NU 302 Exam 3 Flashcards
What is epidemiology?
The study of causal mechanisms of diseases and methods for disease and control
What is an epidemic?
Increase in occurrence in a specific community or region
What is a pandemic?
Increased occurrence or outbreak world-wide
What is R-Zero (reproduction number)?
How many people may be affected by the disease
What is the attack rate?
Number of new cases/number of individuals at risk.
What is included the epidemiology triad?
The host, agent, and environment
What is a host?
Susceptible human or animal who harbors and nourishes a disease-causing agent. May have ability to resist infection
What is an agent?
A factor that causes or contributes to a health problem or condition.
What is an environment?
All the external factors surrounding the host that might influence vulnerability
What does the chain of causation explain?
The causation in infectious diseases
What is the chain of causation in order?
Reservoir > Portal of Exit > Mode of Transmission > Agent > Portal of Entry > Host
What is a web of causation?
Multiple factors that may contribute to an illness. Theoretically, breaking any chain nearest the outcome should stop the web.
What is immunity?
A host’s ability to resist a particular infectious disease causing agent.
What is passive immunity?
Short term resistance such as a transfer of antibodies from mom to baby. Naturally acquired.
What is active immunity?
Long term; may be long and may be natural or artificial.
What is cross immunity?
May be passive or active. Exposure to one infection may increase immunity to another.
What is herd immunity?
Level of immunity to a group of people.
How do you calculate the relative risk ratio?
exposed group/ unexposed group
What are the stages of disease?
Susceptibility- not exposed but may be more susceptible
Subclinical- Exposed but asymptomatic
Clinical—Signs and symptoms of the disease develop
Resolution-May return to health may have chronic conditions
During which of the following stages would the community health nurse first expect to see signs of a disease via laboratory testing?
A. Susceptibility stage
B. Subclinical disease stage
C. Clinical Disease Stage
D. Resolution stage
C. Clinical Disease Stage
What is descriptive epidemiology?
Investigates patterns of health conditions. Includes counts and rates.
What is analytic epidemiology?
Includes prevalence studies, case-control studies, and cohort studies.
What is incidence?
Number of new cases of a specific disease or condition during a period of time.
How do you calculate incidence?
Number of persons developing disease(new cases)/total number at risk per unit of time.
What is prevalence?
All active cases of a disease or condition at a given point in time.
How do you calculate prevalence?
Number of persons with disease/number of people in a population.
A study was looked at diabetics over a one year time period. It included those who had diabetes at the onset of the study as well as those who were diagnosed during the one year time. What would the study be looking at?
Prevalence
A study looked at diabetics newly diagnosed over a 1 year time period. What would the study be looking at?
Incidence.
What is morbidity?
Incidence of the disease
What is mortality?
Death rate or sum of deaths
What is the research process for an epidemiological study?
- Identify the problem
- Review the literature
- Design the study
- Collect the data
- Analyze the findings
- Develop conclusions
7 Disseminate the finings
What is the location of a community?
Community boundaries, geographic features, climate
What is the population of a community?
Size, density, composition, cultural characteristics
What are social systems of a community?
Variables, healthcare delivery system
What is a population profile?
Size,density, rate of growth or decline, health status, social class, poverty level, unemployment rate
What are social determinants of health?
Social factors and the physical conditions in the environment in which people are born, live, learn, play, work, and age.
What is a windshield survey?
A drive-through of the community. Allows you to assess needs, condition of buildings, homelessness, places for employment, schools, libraries health clinics, and hangouts.
T or F, a survey examines the amount of distribution of a disease.
False. An epidemiological study examines the distribution of a disease.
How is primary data gathered?
By talking to the people
How is secondary data obtained?
Records produced by people who know the community well.
Describe a formative evaluation process.
Focus on process during actual interventions; development of performance standards.
Describe a summative evaluation
Focus on the outcomes of interventions; effect; impact.
Describe direct transmission (think about chain of causation)
Occurs by immediate transfer of infectious agents from a reservoir to a new host
Describe indirect transmission
Occurs when the infectious agent is transported within contaminated inanimate materials such as air,water, or food (vehicle-borne transmission)
What is vector transmission?
Occurs when the infectious agent is carried by a vector (nonhuman carrier such as an animal or insect)
What are some examples of bacteria, viruses, or parasites that can be transmitted via food and water.
Salmonella, Shigella, E. Coli, Giardia, Hep. A
Define direct contact
May occur through direct skin to skin contact (s bites) or direct contact with blood or bodily fluids.
What are examples of illnesses spread via direct contact?
HIV, Hepatitis, herpers zoster
Define indirect contact
Pathogens may be transferred via hands, equipment, clothings, toys etc.
What are examples of pathogens spread via indirect contact?
MRSA, VRE, ESBL, CRE
Define enteric contact.
Organisms are spread via spores
What organisms are spread via enteric contact?
C-diff and norovirus
What equipment is used for contact precautions?
Gown and gloves
What equipment is used for enteric contact precautions?
Gown, gloves, ALWAYS soap and water.
What is droplet transmission?
Spreads droplets when an individual coughs, sneezes, or talking.
What diseases are spread via droplets?
Flu, pertussis, RSV, meningitis
What are droplet precautions PPE?
Basic surgical mask
What is airborne transmission?
Droplets remain suspended in the air for some time.
What are examples of airborne diseases?
TB, shingles, chickenpox, measles, COVID-19
What are airborne precautions?
N-95 respirator, patient in negative pressure room.
Which of the following would you apply droplet precautions?
A. TB
B. Pertussis
C. MRSA
D. Shingles
B. Pertussis is spread via droplets. TB requires airborne precautions. MRSA would require contact precautions as well as shingles.
What is the time between exposure to disease and presentation of s/s for flu?
1-4 days
What is the time between exposure to disease and presentation of s/s for whooping cough?
7-10 days ( can be as long as 21)
What is the time between exposure to disease and presentation of s/s for shingles?
14-16 days
What is the time between exposure to disease and presentation of s/s for hand, foot, and mouth?
3-6 days
What is the time between exposure to disease and presentation of s/s for Ebola ?
2-21 days
What is the time between exposure to disease and presentation of s/s for COVID-19
14 days
Define the incubation period
Time between exposure to disease and presentation of signs and symptoms.
What are s/s of shingles?
Fever, headache, chills, upset stomach, blisters. Dissemination crosses dermatomes.
What are s/s of flu?
Fever, chills, headache/body ache, sore throat, stuffy nose, fatigue.
When can you get a flu shot?
6 months and older.
What is COVID-19?
Respiratory virus caused by a coronavirus strand known as SARS-CoV-2
It is airborne, droplet, and contact.
What PPE is required for COVID-19?
Gown, gloves, N-95, face shield.
Who are the most vulnerable to COVID-19?
Adults age 65 and older. Nursing home residents. Immunocompromised. Individuals with chronic health conditions (COPD, Diabetes, Heart Disease, Obesity)
What are the s/s of COVID-19
Fever, chills, cough, headache, SOB, fatigue, body aches, muscle aches, loss of taste or smell, congestion or runny nose, nausea, vomiting, diarrhea.
How is hepatitis A transmitted?
fecal-oral route
What are the s/s of hepatitis A?
fever, malaise, nausea, abd
pain, jaundice
How is hepatitis B transmitted?
Transmitted via blood and bodily
fluids. Commonly spread through
unprotected sex and sharing of
needles.
What are some complications of Hep B?
Can cause liver cancer, failure, and
death
What are some complications of Hep A?
Can result in chronic liver disease
How is hepatitis C transmitted?
Transmitted via blood or sexual
contact
What are some complications of Hep C?
Causes infection of the liver and
chronic disease
Which variations of Hepatitis have vaccines?
A and B
T or F, there is a vaccine for Hepatitis A,B, and C
False. There is no vaccine for hepatitis C
Which form of Hepatitis is transmitted via the fecal-
oral route?
* Hep A
* Hep B
* Hep C
* Hep B & C
Hepatitis A
How is HIV/AIDS transmitted?
Transmitted through blood and body fluids
What does HIV/AIDS do?
Attacks the body’s immune system making individuals
more susceptible to disease and infections
What is AIDS?
AIDS is the condition that results from the infection with
HIV
T or F, HIV individuals may be symptom free for some time
True
What can influence the progression of HIV/AIDS?
Age of onset
What pathogen causes Tuberculosis?
Caused by mycobacterium tuberculosis
What are the signs and symptoms of tuberculosis?
prolonged cough, fatigue, loss of
appetite, weight loss, night sweats, blood in sputum
What is directly observed tuberculosis treatment?
Insures that clients take daily and
intermittent prescriptions
* Labor intensive
* Meet clients where they are
What is latent TB?
The TB pathogen is in your body but not active.
How is chlamydia transmitted?
sexual contact and maternal transmissio
What are the s/s of chlamydia in women?
vaginal discharge (mucus often yellow tinged),
odor, UTIs, lower back pain, bleeding in between periods
What are the s/s of chlamydia in men?
inflammation in the urethra, watery discharge,
burning and itching in the urethra, lower back and testicular pain
T or F/ chlamydia patients can be asymptomatic
True
What causes gonnorhea?
Neisseria gonorrhoeae bacteria
What are the s/s of gonorrhea in men?
purulent drainage and painful urination
What are the s/s of gonorrhea in women?
vaginal discharge, bleeding after discharge, may also
be asymptomatic
How is gonorrhea treated?
With antibiotics
What causes syphilis?
spirochete Treponema pallidum
What are s/s of primary syphillis?
chancre appears at entry site
What are s/s of secondary syphillis?
Lesions appear on hands, feet, and trunk. Other symptoms
include rash, fever, sore throat, fatigue, lymphadenopathy
What are s/s of tertiary syphillis?
neurological effects including deafness, cranial nerve palsy,
meningitis or even death
How is syphilis spread?
Spread through contact with the lesions or from mother to baby
How is syphilis treated?
Treated with penicillin
What pathogen causes genital herpes?
Herpes simplex virus type 1 & type 2
What are the s/s of genital herpes?
fever, malaise, lesions or blisters on genitalia, rectum, or mouth
True or False, there is a cure for genital herpes
False
How do you treat genital herpes?
May use antiviral meds (Acyclovir) to treat outbreaks
What pathogen causes viral warts?
human papillomavirus (HPV)
How are viral warts transmitted?
via direct skin-to-skin contact or from mother to baby
How long is the incubation period for viral warts?
Incubation period may be 2-3 months
What are complications of viral warts?
May lead to cancer of the anus, cervix, vulva, vagina, or penis
True or False, viral warts are vaccine preventable
True
Describe viral warts
May appear as flat or raised bumps or may be shaped like cauliflower. Lesions may also
occur in the throat or respiratory tract
True or False: Quick treatment of Chlamydia and Gonorrhea can prevent the spread of
the disease.
True
* Rationale: Screening programs which include early recognition and expedited treatment
have actually reduced the incidence of Chlamydia and Gonorrhea
What are methods of primary prevention for preventing the spread of communicable diseases?
Mass media education campaigns
* One-on-one education
* Immunization
What are secondary methods of prevention for communicable diseases?
Screening and
disease
investigation
What are tertiary methods of prevention for communicable diseases?
Ensure additional
people not infected
* Ill receive care and
treatment
Which activity would the community health nurse
be involved with at the primary level of
prevention?
A. Screening
B. Partner notification
C. Immunization
D. Isolation
. Immunization
Rationale: Primary level of prevention activities
would include education and immunization.
Screening, partner notification, and case and
contact investigation are secondary level of
prevention activities
What did Hippocrates contribute to the study of epidemiology?
Greek physician who recognized that there were natural causes of disease. Recognized environmental and living habits affected health.
What did Thomas Sydenham do?
Observed London fevers (1660’s-1670’s)
What did James Lind discover?
Relationship of diet and disease and prevention of scurvy
What did Edward Jenner do?
Discover the smallpox vaccine
What did Ignaz Semmelweis do?
Promoted hand washing in the hospital to reduce the number of maternal deaths
Who is John Snow?
Investigated cholera epidemic and is known as the father of
epidemiology
Who is Florence Nightingale?
monitored and cared for soldiers from the Crimean war,
used statistical methods and graphs and coding system for medical conditions.
What are the principles of public health nursing within the community?
- Focus on the community
2. Give Priority to Community Needs
3. Work in Partnership with People
4. Focus on Primary Prevention
5. Promote a Healthful Environment
6. Target all who might benefit
7. Promote optimum allocation of resources
8. Collaborate with others in the community.
What are the Dimensions of Community as a
Client (Donabedian’s Model)
Status/people: morbidity and mortality data identifying physical,
emotional, and social determinants of health
Structure: services and resources
Process: ability to function effectively
List the different community assessment methods
SURVEYS
DESCRIPTIVE EPIDEMIOLOGIC STUDIES
COMMUNITY FORUMS/TOWN HALL MEETINGS
FOCUS GROUPS
Which of the following is not a universal imperative of care?
A. Mortality
B. Morbidity
C. Collaboration
D. Cost
C. Collaboration
The era of long term conditions is a result of what?
A. Chronic conditions often from infectious disease
B. Decreased tobacco use
C. Water sanitation
D. Shorter life expectancies
A. Chronic infections often from infectious disease
T or F, 680 million people die annually from illnesses linked to unsafe drinking water.
True
T or F Vaccines prevent 2.5 million deaths amongst children 5 and younger annually.
T
Which of the following is not a component of oral hydration therapy?
A. Salt
B. Magnesium
C. Sugar
D. Potassium Chloride.
B. Magnesium
Which region has the highest number of deaths from TB?
A. Asia
B. South America
C. Africa
D. Europe
C. Africa
Which of the following is not a leading cause of death in developed countries?
A. Ischemic heart disease
B. Pre-term birth
C. Self harm
D. COPD
B. Pre-term birth
Which agency is the leading global agency focused on health?
A. World Health Organization
B. World Health Assembly
C. United Nations
D. Centers for Disease Control and Prevention.
A. World Health Organization
The combination of years of life lost because of premature mortality and years lived with disability is known as
A. Global burden disease
B. Disability adjusted life year
C. Mortality
D. Disability adjusted global burden
B. Disability adjusted life year
Interruption of person-to-person transmission so that no further preventative efforts are needed.
A. Prevention
B. Elimination
C. Eradication
D. Worldwide control
C. Eradication
T or F Education about pre-natal care is secondary prevention
False
Which of the following is not a symptom of ebola?
A. Hemorrage
B. Fever greater then 100.4
C. Diarrhea
D. Cough
Cough
Describe what viral warts look like
May appear as flat or raised bumps or may be shaped like cauliflower. Lesions may also
occur in the throat or respiratory tract
What is the structure of a community?
(Donabedian’s Model)
services and resources
What is the process of a community
(Donabedian’s Model)
ability to function effectively
What is the status/people of a community?
(Donabedian’s Model)
morbidity and mortality data identifying physical,
emotional, and social determinants of health
What is the first step of change?
Unfreezing: An internal or external factor causes someone to want to change
What is the second step of change?
Changing/moving: People experience a series of attitude transformations, ranging from questioning to full acceptance and commitment, then finally change.
Ex. Prenatal participants learn new exercises or senior citizens learn how to make their homes safer.
What is the third step of change?
Refreezing: When change has been established as a permanent part of the system. Involves integrating or internalizing the change and maintaining it
What is the cognitive domain of learning?
Deals with recalling and recollection of knowledge and development of intellectual abilities and skills.
What is the affective domain of learning?
Learning through emotion, feeling, or affect. Deals with changes in interests, values, and attitudes.
What is the psychomotor domain of learning?
Includes demonstratable performance skills that require some sort of neuromuscular coordination.
Describe the Health Belief model
Explains the actions people take to prevent illness and injury. Readiness to act on behalf of a person’s health based on
1. Perceived susceptibility
2. Perceived seriousness
3.Perceived benefits of action
4. Barriers to taking action
5. Cues to action
6. Self-efficacy
Describe Pender’s Health Promotion model
Focuses on predicting behaviors that influence health promotion.
Individual characteristics and experiences interact with behavior specific cognitions and affect to influence behavior outcomes.
Describe the era of infectious diseases
Death rate was high due to people dying from infectious diseases. Life expectancy was not very long. Families had many children because they knew most would die before adulthood. High birthrate. Depended on their children for care as older adults. Often died from the plague, TB, or measles
Describe the era of chronic coniditions
People survived common infections thanks to antibiotics and live longer. Life expectancy increased. Birth rate dropped. People survived infections and aged, developing long-term chronic conditions like heart disease, and cancer.
What are the leading causes of death in African regions?
Lower respiratory infections, HIV/AIDS, Diarrhea diseases, ischemic heart disease, malaria, TB, stroke, preterm birth complications, birth asphyxia, road injury
What are leading causes of death in European regions?
Ischemic heart disease, stroke, Alzheimers and other dementias, trachea, lung and bronchus cancers , COPD, colon and rectum cancer, lower respiratory infection, DM, cirrhosis of liver, and breast cancer
At what temperature range do bacteria contaminating food grow and multiplty?
39-140F
What is the minimum internal food temp for poultry?
165F
What is the minimum internal food temp for seafood and beef?
145F
What is the minimum internal food temp for ground meats and eggs?
160F
What temp is refrigerator temp?
40F
Define elimination of a disease
Removing it from a certain region (not completely gone)
What is eradication of a disease?
No further prevention measures needed (like smallpox)
What is Ebola and list interventions?
Transmitted via bodily fluids or nonhuman vector. Avoid touching infected bodily fluids or, animals.
What is TB and list some interventions?
Bacterial infection of the lungs that can spread to the rest of the body. Avoid contact with infected invididuals. Avoid coughing on other people.
What is malaria and list some interventions
Parasitic infection transmitted via mosquito. Use insect repellent, wear long sleeved clothing, remove standing water.
What is HIV/AIDS and list some interventions
Virus that attacks the body’s immune system. Practice-safe sex, avoid sharing needles use prophylaxis if exposed
T or F, Malaria is a leading cause of death in developed countries?
False; it is in the top 10 for DEVELOPING countries
T or F, one half of the leading causes of death are communicable diseases
True; of the 10 leading causes of death, 5 are communicable diseases
List the universal imperatives of care in order of important
Mortality- number of deaths
Morbidity- rate at which people are getting sick or have symptoms
Daily functioning- ability to care for yourself
Decision making- having options to choose from
Cost- who’s responsible for costs
T or F, the primary universal imperative is morbidity?
False, mortality is the first priority
Describe the World Health Organization
Leading global agency focused on health, born from U.S., creates policy, support to governments, World Health Assembly highest governing body within
What is the highest governing body within WHO?
WHA
What is normative-reeducation strategies?
New information, persuasion and rewards
What is coercive change?
May have repercussions/consequences. May be based on influence of power
What is the ILO?
International Labor Organization- focuses on working conditions
What is UNESCO?
United Nations Educational Scientific and cultural Organization- focuses on educational issues
What is the GBD?
Global Burden of Disease- calculation of health disparities
Give examples of social determinants of health
Safe housing, safe workplaces, quality education, adequate community resources, clean water, food, and air, access to social and economic opportunities, equitable social interactions
What did Bandura’s theory include?
Coincidental association, inappropriate generalization, perceived self-inefficacy
What was Maslow’s theory?
The hierarchy of needs (review the pyramid)
What is Knowles theory?
Adult learners, self directed, life experience, readiness to learn, problem centered time perspective
Which characterizes normative–reeducative
strategies for change?
A. Persuasion
B. Coercion
C. Rationality
D. Best interests
A. Persuasion
Rationale: The normative–reeducative strategy involves new
information that directly influences people’s attitudes and
behaviors through persuasion. Empiric–rational strategies are
used to effect change based on the assumption that people
are rational and when presented with information will adopt
new practices that appear to be in their best interest. Power–
coercive strategies use coercion based on fear to effect
change.
What principles afffect change?
Participation
* Resistance to change
* Proper Timing
* Interdependence
* Flexibility
* Self- understanding
A community health nurse develops a
written teaching plan for an individual
regarding a low cholesterol/ low fat
diet. The client is comparing fat content
in various food products This
demonstrates which phase of learning
in the cognitive domain?
A. Knowledge
B. Application
C. Analysis
D. Synthesis
C. Analysis
Comparing indicates the client is analyzing. Synthesis would be putting it into
practice with his meals. Knowledge would be listing specifics, and application
would be using the specifics of knowledge such as trying new foods.
Is the following statement true or false?
* Skinner is a behavioral theorist who used conditioning with
reinforcement.
True
* Rationale: Skinner is a behavioral theorist who addresses
conditioning with reinforcement, such that successive
systematic changes in a learner’s environment enhance the
probability of the desired response
Which health teaching model explains the
behaviors and actions taken by people to prevent
illness and injury?
A. Health Belief Model (HBM)
B. Health Promotion Model (HPM)
C. PRECEDE mode
A. Health Belief Model (HBM)
* Rationale: The HBM is useful for explaining the
behaviors and actions taken by people to
prevent illness and injury.
* The HPM includes three general areas:
individual characteristics and experiences,
behavior-specific cognitions, and behavioral
outcomes.
* The PRECEDE model involves social,
epidemiological, and education/ecological
assessments followed by administrative and
policy assessment and intervention alignment,
and implementation
What are examples of primary prevention?
Immunization
* Healthy eating habits
What are examples of secondary prevention?
BP control with HTN
Dx
* Screenings
What are examples of tertiary prevention?
Tertiary
* Support Groups
* Rehabilitation after
stroke
What is the leading (1st) cause of death in developing countries?
Lower respiratory infection
What is the leading (1st) cause of death in developed countries?
Ischemic heart disease
Compare the causes of death in developing and developed countries
In developing countries there are more deaths due to communicable diseases.
In developed countries there are greater numbers of death due to non-communicable diseases.
Is the following statement true
or false?
One half of the leading
causes of death are
communicable diseases.
True
Rationale: Of the 10 leading
causes of death, 5 of the causes
are communicable diseases.
How do you prevent shingles?
Get an immunization
How do you prevent HIV?
Avoid infected bodily fluids and blood, avoid sharing needles, utilize pre-exposure prophylaxis and post exposure prophylaxis.
How can you prevent TB?
Avoid infected individuals, use N-95 respirator
How can you prevent STIs/STDs?
Abstinence, vaccination, reduce number of sex partners, condoms
What are s/s of Hep B?
Anorexia, fatigue, light or gray stool, nausea, vomiting, dark urine, fever
What treatment is used for HIV/AIDS?
antiretroviral therapy (ART)
Describe a windshield survey
Nurse walks/drives around the community to identifty physical, eonomic, social, and service related factors of the community.
Describe a problem-oriented assessment
Adresses a specific problem instead of the community as a whole. INvolves gathering local incidence and prevelance data, identifying services, and interviewing officials about policy.
Describe a community subsystem assessment
Focuses on one element of the community ( ex. religious organizations) to discover it’s role, what kinds of needs do it’s people believe exist, and what services it offers.
Describe a comprehensive assessment for a community
Obtain all relevant info on a community. Can interview key leaders for information, obtain data such as population size and density. Describes the community power dynamic and it’s systems.
Describe a community assets assessment
Looks at the strengths of a community rather then its weaknesses. Identifies individuals or organizations with beneficial skills, organizations controlled by the community, non-local organizations controlled outside the community.
What physical aspects of the community does a windshield survey inspect?
Condition of buildings, signs of pollution, open spaces for building, community boundaries
What are economic aspects of the community a windhsield survey inspects?
Are there homeless people, are there soup kitchens, is the community thriving
What are service aspects of a community assesed by a windshield survey?
Availability of churches, health services, schools, libraries, police/fire services.
What social aspects are assessed by a windshield survey?
Local hangouts, individuals views on the community, diversity of population.
What are the major risks for CAUTI?
Using and indwelling urinary catheter and the length of its use
