.
barton
red cross
Lillian wald
Henry street
direct transmission
physical contact
indirect
vector or fomite
policy making
Setting an Agenda: when the problem of common interest is identified.
o Policy formation: possible and available alternative policies are identified, and a
specific policy is selected.
o Policy Adoption: selecting the policy that should gain support, power, and
directions for the legislators.
o Policy implementation: actual carrying out of the policy takes place.
o Policy Assessment: evaluation of the implemented policy in terms of being
compliant or congruent with the statutory requirements.
o Policy Modification: the policy can be maintained, changed, or eliminated,
according to its level of appropriateness.
8 principles of public health nursing
- Client or unit of care is population.
a. People are your population. - Primary obligation is to achieve the greatest good for the greatest number of
people.
a. Do the most good for the greatest number of people. - Public health nurses collaborate with the client as an equal partner.
a. Client and nurse has open relationship for collaboration.
a. Equal partnership between nurse and client. - Primary prevention is the priority in selecting appropriate activities.
a. Prevention strategies must reflect patient appropriate activities.
a. Prevention is the priority. - Public health nursing focuses on strategies that create healthy environment, social,
economic condition in which populations may thrive.
a. Public health encompasses all aspects of population health and well-being
to ensure adequate survival.
a. Ensure all aspects of a group so the people can thrive. - A public health nurse is obligated to actively identity and reach out to all who
might benefit from a specific activity or service.
a. A public health nurse must reach out to all who could benefit from an
activity or service.
a. Reach out to all who could benefit from the service. - Optimal use of available resources and creation of new EB strategies is necessary
to assure the best overall improvement in health of populations.
a. Must use the best resources and strategies to assure the best improvement
in health populations.
a. Uses best resources with EB interventions to best improve. - Collaboration with other professionals, populations organizations and stakeholder
groups is the most effective way to promote and protect the health of people
a. Working together with organizations, health professionals, populations to
achieve common public health goals.
a. Collaboration to promote the health of the people.
cultural traditions
Personal preferences, values, family, lifestyles. The shift
towards pt/client care means that a broader range of outcomes needs to be
measured from the pts perspective to understand the true benefits and risks of
healthcare interventions.
live attenuated vacine
Part of the virus is given to build up an immune response.
passive immunity
passed through people
stages of infection
Latent: invaded host and replicates. Begins shredding.
o Communicable: begins with shredding and follow latency.
o Incubation: when first symptoms appear, May overlap with communicable.
pathogenicity
Ability of the agent to produce an infectious disease in a susceptible host.
virulence
Severity of the infectious disease that results from exposure to the agent.
infectiivty
Infection large number of people.
web of causation
MULTIPLE
epidemiology trinage
single cause
first industrial nurse
ada
What is implicit bias? How can this affect the nursing care you provide?
Implicit bias is when you are unaware of a negative attitude that you have for
someone. You judge them based on this bias and don’t even realize it which in
turn can affect your patient care.
What is a health disparity, what are some of the causes, and what might be an
upstream approach to this problem.
A health disparity is when there is a difference in health outcomes when
comparing two populations. Some causes may be race, discrimination, social
inequality related to resources. Access to healthy food, education, literacy.
Upstream thinking example a community have higher rates of heart disease or
diabetes. Upstream thinking would be to provide healthier food options to that
population. Or provide education about food to the community. Something that
targets the problem before it’s a problem.
What is are the stages in the transtheoretical change model, and how can you use
this model when using motivational interviewing communication skills?
Precontemplation, not thinking about the problem.
o Contemplation knows it’s a problem but still doing it.
o Preparation, bad weighs more than the good.
o Action, change.
o Maintenance, >6 months, change is easy, less cravings.
o Relapse, return to using.
o Using the change model, you can gage with a patient where they are in the
process of changing something. Asking open ended questions to assist the person,
meeting them where they are at but also exploring things to help guide them.
Please list three major changes that have occurred to bring about change to the 21 st
century health care.
More personal responsibility
o The use of technology for advancements
o More patient-centered care
Please describe in your own words the 8 principals of public health nursing.
Do the most good for the most amount of people.
o Include all those who could benefit from the resource.
o The people are your population.
o Integrate EBP within your research and implementation.
o Partnership between the nurse and patient
o Prevention is the priority.
o Include all aspects of a group to obtain most beneficial results.
o Collaboration with other health officials to promote health of the people.
Social determinants of health
o Education access and quality
o Economic status
o Social and community context
o Neighborhood and built environment.
o Health care access and quality
inequities cause
disparities
HiTect Act (how did this help and explain it)
HITECH= health information technology
o Helped communication between health professionals, track, and surveillance.
o Enhance coordination of care, diminish duplication of services and permit
reporting on quality of care.
Public health intervention wheel
a population-based model that is applied to individuals, families, communities, or
within systems and defines 17 public health interventions focusing upon
prevention. It is a way of defining public health nursing by the type of actions
taken on behalf of clients to protect or improve health status.
o Lemuel Shattuck
prepared a report for the Massachusetts Sanitary Commission that pointed
out that much of the ill health and disability in American cities in 1850
could be traced to unsanitary conditions.
dix
metal
breakinride
developing a system of rural healthcare in the remote regions of Kentucky
and throughout the world.
Epidemiology
Science of prevention
o provided knowledge of the natural history of diseases and identified the (risk)
factors that increase a person’s susceptibility to illness.
Theory of reasoned action
Behavior model that emphasizes that individual performance of a given behavior
is primarily determined by a person's intention to perform that behavior.
outreach
locate
at risk
surveleince
monitor
screening
identies
Role of federal government regulation of public health
food, drugs, devices, occupation health, and the environment
who cares for refugees
The U.S. Department of Health and Human Services or USDHHS (USDHHS)
philantrhopic
endowed
politics
influencing the allocation of resources, persuading.
policy
set of principles, targets specific behaviors.
3 benefits of affordable care act
Improve quality, accessibility and reduce costs.
prevention
Nurses focus on modifiable risks.
Risks that can be altered. Like diet, physical exercise, not something like age, sex,
genes.
Health belief model
severity
susceptibility
taking preventative action
what stands int eh way
children’s burea
wald
logic model
Who, what, when where and why
For planning and communication
ROAD MAP
SMART goals
Specific
Measurable
Achievable
Relevant
Time-bound
father of epidemology
Hippocrates of cos
farr
modern statistics
best known epidemiology’s of 19th century
snow
Ethnocentrism
The assumption that others believe and behave as one’s own culture does, or the
belief that one’s own culture is superior to others.
Relative risk ratio
Incidence rate in exposure group/ incidence rate in nonexposed group
If someone is infectious
depends on how it is transmitted.
what is gold standard trials
RCT
descriptive
who what where when
NOT cause
o Analytic:
Investigates the causes and risk factors associated with a particular health
problem It seeks to answer the “how and why” questions.
Descriptive epidemiology research
o Case studies, specific group.
o Survey research, now population.
o Cross-sectional, compare with other variables.
Analytic epidemiology research
non experimental and experimental
non experimental
Cohort: Prospective,
Case-Control: Retrospective,
experimental
Preventive trials and therapeutic trials
RCT’s = gold standard
cold chain
Vaccine that must be stored in a temperature sensitive compartment until
the time it is given. Even in storage and transportation
Assessment questions you would ask about GI symptoms and what would be red
flags.
I would ask about pain, duration, anything make it worse or better.
Medications they take. Lumps, sores, unrelenting pain
Discuss the Tuskegee syphilis trial.
1932 US Public Health Service began longitudinal- experimental study of 600
AA sharecroppers.
399 had syphilis & 201 did not.
Conducted in one of the poorest counties of Alabama.
They were unaware of Syphilis – told it was “bad blood”.
Enticed by free medical care and meals - joined without understanding.
Even when PCN became available they did not treat them —They monitored
them for 40 years to watch progression of disease,
o Many died, many children born with Congenital syphilis.
1972 Peter Buxtun “Blew the Whistle” on the study by putting in the
newspaper.
10-million-dollar class action.
Pick a related topic about Health literacy, informed consent, withholding
medical treatment, or disparity against low socioeconomic and racial
factors. Discuss how this led to many individuals having a lack of trust
with government and healthcare.
Informed consent: It is nurses’ duty according to the ANA code of
ethics to fully disclose all information to participants related to
research and it is the given right to drop out or withdraw a t any times.
It is very unethical to not tell the participants they had the disease and
go on for over 40 years while their family member got the disease at
well.
TB How is it spread? (Transmission)
Tb is a droplet nucleus so that means is spreads in the air. When people
cough, sneeze or encounter upper respiratory fluids it can be spread
from person to person. It is also suspended in the air longer so that is
why a respirator is needed when you encounter an infected person.
TB S/s
Fatigue, fever, chills, night sweats, weight loss, cough that lasts 3
weeks or longer, coughing up blood.
TB who is t risk
HIV patients or people with weakened immune system- diabetics,
chronic renal failure. People in jail or share needles.
Latent vs active TB
Laten TB means they test positive for TB but show no symptoms and don’t
feel sick. They can’t spread TB to others and have a normal chest x-ray. They
still need to be medicated for the disease, so it doesn’t progress into active TB.
o Active TB means the patient is currently showing symptoms.
The four core medications used for treatment for TB and what you would
monitor or educate your patient about.
o Pyrazinamide
gout, especially in patients with diabetes and kidney disease- monitor
uric acid.
o Ethambutol
vision problems, peripheral neuropathy damage to nerves – numbness.
o Rifampin
Turns body fluids orange, stains soft contact lens, less effective birth
control, no alcohol, liver issues, sunburns easily.
o Isoniazid INH
Potential Decreased VIT B6 watch for peripheral neuropathy, tired,
numbness/tingling.
Provide one example of a population who would show signs of a positive
tuberculin skin test at 5mm or greater, 10mm or greater and 15mm or greater.
5mm+
HIV pts, pts with an organ transplant, immunosuppressed pts
o 10mm+
People in countries where the disease is common, Mexico, Vietnam,
pts who abuse drugs, live or work I high risk congregate setting, low
body weight, kids younger than 5.
o 15mm+
Pts with no none risk factors.
Foodborne illness complaints what can the health department and nurses
do?Please list the 6 items in your own words the very important role of the
health department and nurse.
Be up to date on upcoming health problems the community could be a t risk
for via notable disease reports.
o Prevent from a large influx of sickness. We need to investigate the complaint,
identify the source, and correct the problem.
o Intergrade our knowledge of foodborne illness with preparation of practices
within the community.
o Provide training on proper food preparation.
o Provide education.
o Show interest and responsiveness to the pt.
lead
Lead: most common source is homes painted before 1978, affects children’s brains, a lead
level 5 or greater is the level at which action is needed.
Asbestos:
has been used for a range of manufactured goods mostly in building materials,
affects workers who have worked with asbestos, it affects the lungs and can increase your
chance of lung cancer.
Radon:
naturally occurring radioactive gas, can damage lungs and linked to lung cancer
Pesticides:
chemicals used to kill pests, can affect nervous system, irritate skin or eyes,
affects hormone or endocrine system.
Biomonitoring:
process of measuring contaminants in blood or urine to determine
whether a person has been exposed to a contaminant and how much exposure he has
received.
