older adults, postmortem, maternal, adolescents

• Childbearing Women

• Pregnant Adolescents

• Infants

• Children through Adolescence

Maternal and Child Health Populations

LBW Risk Factors

• Lifestyle

  • (smoking, secondhand smoke, nutrition, alcohol and drugs, violence, prenatal care)

• Sociodemographic

  • (maternal age below 15 and above 35, low educational levels. Poverty, violence, unmarried)

• Medical history

  • ( maternal age below 15 and above 35, low educational levels. Poverty, violence, unmarried)

    • cam lead to conjunctivitis, neurological damage, blindness, sepsis, and still birth, LBW

• gestational history

Access, location, fear, drug/alcohol/physical abuse. Covering it up

What are barriers to prenatal care?

• FAS, small for gestational weight, developmental, school, coordination difficulties, vision and hearing problems, sleeping disturbances.

• Fetal alcohol spectrum disorders (FASD)

• Fetal alcohol syndrome (FAS)

• Alcohol-related birth defects (ARBD)

• Alcohol-related neurodevelopmental disorder (ARND)

alcohol abuse in maternal affects on infants?

• LBW, preterm births, withdrawal, CNS abnormalities, miscarriage, placental abruption, developmental delays

• Often associated with limited prenatal care, inadequate nutrition, low prepregnancy weight, hypertension, more rapid heart rate, high rates of depression, physical abuse, HIV/AIDS, and other STDs

• Increased risk for intrauterine fetal death, increased risk for infection, birth defects, neurologic problems, learning disabilities

• Fetal growth restriction; neonatal withdrawal

maternal drug abuse affects on infants

• ectopic pregnancy, spontaneous abortions, intrauterine growth retardation, preterm birth, stillbirth, increased perinatal mortality, small-for-gestational-age birth, low birth weight, neonatal anomalies, and lower APGAR scores

• Passive smoking: associated with decreased head circumference, depressed cognitive development,

maternal tobacco abuse affect on infants?

High stress, may prevent smoking cessation, or stopping of drugs/alcohol. May prevent prenatal care

maternal Intimate partner violence affect on mom and baby?

• LBW, still birth, conjunctivitis, blindness, deafness, liver dx, neurological damage, premature rupture of membranes, cervical cancer, infertility, PID

Infection of neonate while passing through birth canal

• cirrhosis, neonatal sepsis, and pneumonia

• Maternal premature rupture of membranes and resultant infection; possible premature onset of labor

• If the mother is HIV-positive, breast-feeding not recommended

maternal STIs affects on mom and baby

• educate.

• Primary prevention – encourage healthy lifestyles, birth control,

• secondary – early detection, education, resources for smoking cessation, alcohol and drug abuse resources esp. once pregnant

What can a community health nurse do in regards to substance abuse/partner abuse, STIs behaviors?

25-35lbs

what is the average weight gained by mom with BMI 18.5-24.9 during pregnancy?

preterm births, LBW, Preeclampsia

Maternal periodontal disease linked to

28-40lbs

what is the average weight gained by mom with BMI <18.5 during pregnancy?

15-25lbs

what is the average weight gained by mom with BMI 25-29 during pregnancy?

low birth weight, premature birth, perinatal mortality

Inadequate weight gain related to …

c-sections, large baby, maternal retention of excess weight

Excessive weight gain possibly leading to ..

GD, UTIs, wound infection, thromboembolism, hypertension of pregnancy, fetal monitoring difficulties, prolonged labor, and birth trauma

obesity during pregnacy puts at higher risk of…

• preterm delivery, neonatal, and post neonatal mortality

• Increased psychological risks for teen mothers

• Less likely to receive early and continuous prenatal care

• more likely to use alcohol and smoke during pregnancy

• Emotional need

Infants born to teenage mothers: increased risk for

• HTN – preeclampsia

• Gestational Diabetes

• Postpartum Depression

• Fetal or infant death

common pregnancy complications

seizures, renal failure, liver rupture – bleeding issues, pulmonary edema

HTN in pregnancy can cause

HBW babies, risk for type 2 diabetes

GD in pregnancy can lead to …

postpartum visits, support, exercise, education on symptoms, therapeutic communication, teaching relaxation techniques

PHNs role in supporting those with postpartum development?

less allergies, asthma, dermatitis, diabetes, higher IQ scores, less obesity

what are the long term benefits of baby sleeping on back?

• Issues with lactation and latching.5

• Concerns about infant nutrition and weight.5

• Mother’s concern about taking medications while breastfeeding.5

• Unsupportive work policies and lack of parental leave.6

• Cultural norms and/or lack of family support.6

• Unsupportive hospital practices and policies

what are the barriers of breastfeeding?

american indian/ alaska native

what ethnicity have highest death rate from injury?

suffocation

leading cause of infant deaths

(asthma, autism, sickle cell anemia, food allergies, MD, and CF)

chronic diseases in Infants, Toddlers, and Preschoolers

F; infants

bronchiolitis most common adoelscents. T or F

Healthy People 2020 Objectives for Childhood

1. Increase the proportion of children and adolescents who communicate positively with their parents.

2. Increase the proportion of children whose parents read to them at least 4 days per week.

3. Increase the number of children who get sufficient sleep.

4. Increase the proportion of children with developmental delays who get intervention services by age 4 years.

SIDs

• Cx unkown

• may be associated with brainstem control of heart and lung functions

• more common in children assigned male at birth and most often occurs in infants between 1 and 4 months of age

• lead cx of death in infants

• Asthma

• Autism

• Diabetes

• Juvenile rheumatoid arthritis

• Seizure disorders

chronic diseases in school age children

1. Overcrowded conditions

2. Air pollution

3. Allergens

4. Cigarette smoke

5. Infections

6. Stress

7. Exercise

8. Weather changes

what triggers asthma?

asthma

•13% of Children < 18 have been diagnosed

•One of the top reasons for children being hospitalized

to help ppl with asthma achieve better health

what is EXHALE used for?

EDUCATION on asthma self-management

E in EXHALE

eXtinguishing smoking and exposure to second hand smoke

X in EXHALE

HOME visits for tigger reduction and asthma self management education

H in EXHALE

ACHIEVEMENT of guidelines based medical management

A in EXHALE

LINKAGES and coordination of care across settings

L in EXHALE

ENVIRONMENTAL policies or best practices to reduce asthma triggers from indoor, outdoor, or occupational sources

last E in EXHALE

• monitoring

• medication side effects

• healthy lifestyle promotion

what is tertiary prevention for school age kids with diabetes?

• monitor BMI

• screenings

• early treatment

what is secondary prevention for school age kids with diabetes?

• promote good nutrition

• healthy food choices

• exercise

what is primary prevention for school age kids with diabetes?

fish, shellfish, soy, milk, eggs, wheat, peanuts, tree nuts

most common food which account for allergies?

Autism (ASD)

• Focus on early detection and intervention

• Affects 1 of every 59 children 8 and under

• Boys 5x more likely

• Social and Communication Issues

• Unusual interests and behaviors

seizure disorders

•May increase risk for ASD, mental health disorders, and physical co-morbidities

• Appropriate training necessary for occurrence of seizures

1. Tegretol

2. Dilantin

3. Depakote

4. Neurontin

5. Topamax

6. Diazepam

what medications are common for those with seizure disorders?

• Flu

• RSV

• Measles

• Mumps

• Pertussis

• Head Lice

• MRSA

what are common communicable diseases in school age children?

flu

• Symptoms: fever, cough, sore throat, runny nose, body aches, headache, fatigue, nausea, vomiting

• Spread via droplets

• Vaccine available for 6 months or older

• Complications – pneumonia, dehydration, encephalopathy, ear infections

RSV

• Symptoms include fever, runny nose, coughing, sneezing, decrease in appetite

• Especially dangerous to premature infants, very young infants, and children under 2.

• Can cause bronchiolitis and pneumonia

mumps

• Signs and symptoms include:

  • Fever

  • Headache

  • Muscle aches

  • Tiredness

  • Loss of appetite

  • Swollen and tender salivary glands under the ears on one or both sides (parotitis) results in puffy cheeks

• Vaccine is Available

• May begin 16-18 days after infected.

• Spread via saliva or mucus

measles

• Signs and Symptoms include:

  • fever, cough, runny nose, red, watery, eyes, rash, and Koplik spots

• Koplik spots may appear 2-3 days after symptom onset

• Vaccine available

• Airborne transmission.

pertussis/whooping cough

• Symptoms can include:

  • runny nose, low-grade fever, mild occasional cough, apnea (in babies), cough, vomiting, exhaustion

• Vaccine available. – Booster every 10 years

• Caused by Bordetella pertussis.

• Treat with antibiotics.

• Droplet transmission

Pediculus humanus var. capitis/ lice

• Spread by close contact, sharing hats, brushes, accessories, pillows, towels

• Treatment includes RID or prescription (Ulesfia & Natroba)

MRSA/Methicillin resistant Staphylococcus aureus

• Skin infections

• May spread through close contact, gyms, sports equipment, towels, sharing razors

• Education on hygiene, not sharing products, washing linens

• Learning disabilities

• ADHD

• Behavioral and emotional problems

• Disabled children

common Behavioral and learning problems

• Reading Problems

• Writing Problems

• Math Problems

• Language Problems

• Motor Problems

• Sequencing

• Memory

common learning disabilities

childhood cancers

• Improved outcomes – Survival rate 86%

• Later complications in life – 95% of childhood cancer survivors

• Affects school attendance

• Weakened immune system

• #1 cause of death due to disease in children

suicide

is 2nd leading cause of death in 10-19 year olds.

• Depression

• Suicidal ideation or attempts

• Fear and anxiety

• Eating Disorders

common Adolescents: Emotional Problems

Immunizations and TB testing

Education and social services

Preventive health programs for adolescents

• Safety and injury prevention

• Infectious diseases

• Child protective services

• Oral hygiene and dental care

Health protection program for adolescents

Lina Rogers Struthers

who was the first school nurse?

contagious diseases; NOW chronic diseases

what was school nurses initial focus?

• health promotion

• collaborates

• clinician

• work w school officials to ensure a safe and healthy school environment

• conduct screenings and promote wellness

• positive working relationships with administrators, teachers, and families

what are the roles of a school nurse?

• G tube feedings

• Catheterization

• Diabetes management and insulin pumps

• Screenings (vision, hearing, scoliosis, TB, BMI, oral health)

• First aid and emergency response

• Medication Administration

school nurse responsibilities

Gerontological Nursing

• The aging process

• Holistic approach

• Focus on improving the health of aging population

67

average life expectancy

ageism

is negative stereotyping of older adults and discrimination because of older age.

• Myth of Senility

• Myth of the Rocking Chair

• Myth of Homogeneity

• Myth of Inability

older adult myths

myth of senility

It's normal for older adults to become confused, childlike, and forgetful. They become

"senile."

myth of the rocking chair

As age increases, older adults withdrare, become inactive, and cease being productive.

myth of homogeneity

As older adults age, they lose their individual differences and become progressively more alike.

myth of inability

Older adults are unable to learn new things and are set in their old ways of doing things.

• Inability to live independently

• Chronologic age as a determinant of oldness

• Most with diminished intellectual capacity or senility

• All content and serene

• Inability to be productive

• Resistant to change

• No social security on retirement

Common Misconceptions About Older Adults

• Lifetime of healthy habits

• Strong social support system

• Positive emotional outlook

• Affected by personality traits, life experiences, current physical health, and current societal supports

Characteristics of Healthy Older Adults

• Alzheimer’s disease

• Arthritis

• Cancer

• Cardiovascular disease

• Depression and suicide

• Diabetes

• Obesity

• Osteoporosis

Diseases and conditions of the Aging population

• Good Nutrition

• Good dental care

• Immunizations

• Exercise

• Sleep

• Safety

primary prevention with older adults?

• Screening (diabetes, heart disease, cancer)

• Reflect on past success and organize free time into satisfying activities.

secondary prevention of older adults

• Rehabilitation

• Follow-up and assistance after disease has occurred

tertiary prevention of older adults

• Exercise

• Diet

• Sleep

• Cognitive activities

• Independence

• Activity

• Check-ups

• Screenings

• Safe environments

• Avoid smoking

• Positive attitude

successful aging strategies

medicare healthcare costs

• Provided for individuals 65 and older and disabled.

• Does not cover long-term care, dental and eyecare

• Part A – Hospital insurance

• Part B – Supplementary

• Part C – Medicare Advantage

• Part D – Prescription

medicaid

• Provided for families, children and elderly.

• May provide custodial care

• custodial care= NON SKILLED BASIC CARE; cooking, cleaning, dressing

hospital insurance

medicare part a

supplementary

medicare part b

medicare advantage (separate insurance company; no good)

medicare part c

prescriptions

medicare part d

• Physical abuse

• Neglect

• Emotional or psychological abuse

• Verbal abuse and threats

• Financial abuse and exploitation

• Sexual abuse

• Abandonment

type of elder abuse

• Assisted Living

• Skilled Nursing Facility (SNF)

• Nursing Home

• Home Health

living arrangements and care options for older adults

assisted living facility

They mostly take care of themselves but need help with things like bathing, meals, or medications.

skilled nursing facility SNF

• They need skilled medical care, often temporarily, such as after a hip replacement or hospitalization.

• short-term rehabilitation after hospitalization

nursing home

They need 24-hour nursing care and cannot safely live on their own.

home health

The patient stays in their own house, and nurses/therapists come to them.

• Case management for resources and referrals

• Development of creative living arrangements and services

• Encouragement of healthy lifestyle changes to avoid disease and disability

• Education about immunizations and safety measures including fall prevention

CHN role in aging adults

• flu vaccine

  • rec. for ALL adults

• COVID-19 Vaccine & Boosters

• Pneumococcal Polysaccharide Vaccine (Pneumovax 23)

  • shingles

  • 65yo+

  • Prevents infections caused by streptococcus pneumonia bacteria

    
    

    
    

primary prevention vaccines for older adults

Maintenance of functional independence

the goal of service programs for healthy older adults?

palliative care

begins at diagnosis and is provided at the same time as treatment of the disease

hospice care

• begins AFTER treatment of the disease is stopped and when it is evident the death is inevitable

• <6m life expectancy

palliative and hospice care

both focus on the provision of comfort and holistic support for those with terminal illness

• spiritual needs

• cultural needs

• psychosocial needs

• provide honesty, dignity, respect

in addition to physical needs, how else can the nurse advocate for the dying and their family?