Test 3 Flashcards
List 5 activities linked with prevention/protection that CHNs do
- Surveillance
- Epidemiological data
- Informed decision-making through education
- Identify risks within the population
- Population level actions (screening, immunizations, and CD control)
Define primordial prevention and provide an example
Prevention of risk factors for disease from existing - attempts to destruct the social and structural inequities that exist
Removal of access to tobacco products and environmental tobacco smoke from public venues
Define primary prevention and give an example
Reduces the impact of specific risk factors, thereby reducing the incidence of disease and can be directed at total populations, selected groups, or even healthy individuals
Protection of health by personal and communal efforts, such as enhancing nutritional status, immunizing against communicable diseases, smoking cessation, and reducing environmental risks - awareness campaigns, education, immunizations, and universal precautions
Define secondary prevention and provide an example
Reduces the prevalence of disease by shortening its duration, and are directed at high-risk individuals not yet accessing health care, or at patients already receiving care
Screening programs for early detection and prompt intervention to control disease and minimize disability - such as mammograms, PAP tests, and metabolic screens
Define tertiary prevention and provide an example
Reduces the impact of long-term disease and disability by eliminating or reducing impairment, minimizing suffering, and maximizing potential years of useful life
Rehabilitation expertise aimed at people with advanced disease - medication education, oral rehydration therapy
Define quaternary prevention and provide an example
Identifies people at risk of medical mishaps (i.e., over-medicalization), protects from new medical treatments that are untested, and suggests interventions that are ethically acceptable
Quality assurance in health care programs that ensure patient safety and best practices
What are the 4 stages of natural history of disease? What levels of prevention allocate to which stage?
- Pre-exposure stage (primary)
- Preclinical stage (secondary)
- Clinical stage (tertiary)
- Resolution stage (tertiary)
Define the pre-exposure stage and what level of prevention falls into this stage
Factors present leading to potential problem development
Primary prevention
Define the pre-clinical stage and what level of prevention falls into this stage
Exposure to causative agent - no symptoms present
Secondary prevention
Define the clinical stage and what level of prevention falls into this stage
Symptoms present
Tertiary prevention
Define the resolution stage and what level of prevention falls into this stage
Problem resolved - returned to health or chronic state or death
Tertiary pervention
Describe the three stages of the iceberg concept of disease and what level of prevention relates to each
Tip of the iceberg - clinical phase of disease (symptomatic disease), tertiary prevention
Middle of iceberg - preclinical phase of disease (no symptoms, but pathogenesis may be occurring), secondary prevention
Deepest part of iceberg - the population (includes those at risk for disease), primary prevention
Define upstream approaches
interventions and strategies focus on improving fundamental social and economic structures in order to decrease barriers and improve supports that allow people to achieve their full health potential
Define downstream approaches
interventions and strategies focus on providing equitable access to care and services to mitigate the negative impacts ofdisadvantageon health
Define epidemiology
The study of the distribution (or patterns) of health events in populations and the determinants or factors that influence those patterns
the distribution and determinants of morbidity and mortality in human populations
Define descriptive epidemiology
Discusses a disease in terms of person, place, and time
Define analytical epidemiology
Linking possible risk factors to disease
What are the 4 principles of epidemiology?
- Health phenomena
- Population
- Distribution
- Determinants
What are the three parts of the epidemiological triangle?
- Agent
- Host
- Environment
Describe the agent of the epi triangle
An animate or inanimate factor that must be present for a disease to develop
Describe the host of the epi triangle
A living, susceptible species capable of being infected/affected by an agent - may be symptomatic or simply be a carrier (i.e., mosquito for malaria)
Describe the environment of the epi triangle
Favourable internal/external surroundings that allow the disease to be transmitted
What is the key goal of the CHN with the epi triangle?
Key goal of public health/community health nurses is to intervene and interrupt the triangle and reduce its effects on the health of individuals
i.e., changing the environment (sanitizing) or improving host health through vaccines
What are the three final clinical endpoints of disease?
- Death (mortality)
- Disability (morbidity)
- Recovery (or remission)
Define mortality and morbidity rate
Mortality Rate: The occurrence of deaths in a population in a given time
Morbidity Rate: The occurrence of disease or health challenges in a population in a given time
Define incidence and prevalence rate
Incidence - The number of new cases over a specific time period
Prevalence - The number of existing cases at one point in time
What is one limitation of clinical endpoints of disease?
Limited in ability to tell us the distribution of diseases
How does incidence inform resource and staffing allocation?
New cases of disease/illness can help inform resource needs and staffing requirements to combat the effects of a disease
Why do we need to know incidence?
Incidence - Gives us information on the transition from healthy to disease; estimates risk of developing disease within a population; useful for evaluating how effective an intervention or program is
Why do we need to know prevalence?
Tells us how much of the population is affected by a disease
Estimates extent of the disease within a population
Useful for allocating resources
Describe the sink example for incidence and prevalence
The tap - Incidence or relapse; new drops of water entering the sink
The sink/bowl - prevalence of the disease
Drain - mortality or remission
Define communicable disease
Illnesses caused by specific infectious agents, or its toxic products that arise through transmission of that agent, or its products from an infected person, animal, or inanimate source to a susceptible host, either directly or indirectly through an intermediate plant or animal host, vector, or the inanimate environment.
Define an endemic and provide an example
Constant presence of a disease in a particular population or geographical area
Pertussis in the USA, Malaria is endemic to specific countries in Africa
Define an epidemic and provide an example
Occurrence of a greater number of cases of a disease, an injury, or other condition than expected in a particular group
One case of polio in Canada; syphilis increasing in Alberta/Canada
Define a pandemic and provide an example
An epidemic occurring in a geographically widespread area or in a large population
HIV/AIDS
Define emerging infectious diseases & provide an example
Those where the incidence has increased in the past two decades or has the potential to increase in the near future
May include new or known infectious disease
i.e., COVID-19 and monkeypox
Define vaccine-preventable diseases
Those which are prevented and controlled by vaccines
Vaccines are one of the most effective ways to prevent and control communicable diseases
i.e., polio
Define non-vaccine preventable diseases
Diseases that cannot be prevented
Malaria, salmonella
Define infectious diseases & provide examples
Caused by a microorganism and is potentially infinitely transferable to new individuals (virus, bacterium, parasite, or fungus)
May or may not be communicable
i.e., STIs, HIV, rabies, e.coli
What are five types of infectious diseases and provide examples of each
- Hepatitis (A,B,C,D,E,G)
- Waterborne and foodborne diseases (salmonella, e.coli)
- Vector-borne diseases (Lyme disease, West Nile virus, Rocky Mountain spotted fever)
- Diseases of travellers (malaria, TB, ebola, cholera)
- Zoonoses (rabies, hantavirus)
What does communicable disease control?
Provides rapid, coordinated, and effective responses to disease outbreaks or threatening situations.
Requires active participation and cooperation of health care professionals and the public.
What are 4 examples of primary prevention in CDC
- Assessment for risk behaviors
- Promoting and implementing immunization programs
- Health promotion & education
- Evaluation of risk behaviors
What are 4 examples of secondary prevention in CDC
- Screening for diseases
- Early diagnosis, identification, and treatment
- Investigation / Contact tracing
- Advocacy for accessible dialogistic and treatment services for socially disadvantaged groups
What are 4 examples of tertiary prevention in CDC
- Monitoring of treatment compliance
- Monitoring effectiveness of treatment
- Surveillance
- Follow-up
Define the process of surveillance
The systematic and ongoing observation and collection of data on disease occurrence to describe phenomena and detect changes in frequency or distribution
What is the CHNs role in surveillance?
play an important role in collecting data, making diagnoses, investigating and reporting cases and providing information to the public
Define active surveillance
The collection of data utilizing screening tools, interviews, and sentinel systems to identify diseases occurrence in the community when individuals present with suggestive symptoms
Define passive surveillance
occurs when a healthcare provider must notify the local health authority to report an identified case of a reportable disease
it is passive since a case typically is presented to the healthcare provider and one is not actively going out looking for sick individuals
Define sentinel surveillance
form of passive and active surveillance in which selected clinicians gather data and pass them on to those responsible for the surveillance.
Use of sentinel sites has become the preferred approach for human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) surveillance for certain countries where national population-based surveillance for HIV infection is not feasible.
What is the preferred type of surveillance for HIV/AIDS?
Sentinel surveillance
Who does CDC surveillance in Canada?
Public health agency of Canada
What three things must the CHN know to determine what constitutes contact?
CHN must know the mode of transmission, incubation period, and infectious period of a particular disease in order to determine what constitutes a contact
What are the three leading causes of death in Canada?
Heart disease, cancer, and diabetes
What type of intervention does injury prevention require?
Primary prevention
What is the first line of defence of the immune system?
The integumentary system
What are the two types of lymphocytes?
B and T cells
Define B cells
Develop in the bone marrow and produce antibodies (IgA, IgD, IgE)
Each B cell has one specific antigen receptor
What happens once a B cell is triggered?
Once triggered, they divide and turn into plasma providing an immune/antibody response
What is opsonization?
When antibodies kill the antigen
When particles, microorganisms, or immune complexes become coated w/ molecules that allow them to bind to receptors on phagocytes, thereby enhancing their uptake
What would IgG and IgM test for?
IgG - would be tested to see if the person has previous immunity due to a vaccine
IgM - would be tested if you currently are infected with something
Define T cells
develop in the thymus gland and help B cells produce antibodies, recognize and destroy cells that have become infected with pathogens, activate phagocytes to destroy the pathogens they “ate,” and regulate the level and quality of the immune response.
Define natural killer cells and provide another name for them
are also lymphocytes that originate from bone marrow stem cells. They do not require activation like B cells and T cells. They’re always ready to fight!!
they immediately kill bacteria once they come into contact
Cytotoxic cells
What type of cell does NOT require activation?
Natural killer/cytotoxic cells
Describe/list the B cell division cycle
Virus - Antigens - B-cell (Native) - B cell activation from antigen - turns into lymphoblast - turns back into B cell - divides into memory B cell and plasma cells - leads to antibodies
Describe the cytotoxic T cell activation cycle
Immature cytotoxic cell divides into activated cells and memory T cells - creates a lethal hit on target cells - target cells die
Describe the helper T cell activation cycle
Antigen binds to helper T cell - cells divides effector cells and memory T cells - divides into neutrophils, macrophages, killer T cells, and B cells
What types of immunity do neutrophils and macrophages provide?
Nonspecific defence
What types of immunity do killer T cells provide?
cellular immunity
What types of immunity do B cells provide?
humoral immunity
Define phagocytes
Types of white blood cells that develop from bone marrow stem cells
Present all over the body, the phagocytes engulf/destroy foreign antigens
Process and present antigens to lymphocytes
What are the 3 types of phagocytes and where are they present?
- Monocytes (circulate in the blood)
- Macrophages (present in tissues)
- Neutrophils (Normally circulate in blood)
Define accessory cells and list the 5 types
Develop in bone marrow and are released into the blood when needed to support the immune system through different processes.
Eosinophils, basophils, mast cells, platelets, and dendritic cells
Define eosinophils
a type of granulocyte that help protect against some parasites by releasing crystalloid enzyme granules. Also contributes to allergic responses.
Define basophils
a type of granulocyte that help mediate the inflammation process by releasing enzyme granules that help with inflammation and allergic responses.
Define mast cells
Attached to blood vessel walls of most tissues and contain granule enzymes such as histamine and platelet-activating factor to help with inflammation and allergic responses
Define platelets
Present in blood and act to seal up (i.e. clot) any broken blood vessels. They also help mediate inflammation.
Define dendritic cells
Look like nerve cells and detect foreign antigens in tissues and present these antigens to T cells.
List the 3 types of immunity
innate, adaptive, and herd
Define innate immunity
Organs, tissues, and cells of the immune system that you are born with
Define adaptive immunity and list its two types
Immunity that develops during your lifetime - active and passive
Define adaptive immunity and its natural and artificial subtypes
Develops in response to an infection or vaccination
Natural - antibodies developed in response to an infection
Artificial - antibodies developed in response to vaccination
Define passive immunity and its natural and artificial subtypes
Develops after you receive antibodies from someone or somewhere else
Natural - antibodies received from mother
Artificial - antibodies received from medicine (i.e., infusion or immune globulin)
What 7 cells make up innate immunity?
macrophage
dendritic
neutrophil
natural killer cell
mast cell
basophil
eosinophil
What two types of T cells exist?
CD4 and CD8
What 6 types of cells make up adaptive immunity
B cell
T cell
antibodies
CD4
CD8
Define humoral immunity and what cells it involves
The arm of the immune system that deals with antigens outside of cells (extracellular)
Involves B cells, T (helper) cells, and antibodies.
Define cell-mediated immunity and what cells it involves
The arm of the immune system that deals with antigens inside cells (intracellular)
Involves T (helper) and T (cytotoxic) cells.
Define hypersensitivity reactions
Hypersensitivity is an exaggerated immune response to an antigen.
Antigens can be harmless and don’t require an immune response, but the immune system reacts anyway.
Immune response is out of proportion to the virulence of the antigen.
Define type I (immediate) hypersensitivity and an example
Develops within minutes of exposure to an antigen.
Involves mast cells and other components to produce acute inflammation.
Can be caused by inhaled or ingested allergens.
Develops after an initial exposure to an antigen, usually with mild reaction.
Immune system is now “primed” for future exposures to the antigen.
Anaphylaxis is a Type I Hypersensitivity reaction.
Define type II (antibody-mediated) hypersensitivity and an example
Caused by antibodies that act on membranes and antigens on the surface of cells.
Membranes can be damaged due to the immune response.
Where the damage occurs depends on which antibodies are involved in the reaction.
Transfusion reactions are Type II Hypersensitivity reactions.
Define type III (immune-complex-mediated) hypersensitivity and an example
Results from deposition of immune complexes (combinations of antigen, antibodies, and other immune system components) into blood vessels and tissues.
If there is severe deposition of immune complexes, disease can result which depends on the site of deposition.
Rheumatoid arthritis is caused by Type III Hypersensitivity reactions.
Define type IV (delayed) hypersensitivity and an example
Reaches its peak more than 12 hours after the exposure to the antigen.
Cells responsible for the response are T cells rather than antibodies (as in Types I, II, and III).
Positive tuberculin skin test is a Type IV Hypersensitivity reaction
A hypersensitivity reaction is considered anaphylaxis if _____ or more of the organ systems are involved
Two
Define inactivated vaccines
Contain whole viruses, bacteria, or toxoids that have been treated so they cannot cause disease
Require booster doses as immunity drops off over time (not lifelong immunity)
Typically cause fewer side effects that occur within hours of immunization and are short-lived
Safe for anyone to receive
Which type of vaccine requires boosters over time?
Inactivated
List examples of inactivated vaccines
Hep A, Polio, Rabies, Japanese Encephalitis, Influenza, Typhoid (injectable)
Define live attenuated vaccines
Contain whole live bacteria or viruses that have been treated or “attenuated” so they are weakened and cannot reproduce in the body
Mimic natural infection
They are, however, still “live” so they could cause disease in immunocompromised individuals; however, they cannot spread
Typically, one or two doses can produce life-long immunity, but not always (e.g. Typhoid requires boosters if still at risk)
Side effects are usually delayed (1-2 weeks after immunization) and if they occur, they can resemble the symptoms of the actual disease (e.g. Varicella vaccine can cause chickenpox-like spots).
List examples of live attenuated vaccines
Measles/Mumps/Rubella, Varicella (Chickenpox), Yellow Fever, Polio (Oral Polio Vaccine), Rotavirus, Influenza (Intranasal) BCG, Typhoid (oral)
What types of vaccines could cause disease in immunocompromised individuals?
Live attenuated
What four vaccines are injectable, three that are oral, and one that is intranasal
Injectable - MMR, Varicella, Yellow Fever, BCG,
Oral - Polio, Rotavirus, Typhoid
Intranasal - Influenza
Define toxoid (inactivated toxin) vaccines
Toxoid vaccines help prevent disease caused by toxins produced by bacteria
Target the toxin rather than the bacteria
Upon exposure to certain bacteria typically through open wounds contaminated with dirt, dust, or feces, the bacteria can produce toxins which cause symptoms and disease
A “tetanus-prone injury” would be a wound that was likely contaminated with a tetanus-containing substance
Route of administration is IM injection
Tetanus and Diphtheria are given together in a combination vaccine
What is the typical route of admin for toxin subunit/conjugate/recombinant/polysaccharide vaccines?
IM
Define subunit/conjugate/recombinant/polysaccharide vaccines
Contain a piece or subunit of the virus or bacteria, rather than the whole thing
The pieces are typically proteins or sugars (polysaccharide) that are presented on the outside of the pathogen that our immune systems recognize as foreign antigens
Sugars often need to be linked or “conjugated” to something else (often Tetanus or Diphtheria toxoid) in order to induce a strong immune response
Often require multiple primary series doses followed by boosters to maintain adequate immunity (not lifelong)
Why are subunit/conjugate/recombinant vaccines referred to as acellular?
Can also be called “acellular” as they do not contain the whole virus or bacteria
Provide examples of subunit/conjugate/recombinant/polysaccharide vaccines
Hep B, Haemophilus influenza type b (Hib), Human papillomavirus (HPV), Pertussis, Pneumococcal, Meningococcal, Zoster (shingles)
Define immune globulin vaccines
Contain pre-made antibodies from another source (most often pooled human plasma of screened donors)
Provide passive immunity
Are considered blood products
Provide immediate protection that is short in duration (around two weeks)
Typically used if exposed client is under or non-immunized
Provide examples of immune globulins
Most commonly used by CHN/PHN include TIG, HBIG, VZIG, RIG (all human origin)
What is the difference between immune globulins and other vaccines?
Immune globulin is only indicated for individuals who ARE NOT previously vaccinated and have come into contact with the virus/bacteria
Define mRNA vaccines
mRNA that code for specific cellular components (e.g. COVID-19 viral spike protein) is isolated from pathogens and added to vaccine
This mRNA then enters host cells of the recipient which begin producing the specific cellular component
The immune system detects the foreign antigen and produces antibodies against it
What occurs with mRNAs and spike proteins?
spike proteins mutate, making the strain of the vaccine less effective or won’t work against the mutated version
List 5 barriers to vaccine access in Canada
- Vaccine administration is a restricted activity
- Rural and remote clients may experience difficulty accessing a provider
- Cost of some non-provincially funded vaccines can be prohibitive (e.g. travel vaccines)
- Proper storage and handling of vaccines can be expensive and complex (e.g. cold chain)
- Religious, cultural, or circle of friends may deter uptake of vaccines
Define vaccine hesitancy
Vaccine hesitancy refers to a delay in acceptance or refusal of vaccination despite the availability of vaccination services
Describe the three stages of the vaccine hesitancy continuum and the two strong end points of it
Accept all with confidence - accept all, but unsure - accept some & delay, refuse some - refuse all, but unsure - refuse all with conviction
Describe the difference between risk associated with vaccines and risk perception
Risk association is very low from vaccines and discusses the severe outcomes and secondary infections that may arise form vaccines - most risk often associated is perpetuated by myths
Risk perception is the fear associated with vaccines and the artificial amplification of risk amplifies from misinformation
How are most live vaccines administered?
Subcu
What type of vaccine is highly recommended in pregnancy? why?
mRNA vaccines are recommended in breastfeeding and pregnancy, as the antibodies produced can be transferred to the baby
What SDOH is the greatest barrier to immunization
Income
What is the ASK approach?
An approach to discussion around vaccines
A - acknowledge concerns
S - steer the conversation by refuting myths
K - provide evidence-informed knowledge
What is the primary way/action of addressing primordial prevention?
Through comprehensive health promotion tools and policy development
Primary care and PHC systems are the main deliverer of ____ prevention strategies in the Canadian health system
Primary
What three levels of prevention have effective strategies but are extremely cost and resource heavy?
Secondary, tertiary, and quaternary
What level of prevention is the highest cost with the fewest impacted?
Quaternary
Addressing the determinants of health through population health and proactive management are related to which level of prevention?
Primordial
What 5 general actions guide the public health/community nursing practice?
- Focuses on entire populations and sub-populations that have similar health concerns or characteristics
- Guided by an assessment of population health status that is determined through a community health assessment process
- Considers the BROAD determinants of health
- Considers all levels of prevention, with a focus on primary prevention
- Considers all levels of practice by including a community focus, a system focus, and an individual/family focus
Define community-focused practice
aimed at entire populations within a community or sometimes toward target groups within those populations
Define system-focused practice
does not deal directly with individuals and community but with systems that have an impact on health such as policies, laws, organizations, and power structures
Define individual/family focused practice
aimed at developing positive attitudes, beliefs, and behaviours in individual(s)
This practice level targets individuals alone or as part of a family, class, or group.
What are the 6 areas that CHNs play a key role?
- Health promotion
- Disease and injury prevention
- Health protection
- Health surveillance
- Population health assessment
- Emergency preparedness and response
What are the four actions of T cells?
- helping B cells make antibodies
- recognizing and destroying cells that have become infected with intracellular pathogens
- activating phagocytes to destroy pathogens that they have taken up
- regulating the level and quality of the immune response
What type of vaccine are a blood product?
Immune globulins
Monocytes circulate and migrate into tissues and differentiate into ____
Macrophages
Which accessory cell constitutes the most amount of blood leukocytes?
Neutrophils
What are the two key features of the adaptive immunity response?
Memory and specificity
Is natural immunity improved by repeated encounters with an agent?
No
Why is passive immunization required over an active immune response?
The individual’s immune response would be too slow or weak
i.e., in response to a snake venom or tetanus
What is the difference between T-dependent and T-independent antigens?
T-independent antigens can stimulate B cells to produce antibodies without the help of T-cells
T-dependent needs both T cells and B cells recognition to elicit an antibody response
Who are the most trusted sources for vaccine information, according to PHAC?
Doctors
What three values are the predominant reasons for vaccine hesitancy, delay, or omission amongst parents?
Safety, efficacy, and effectiveness concerns
What is the most common reason for parents to decide to have their child vaccinated, despite initial reluctance?
Advice from a doctor or health care professional
What is the incubation period of rabies?
Can be as short as 5 days or as long as several years - usually 20-60 days
What is the flu antigenic drift/shift and what type of flu virus does it affect?
Minor antigenic changes in type A result yearly and influence epidemics and regional outbreaks
Shift refers to new subtypes of the type A virus
What does DOT intend to do for the population and individual in regard to TB?
Nurses watch the client daily to ensure they take their TB meds daily so the TB does not become antibiotic resistant programs are aimed at
the population level to prevent antibiotic resistance in
the community and to ensure effective treatment at the individual level.
