Populations Exam 1

What is health:

- state of complete well-being, physical, social and mental & not just the absence of disease--it can vary from person to person

How community & public nurses impact:

- considers health as families and populations choosing actions to ensure safety and well-being

o they can assist the U.S. health care system to transition from being disease-oriented to a health-oriented system

What influences community:

- behavior choices by people have a major influence on the health of a community

What are the two important priorities of public nursing

- address health issues and disparities

- engage in policy reform activities to improve accessibility, quality and cost of health care

what is the public health mission?

- public health mission: public health aims to provide maximum benefit for the largest number of people (WHO)

o includes social justice (entitles all people to basic needs)

o focuses on health promotion & preventions instead of disease management

3 core functions of public health

o assessment: monitor risks/trends/health status of populations

o policy development: what PH measures should be taken, legislative changes

o assurance: promotion & protection of public health through dedicated programs and strategies to safeguard health & wellness across populations

What is health promotion

any combination of health education and related organizational, economic, and environmental actions for behavior changes in individuals/groups

o motivated by the desire to increase well-being and to reach the best possible health potential--health fairs, smoking cessations

health protection is?

- those behaviors one engages with the specific intent to prevent disease, detect disease in early stages or maximize health within the constraints of disease or control the disease

o ex. immunizations, wearing masks, testing water or soil

health risks:

- probability that a specific event will occur in a given time frame

risk factors:

- a variable that is associated w/ a disease or behavior

modifiable risk factors:

factors an individual has control over like smoking, lifestyle, exercise, diet

nonmodifiable risk factors:

factors an individual has little or no control over like genetics, gender, age, exposure

what is the leading cause of preventable death?

tobacco

- it is the leading cause of preventable death, more common in lower income and less educated populations

life expectancy:

- a key measure of population health is life expectancy, average number of years a person born in a given country would live if mortality rates remain constant

o Life expectancy of a male born in the U.S. born in 2018: 76.2 years

o What about in Afghanistan? 62 years

improvements in life expectancy is d/t what?

higher standards of living, better nutrition, a healthier environment, family planning, immunizations and improved and accessible medical care

what are the 3 levels of prevention?

primary, secondary, and tertiary prevention

primary prevention:

o prevention of problems before they occur

o reduce risk factors & promote protective factors

o health promotion & health protection (health fair, immunization clinic)

secondary prevention:

o early detection and prompt intervention (mammogram, prostate screenings, B/P check)

o early diagnosis and treatment (well child exams)

tertiary prevention:

o correction and prevention of deterioration of a disease state (good control of DM)

o limitation of disability and rehabilitation programs, support groups

HP 2030 Leading Health Indicators

○ Access to health services

○ Preventive services and screening

○ Environmental quality

○ Injury and violence

○ Maternal infant and child health

○ Mental health and suicide prevention

○ Vaccination

○ Reduce DM

○ Nutrition, physical activity and obesity

○ Improved oral health

○ Increased people who have health insurance

○ Reproductive and sexual health

○ Social determinants health

○ Substance abuse, Tobacco use, and overdose

○ Food insecurity

Social determinants of health:

conditions in which persons are born, grow live, work and age including the healthcare system

what are the social determinants of health categories?

- Economic stability, social & community context, neighborhood & environment, health care, education

what are the two MOST important social determinants of health

o most important: economic stability and education

nightingale

established modern nursing, concerned w/ environmental health, emphasized sanitation, political advocate, education reform for nurses (Crimean war stats)

wald:

- established house on henry street (help people help themselves), establishing public health nursing (visiting nurses), establishing school nurses placing Linda Rogers in N.Y school ➡️ considered the first U.S. public health nurse

jenner:

developed smallpox vaccine

salk:

developed polio vaccine

snow:

- demonstrated transmission of cholera via public water pump source--called father of epidemiology for his use of disease mapping

endemic:

disease that are always present in a population (colds, flu, pneumonia)

epidemic:

- diseases that are not always present but flare up on locations--usually in a geographical area (mumps, measles, pertussis)

pandemic:

- the existence of a disease in a large proportion in the population-often a global issue (Covid, HIV, some flu)

what is upstream thinking?

- Examining the origins of disease, nurses identify social, political, environmental and economic factors that often lead to poor health options for both individuals and population

- Refocus the efforts of nurses "upstream" where the real problem lies. Downstream is the action taken after a disease

what are nursing theories?

- nursing theories provide guides to practice and improving nursing practice

microscopic nursing theories

- concerned with just the problem at an individual level

macroscopic nursing theories

looking at a population or community-based approach, use of mid-level practitioners evolved from this

what is community:

group of people with diverse characteristics who are linked by social ties and geographical locations or settings

what is a aggregate?

- community of people who have common characteristics, for example senior citizens, ethnic backgrounds, religious organizations, group of study w/ same risk factors

windshield survey (shoe leather):

- used to make organized observations of the area and its people, first impression of community, helps map the community

what do you follow up a windshield survey with?

- census reports, vital statistics, morbidity & mortality reports, vital stats (official registration records of births, deaths, marriages, divorces, and adoptions

census data (demographics):

- taken every 10 years, helps the nurse become familiar w/ an area and see how it has changed over time

morbidity & mortality weekly report by CDC:

- provides UTD public health information on PH issues, trends, guidance and outbreaks--first step in assessment and intervention

focus groups:

- receive input from an aggregate (in-person interviews, with a group to understand behavior)

who should you interview when conducting the needs for a community?

- interview the community’s key informants: long-term residents or informal leaders such as business owners, teachers, clergy

- nurses should always interview community members about the needs they perceive

- use community forums, focus groups, or surveys--gain insights, information and personal beliefs and encourage participation

SWOT stands for

strengths, weaknesses, opportunities, threats

what is the next step after gathering assessment data?

- next step is to connect dots and write diagnosis (issues & SMART issues)

o four components:

- health problem or risk (basically "chief complaint")

- affected aggregate or community (seniors, teens, etc.)

- etiology or cause (why is it happening)

- evidence or proof (data-MMWR, vital stats, survey)

community competence/capacity:

- is helping a community to develop the ability to address and make changes to future problems. Develop or identify resources/assets. Identify areas of weakness or needed change

what does the nurse need to decide when health planning?

- nurse must first decide on and define the aggregate to receive care and determine priorities

- plan: find needs, set SMART goals, identify resources, team up w/ stakeholders, implement idea

Community Health Intervention & Implementation

- stick to plan

- CDC has models (GPS) like MAPP, APEX and PRECEDE-PROCEED

- variety of strategies, get participants involved in small group activates, see their perspective

- thing’s do not go according to plan

- ex. injury prevention for high schoolers = seatbelts, sports concussions & injury prevention for parents of toddlers = baby gates, outlet covers, and keeping Lego pieces off the floor

what is evaluation?

- important component of success or failure of project

o include feedback, look for strengths, weakness, gather follow up recommendations, measure if intervention was appropriate

- process eval: check-ins, able to make changes as needed

- summative eval: did it work (summary)

community health education:

mix of learning experiences designed to help people make choices that help their health--not just saying "eat a healthier diet"

goals of health education:

o turn knowledge into action (make goals)

o boost wellness, cut disability

o shape healthy behaviors

o make changes stick

✨keep learners engaged: make it personal, address real concerns, team up with learners

health literacy:

individual's capacity to obtain, process and understand basic health information, health literacy = empowerment

if you gain health literacy you gain the power to:

o access information

o understand knowledge

o use innovations

what is the nursing role in health education?

- work w/ individuals and communities not against them

- first move is not talking it's listening

- provide interventions that fit & point people toward resources that make changes realistic & attainable

- when planning considers the culture of clients and be sensitive to their needs

- eval teaching by looking for REAL CHANGE etc. long-term change in knowledge and client behavior

Who was john snow?

- "father of modern epidemiology": 1800s cholera outbreak, used disease mapping, spotting the cluster, persuaded officials to remove pump and cholera cases dropped

epidemiology:

- studies who gets sick, where, when, and why and helps us uncover the patterns behind health and diseaseàwhat, why, where

o looks at populations (neighborhoods, cities, whole countries), compares who get sick and who states healthy

o use findings to stop outbreaks and improved community health

What is the epidemiological triangle?

epidemiologists look at three players (triad/triangle)

o host: person or population sick or at risk

o agent: the cause (bacteria, virus, or toxin)

o environment: conditions that allow it to spread (crowding, sanitation, climate)

What is the person place and time model of public health

o person (who): characteristics of people affected, age, sex, occupation etc.

o place (where): where did disease happen, neighborhood, regions, workplaces, etc.

o time (when): when did case happen, specific days, seasons

**used when describing how a disease spreads in a population

What is the web of causation

a model that illustrates the complexity of relationships among casual variables from disease

two major types of morbidity rates in public health:

o incidence rate: new cases or conditions

o prevalence rate: all cases of a specific disease or condition at a given time

Surveillance:

- ongoing collection of health information is called surveillance, and it comes in two main times

active surveillance:

health workers go out, collect data, knock on doors, more accurate, but takes more time & resources

passive surveillance:

healthcare providers report cases to public health authorities, easier and cheaper but may miss cases

why does surveillance matter?

helps spot trends in diseases and risk factors by population & location--how we know whether health in America is getting better or worse

True or false? All surveillance studies are positive

FALSE

- not all is data is positive: Tuskegee Syphilis Study, this reminds us that surveillance must always be guided by ethics, consent, and respect for human rights

what are communicable diseases?

- illnesses that spread from one person to another or from animal, surface or food (CDC)

what are the challenges of communicable diseases?

- emerging pathogens (covid-19), reemerging pathogens (old diseases that come back after under control like measles), drug-resistant pathogens (superbugs like MRSA), vector-borne infections on the rise (diseases spread by ticks, mosquitoes etc.)

burden of communicable disease:

- diseases mutating into new ones, vaxs have given us huge wins but some are making a comeback

o eradicated communicable diseases (through immunizations): smallpox, polio, diphtheria

What is direct transmission?

- person➡️person contact

o vertical transmission: mother ➡️ baby (pregnancy birth, breast milk)

o horizontal transmission: coughing, sneezing, kissing and sexual contact

What is indirect transmission?

- carriers and objects help germs move

vectors: mosquitoes, ticks, fleas (biological or mechanical)

fomites: inanimate objects like doorknobs, phones, or used tissues

How do we break the chain of transmission

o index case: 1st person identified w/ the CD

o controlling agent: reduction of incidence (new cases) or prevalence (existing cases)

o quarantine: isolation during incubation period--who can order a quarantine

o controlling the portals of exit & entry: isolate the sick people, universal precautions

Contact Isolation

- prevent the spread of agents that can be transmitted through direct or indirect contact

■ infections that can be spread by touch, like MRSA, VRE, C. diff

■ Wear gown and gloves PPE

Droplet Isolation

- prevent the spread of respiratory droplets from which can travel through the air 3 feet

■ influenza, whooping cough (pertussis), and COVID-19

■ PPE and mask

Airborne Isolation

- prevent the spread of very small particles that can stay suspended in the air for long periods and travel greater distances.

■ Used For: tuberculosis (TB), measles, and chickenpox.

■ Use All PPE, N95 mask and negative pressure room

Protective (Reverse) Isolation

- protect immunocompromised patients

■ HIV/AIDS, leukemia, bone marrow transplants or chemotherapy. Use all PPE and HEPA (high efficiency particulate air) filtration systems.

What are the topic areas for improved health in healthy people 2030?

- Three topic areas for improved health: immunization & infectious disease, sexually transmitted diseases, HIV

what are inequities in community disease?

- low-income and minority groups are hit the hardest by infectious diseases. Access to care, living conditions and SDOH all play a role

the surprising side of infection➡️

- new research shows infections may be behind more chronic diseases than we thought:

o ulcers/PUD: caused by H. Pylori (not just stress and spicy)

o coronary artery disease: linked to C. pneumoniae and CMV

o Cervical cancer: caused by HPV (a virus that is not preventable w/ vaccine)

what are sexually transmitted infections?

- preventable disease, unprotected sex is the risk and can lead to PID, cancer etc.

- prevention through education, abstaining and/or consistent condom use

Syphilis

- has 4 stages, can be passed to infant via pregnancy & delivery, tested by RPR (rapid plasma reagin) or VDRL (VD research lab)

Stages of Syphilis

o first stage: painless sore/port of entry

o secondary stage: skin rash (hands/feet/body), swollen lymph nodes, fever (cold s/s) can last 2-6 wks and be intermittent for years

o latent stage: contagious early in this stage, asymptomatic (1-20 yrs)

o tertiary: no longer contagious, can damage brain, nerves, eyes, heart, blood vessels, liver, bones, and joints

💊treated w/ penicillin G 2.4 million U or doxycycline

chlamydia & gonorrhea are...

- most common STI associated w/ PID and can be passed to infant during pregnancy and delivery. Often does not have symptoms

chlamydia:

- PO azithromycin 1 gram x 1 or doxycycline 100 mg BID x 7 days

gonorrhea:

- ceftriaxone 500 mg IM x1

trichomoniasis

- metronidazole 500 mg orally BID x7 (specify no ETOH use)

herpes

- acyclovir, famciclovir or valacyclovir antiviral medications 2-5 times a day for 7-10 days

HIV

- viral HAART (highly active antiretroviral therapy) PEP or PREP

hepatitis ACDE

- supportive/immunization or HBIG/direct acting antiviral (DAA) treatment

HPV genital warts

associated w/ cervical cancer--symptomatic treatment of warts

Tuberculosis

caused by mycobacterium tuberculosis. TB can spread via air to others when they cough, speak, or sing. TB in the lungs can move through the blood and infect other parts of the body such as kidney, spine and brain

symptoms of TB

cough lasting 3 weeks or longer, pain in chest, coughing up blood or mucus, weakness/fatigue, wt. loss/loss of appetite, chills/fever, night sweats

How is TB diagnosed?

H&P (TB questionnaire), TST or Mantoux w/ PPD, IGRA blood testing (QuantiFERON--TB gold test or T-Spot ➡️ more expensive), this one is more specific and can differentiate between TB infection vs BCG vaccine, chest x-ray, sputum smear & culture (acid-fast bacilli), sample or culture from the site

Latent TB:

- have bacteria in your body but are not showing any symptoms and are not contagious, treatment is aimed at preventing the development of active TB disease

o treated w/ isoniazid (INH) taken daily for 6-9 months or shorter duration with the combo of rifapentine & isoniazid, known as 3HP

active TB:

- requires more intensive & longer treatment regimen, usually involving a combo of several antibiotics

o Isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), ethambutol (EMB)

MDRTB:

- involves sensitivity testing and individualized medication plans

directly observed therapy (DOT):

- treatment administered under direct observation by a healthcare worker to ensure that patients take their medication consistently & correctly

Anthrax

serious infectious disease known as bacillus anthracis--found in soil & affects domestic and wild animals. RARE in US but sporadic outbreaks can affect people when in contact w/ infected animals or animal products➡️causes severe illness in animals & humans

o not contagious from person to person: spores enter body then multiply

Anthrax s/s

o fever chills, SOB, body aches, fatigue, cough, flushing, n/v/d, stomach pain

- cutaneous: blisters & ulcers dev. 1 week

- inhalation: **most severe, dev. 1 week to 2 months

- GI: eating undercooked meat from infected animal s/s dev. in 1 week

s/s can develop as late as 70+ days later

anthrax diagnosis/tx

o test directly for bacillus anthraces in blood, skin lesion, spinal fluid or respiratory secretions➡️MUST BE TAKEN BEFORE PATIENT BEGINS ANTIBIOTICS

o meds: antibiotics, PEP w/ ciprofloxacin, doxycycline, vaccine, antitoxins

resistance

- limit the patho burden (reduce the illness effect)