Community Exam 3

Factors that can threaten health

- Low income
- Difficulty assessing health care (uninsured or underinsured)
- Poor self-esteem
- Young or advanced age
- Chronic stress
- Environmental factors
- presence of communicable disease
- racial and ethnic minority status
- the disparities for minority groups that differ across each population

Vulnerable populations

have multiple risk factors for negative health outcomes
- identifying modifiable risk factors and targeting interventions can promote better health outcomes and population resilience

Issues Vulnerable Populations are Subjected to

- violence
- substance use disorders
- mental health issues/illnesses
- poverty and homelessness (low income)
- rural residency
- migrant employment
- veteran status
- disability
- child abuse

Health Disparities- Vulnerable Populations

significant differences in health status and access to health services across varied groups
- can be linked to gender, ethnicity, race, education, and income differences
- Healthy People has a goal to eliminate disparities to achieve health equity

National Health Goals for Vulnerable Populations- Increase

- increasing the number of people who have a routine PCP
- increasing the number of people who have health insurance

National Health Goals for Vulnerable Populations- Decreases

- reducing the number of people who are unable to access, or have a delay in accessing, health care services and prescribed medications
- reducing the number of people who have disabilities who report physical barriers to accessing health and wellness programs in the community

Nursing Actions for Vulnerable Populations

· Advocate for social justice & the elimination of health disparities
· Create rapport & provide a safe environment
· Be knowledgeable about population characteristics, preferences
· Advocate for the needs of the population, focus on preventative services
· Assist client in obtaining as much control over personal health & health care as possible

Types of Violence Within Communities

homicide, assault, rape, suicide, violence (physical, sexual, emotional, and neglect), economic maltreatment

Homicide

- often related to substance abuse
- most are committed by someone known to the victim and occur during an argument
- violence often precedes homicide within families
- rates of _____ are increasing among adolescents more than in other age groups

Assault

- males are more likely than females to be _____
- youths are at a significantly increased risk

Rape

- often unreported
- most incidences are spousal (marital) or acquaintance (date) _____
- females are more likely than males to be ____.

the risk of _____is increased in cities, between 8PM and 2AM, on the weekends, ands in the summer months

Suicide

- rates are highest among individuals 45 to 64 years old
- females are more likely to attempt ____; however, males are more likely to complete ____
- Caucasians are more likely than other ethnic groups to commit ____
- risk factors: depression or other mental health disorders, substance use, having access to a firearm, and partner violence or neglect issues

Human Trafficking

- significant global health issue

- affects all races, ages, and genders, but women and children under the age of 18 are at an increased risk

Physical Violence

occurs when pain or harm results
- toward an infant or child: shaken baby syndrome
- toward a spouse or partner: striking or strangling; higher risk when leaving the relationship
- toward an older adult: pushing which results in a fall
- toward a nonspouse or nonpartner

Sexual Violence

occurs when sexual contact takes place without consent

Emotional Violence

behavior that minimizes an individual's feelings of self-worth or humiliates, threatens, or intimidates a family member

Neglect

failure to provide
- physical care (food, shelter, and hygiene)
- emotional care (to achieve developmental milestones, speaking and interacting)
- education
- health or dental care

Economic Maltreatment

- Failure to provide the needs of a victim when adequate funds are available
- Unpaid bills when another person is managing the finances
- Theft of or misuse of money or property

Individual Risk Factors for Violence

History of being abused or exposure to violence
Low self-esteem
Fear and distrust of others
Poor self-control
Inadequate social skills
Minimal social support/isolation
Immature motivation for marriage or childbearing
Weak coping skills

Recognizing Potential Child Abuse/Neglect

Unexplained injury
Unusual fear of the nurse and others
Injuries/wounds not mentioned in history
Fractures, including older healed fractures
Presence of injuries/wounds/fractures in various stages
of healing
Subdural hematomas
Trauma to genitalia
Malnourishment or dehydration
*General poor hygiene or inappropriate dress for
weather conditions*
Parent considers child to be a "bad child"

Recognizing Potential Older Adult Abuse

Unexplained or repeated physical injuries
Physical neglect and unmet basic needs
Rejection of assistance by caregiver
Financial mismanagement
Withdrawal and passivity
Depression

Social and Community Violence Risk Factors

-work stress
-unemployment
-media exposure to violence
-crowded living conditions
-poverty
-feelings of powerlessness
-social isolation
-lack of community resources (playgrounds, parks, theaters)

What are some strategies to reduce societal violence?

· Primary: teach alternative methods of conflict resolution, anger management, & coping strategies in community settings
· Secondary: identify & screen those at risk for abuse & individuals who are potential abusers
· Tertiary: develop support groups for caregivers & survivors of violence

Caring for Clients who Experience Violence

-Build trust and confidence
- Focus on the client rather than the situation
- Assess for immediate danger
- Provide emergency care as needed
- Work with the client to develop a plan for safety
- Make needed referrals for community services and legal options
- If abuse occurred, complete mandatory reporting if abuse has occurred

Substance Use Disorder

- involves the maladaptive use of substances resulting in threats to an individual's health or social and economic functioning
- have significant effects on family dynamics, and often lead to codependency
- negatively affect family life, public safety, and the economy. they cause more disability, death, and illness than any other health condition
- *recovery occurs over years and usually involves relapses; a strong support system, including 12-step programs and self-help groups for family members, is important
- community health nurses are front-line health professionals who are able to assist these clients

Substance use disorders have significant effects on ____ ____ & often lead to codependency

Family dynamics

Substance use disorders negatively affect?

· Family life
· Public safety
· The economy

Dependence

a pattern of pathological, compulsive use of substances and involves physiological and psychological dependence
- cardinal indicators: tolerance and withdrawal
- denial is a PRIMARY indication (includes: defensiveness, lying about use, minimizing use, blaming or rationalizing use, intellectualizing)

Which issue causes more death, disability, & illness more than any other issue?

Substance use disorders

What are some important points about the effect on alcohol?

· Dependent on person
· Withdrawal: important to ask client when they last had a drink
· Withdrawal Sx: can show up within 4-12 hours & last 5-7 days

Substance Use Disorder Health Problems

- low birth weight
- congenital abnormalities
- accidents
- homicides
- suicides
- chronic diseases
- violence
- disability

Alcohol Use

- the most commonly used substance in the US; socially acceptable, as well as easily acceptable
- A DEPRESSANT; dulls the senses to outside stimulation and sedates the inhibitory centers in the brain
- can develop a tolerance

Effect of Alcohol

- the direct effect of alcohol is determined by the blood alcohol level
- the body processes alcohol dependent on size and weight of drinker, sex (metabolism), carbonation (absorption), time elapsed, food in the tummy, type of alcohol, etc
- excess alcohol that is not metabolized circulates in the blood and affects the CNS and the brain

Alcohol Withdrawal

manifestations occur within 4 to 12 hrs; it is important to determine the time of the last drink
- irritability
- tremors
- N/V
- headaches
- diaphoresis
- elevated BP
- tachycardia
- sleep disturbances

Tobacco Use

the most important preventable cause of death in the US, according to the CDC
- tolerance to nicotine develops quickly
- results in deep inhalation of smoke, which poses the greatest health risk
- secondhand smoke poses considerable health risks to nonsmokers

Nicotine

a stimulant that temporarily creates a feeling of alertness and energy. repeated use to avoid the subsequent "down" that will follow this period of stimulation leads to a vicious cycle of use

Marijuana

has a low level of toxicity. although it is legal in some states, it is considered the most commonly used illegal substance in the US. users can develop tolerance and dependence with long-term use, but withdrawal manifestations are minimal

other stimulants

caffeine, amphetamines, methamphetamines, cocaine

other depressants

barbiturates, benzodiazepines, chloral hydrate, GHB

opiates

morphine, heroin, codeine, and fentanyl

Hallucinogens (psychedelics)

produce anxiety, paranoia, impaired judgement, and hallucinations. some examples are lysergic acid diethylamide (LSD), phencyclidine (PCP), and MDMA (ecstacy)

Inhalants

volatile substances that are inhaled (huffed). death can result from acute cardiac dysrhythmias or asphyxation

Physical Assessment Findings of Tobacco Use

- vital signs vary depending on the substance
- disheveled with unsteady gait
- pupils dilated or pinpoint, red, and with poor eye contact
- diaphoretic, cool, and/or clammy; need track marks/spider angiomas may be visible
- nose can be runny, congested, red, and/or cauliflower-shaped
- fine or coarse tremors

What are some strategies to reduce substance use disorders?

Primary: development of life skills
· Secondary: identify at-risk individuals & assist then with reducing sources of stress, including referral to SS to eliminate financial difficulties or other sources of stress
· Tertiary: assist with developing a plan to avoid high-risk situation & to enhance coping & lifestyle changes

National Alliance for the Mentally Ill (NAMI)

an advocacy group that works to reduce stigma and provide services for clients who have mental health disorders and their families
- individuals who have severe mental illness can experience stigma, marginalization, lack of social support, and inadequate treatment

Characteristics of Mental Health Disorders

- occurs across the lifespan
- high risk of substance use disorders
- high suicide risk
- increased occurance of chronic disease

Individuals who have severe mental illness can experience?

· Stigma

· Marginalization

· Lack of social support

· Inadequate treatment

Specific Mental Health Disorders

- affect disorders (bipolar disorder, major depressive disorder)
- anxiety disorders (obsessive-compulsive, panic, phobias, posttraumatic stress)
- schizophrenia
- dementia
- conduct disorders
- personality disorders

Factors Affecting Mental Health

- individual coping abilities
- stressful life events (exposure to violence, disasters)
- social events (recent divorce, separation, unemployment, bereavement)
- chronic health problems
- stigma associated with seeking mental health services

What are some strategies for improving mental health?

· Primary: teach stress-reduction techniques

· Secondary: screen to detect MH disorders, crisis intervention

· Tertiary: perform medication monitoring, referrals, education, planning

What are things to consider for migrant employment

· Often employed in farming
· Temporary homes during employment
· NOT covered under common labor laws
· Migrant Health Act: provides funding for migrant health centers
· Most do not speak English
· Cultural competence is required in nurses

minors 12 yrs old and older are not covered under the Child Labor Act and can work alongside family members, even under hazardous conditions

Migrant Health Act

provides funding for migrant health centers across the US, which serve about 1/5 of the migrant worker population

Are agricultural workers covered by labor laws?

are NOT covered under common labor laws (Fair Labor Standards Acts, Occupational Safety and Health Administration protections)

What are health problems of migrant workers?

- Dental disease
- TB
- Chronic conditions
- Stress, anxiety, and other mental health concerns
- Leukemia
- Iron deficiency anemia
- Stomach, uterine, and cervical cancers
- Lack of prenatal care
- Higher infant mortality rates
- STIs, HIV/AIDS

-Pesticide exposure: HA, dizziness, dyspnea, confusion, abd. cramp, nausea, poor concentration, eye irritation

Pesticide Exposure- Subjective Findings

dizziness, dyspnea, nausea, abdominal cramps, poor concentration, eye irritation

Pesticide Exposure- Objective Findings

confusion, irritability, muscle weakness and twitching, nasopharyngeal irritation, vomiting, rash

Pesticide Exposure- Complications

long-term exposure is liked to cancer, reproductive problems, Parkinson's, liver damage, behavioral issues
- secondary exposure: through contaminated clothing from a family member

Issues in Migrant Health

- food insecurity
- inconsistent income with yearly cycles of unemployment
- poor and unsanitary working/housing conditions
- exposure to chemicals
- limited access to health care (dental, MH, pharm)
- language barriers and cultural aspects of health care
- discrimination
- immigration status (fear that seeking services will lead to deportation)

What are some strategies for migrant health care?

· Primary: educate reduction to exposure to pesticides, prenatal care
· Secondary: screening programs: pesticide exposure
· Tertiary: Tx pesticide exposure, rehab from injury, education for people w diabetes/anemia on nutrition

Nursing considerations- Immigrants

· Cultural competence

· Identify risk factors specific to culture & race

Veterans Health Administration (VHA)

responsible for purchasing coverage and delivering health care to veterans and dependents
- the nation's largest integrated health care system
- offer inpatient and outpatient services: hospitals, outpatient clinics, home health services, hospice, nursing homes, etc

Veteran Health Issues

- Mental Health Issues
- Substance Abuse
- Suicide
- Infectious Disease
- Exposure to toxins
- Traumatic Brain Injury
- Spinal Cord Injuries
- Traumatic amputations
- Cold Injury
- Military Sexual Trauma
- Hearing Impairments
- Visual Impairments

What are the strategies for veteran health care?

· Coordinate referrals
· Advocate to strengthen the Veterans Health Administration
· Assist with transitioning from active duty
· Ensure continuity of care
· Develop partnerships
· Possible stakeholders: state & local veteran groups

Disability

indicates a factor in the body, senses, or mind that affects the way a person interacts in the daily environment; exact definitions are determined by specific agencies and groups based on data collection needs
- individual or group living environments, aging, chronic illness, injury, substance use, and genetic can cause physiological and psychological disability

about 1/5 of the US population reports having a disability

Americans with Disabilities Act

the initial legislation to promote rights for individuals who have a disability

Individuals with Disabilities Education Act (IDEA)

promotes the rights of children who have disabilities and their parents; ensures free public education and accommodations to prepare children for independent living, assists w/ funding of education, and evaluates the effectiveness of education

Effects of Disability

- Cost of Chronic Health Maintenance
- ↓ employment rates
- ↓ household income and increased poverty rates
- ↓ physical activity (physical impairment)
- Isolation and possible self-esteem issues
- Possible altered roles of family members
- ↑ risk for abuse
- Possible altered family roles
- Presence of co-morbidities

Nursing actions for people with disabilities?

· Implement primary prevention measures to prevent disability
· Identify disability & chronic disease as early as possible
· Connect clients/families with appropriate resources

Immigrants

- often have a waiting period to receive financial assistance for medical care
- unauthorized immigrants are only eligible for immunizations, school lunch, treatment for communicable diseases, and emergency care

Incarcerated Populations

- increased rates of mental health disorders; the presence of major mental health disorders increases the risk for multiple incarcerations
- increased incidence of rape and assault in the prison system
- health care regulated through the Federal Bureau of Prisons (Department of Justice) to promote rights of inmates
- increased rates of chronic disease, when compared with the general population

Incarcerated Populations: Nursing Actions

implements health promotion and counseling, assist with re-integration into society, foster follow-ups, provide transitional care

Issues with LGBTQIA+ population?

Can face barriers to adequate health care
· Social stigma & discrimination
· Poor MH & increased risk for substance use disorder/disabilty

National health goals for LGBTQIA+ population?

· Increase in survey & monitoring systems including standardized questions to allow to identify orientation, gender, pronouns
· Reduce adolescent bullying
· Increase health insurance coverage
· Decrease number of clients experiencing MDD
· Decrease tobacco & illicit drug use
· Increase number of individuals who have routine PCP

Nursing actions for LGBTQIA+ population?

Advocate increasing access to care
Provide safe environment

Nursing considerations for refugees?

· Forced to leave place of origin
· Eligible for Temporary Assistance for Needy Families, Medicaid, & supplemental security income
Nursing Actions:
· Assess MH status & coping
· Help individual apply for assistance

Issues in pregnant adolescents?

· Limited education & job opportunities
- Increased risk for poverty and homelessness
· Increased risk for school problems
· Increased incidence of violence
· Increased risk for malnutrition
· Increased risk for low birth weight & premature infants

Nursing actions for pregnant adolescents?

· Assist with early ID of pregnant adolescents, including early initiation of prenatal care
· Provide counseling/encouragement
· Assist in applying for WIC
· Promote education about self-care during pregnancy

Disasters

an event that causes human suffering and demands more resources than are available in the community
- can be naturally occurring, man-made, or a combo (natural disaster causing technical difficulties)
- includes mass-causualties

Levels of Disaster Management

- disaster prevention (mitigation)
- disaster preparedness
- disaster response
- disaster recovery

Disaster prevention (mitigation)

· Any activity to prevent natural & man-made disasters
· ID community vulnerabilities, capabilities, & possible threats
· ID populations at risk

Disaster preparedness

· Occurs at all levels (national, state, & local)

· Preparedness within the communities should stem from threats & vulnerabilities Identified in prevention phase

- setting up communication protocol is KEY!! (should provide for access to emergency agencies - American Red Cross)

· Practicing drills

- action plans

Disaster response (after initial span of disaster)

· Assessment: how many affected? Injured/dead? Areas of risk? Sanitation problems?
· Classification: according to type, level, & scope
- NIMS provides structure for managing disaster

The National Incident Management System (NIMS)

provides a structure for managing any type of disaster, including various public and private agencies

Their goal is to provide effective communication and clear chain of command

If a Federal Emergency is declared what happens next?

the National Response Framework is activated and provides direction for an organized, effective national response

Disaster Recovery

· Begins when danger no longer exists
· Rebuilding can start, things start going back to normal
· Lasts until economic & civil life are restored
· Need to address PTSD & delayed stress reactions (DSR)

Disaster recovery- Individual Level

it is the time it takes an individual to become functional within a community after a disaster

Phases of emotional reaction during a disaster: Heroic 1st

· Intense excitement & concern for survival
· Often a rush of assistance from outside the area is present

Phases of emotional reaction during a disaster: Honeymoon 2nd

Affected individuals begin to bond & relive their experiences

Phases of emotional reaction during a disaster: Disillusionment 3rd

· Responders can experience depression & exhaustion
· Phase contains unexpected delays in receiving aid

Phases of emotional reaction during a disaster: Reconstruction 4th

· Involves adjusting to a new reality & continued rebuilding of the area
· Counseling sometimes needed & those affected begin looking ahead

What are the roles of the community health nurse for disasters?

· Risk assessment
· Planning
· Response & triage
· Recovery
· Evaluation of disaster response

What does a risk assessment consist of?

· What populations are at risk?
· Previous disasters?
· Disaster plan?
· Warning system?
· Resources available?
· Evacuation measures?
· Environmental dangers?

What does disaster planning consist of?

· Plan: mock drills
· Accessing the warning system
· Agencies that can help at all levels (local, state, & national)
· Role ID
· Locate equipment & supplies
· Assist community members with plans
· Talk with medical facilities: in-house plan?

Disaster response

· Activate the plan: notify local officals
· Triage & transfer
· Evacuate
· Quarantine
· Open shelters
· Collaborate with partners to develop plans for triage algorithms
· Identify & place public health nurses & support personnel to provide care according to algorithms

Disaster recovery

· Home visits to reassess the needs of the community
· Provide care in shelters
· Provide counseling: for PTSD/DSR
· Make referrals: psychological Tx

Evaluation of Disaster Response

- evaluate the area, effect, and level of the disaster
- create ongoing assessment and surveillance reports
- evaluate the efficiency of the disaster response teams
- estimate the length of time for recovery of community services, such as electricity and running potable water

Category A Biological Agents

Highest priority agents

Pose a risk to national security

High mortality rates

require special preparedness

Category A Biological Agents: Examples

anthrax

botulism

plague

smallpox

Tularemia

Ebola (hemorrhagic fever)

Category B Biological Agents

· 2nd highest priority, because they are moderately easy to disseminate & have high morbidity rates

Category B Biological Agents: Examples

west nile virus

caliciviruses

hep A

ricin toxin

salmonella

diarrheagenic E. coli