NSG 403: Vulnerable Populations & Communicable Diseases

Vulnerable Population

More susceptible to negative events

- have little or no control over the effect of the events

- can be manifested by an interactive of internal & external factors

Vulnerable Populations & Health

- Increased risk for developing adverse health outcomes

- Have less control over their health than gen population

Rural Residency: Low Population Densities

Linked to:

- decreased access to care

- decreased health status

- decreased health-seeking behaviors

Fewer health organizations nearby (hospitals or emergency care centers)

Challenges for Community Health Nurses in Rural Areas

Limited resources

Isolation from other providers

Health Status of Rural Residents

• Less likely to seek preventative care

• Higher infant and maternal morbidity rates

• Higher rates of respiratory disorders

• Increased trauma/injuries from:

- lightning

- farm machinery

- drowning and boating

- snowmobile

- ATV + motorcycle accidents

Barriers to Health Care

- Distance form services

- Lack of personal/public transportation

- Unpredictable weather or travel conditions

- Inability to pay for care

- Shortage of rural hospitals/healthcare providers

Homelessness: Population Characterisitics

- Adults that are unemployed, earn low wages or are migrant workers

- Families w/ children

- People w/ mental illnesses and/or substance use disorders

- Veterans

- Unaccompanied youth

- Adolescent runaways

- Intimate partner abuse survivors

- Older adults

Preventing/Helping Homelessness: Primary Prevention

Prevent individuals and families form becoming homeless

- community organizing resources or services

- enhance parenting skills that can prevent younger people from running away

Preventing/Helping Homelessness: Tertiary Prevention

Alleviate existing homelessness

- make referrals for financial assistance, food supplements and health services

- help locate temp. shelters

- important tx for those w/ mental illness

- advocate

Migrant Employment

Employed typically in farming

- make a temp. home during employment @ job location & could be pay for their family to live elsewhere

- most workers don't speak English as first language or are undocumented

Issues in Migrant Health

• Provide environmental health information - pesticides

• TB community screenings

• Skin cancer community screenings

• Dental health community screenings

• Poor or unsanitary work conditions

• Inability to afford care

• Language barriers

• Discrimination

Migrant Clinicians Network (MCN)

Tracking programs developed so healthcare providers could access prior information and maintain cont. of tx

Veteran Health Issues

• Mental health (PTSD, traumatic stress reactions, anger, depression)

• Substance use disorders

• Suicide

• Exposures to herbicides, chemicals, and radiation

• Traumatic brain injuries

• Spinal cord injuries

• Traumatic amputations

• Hearing or visual impairments

Strategies for Veteran Health Care

• Advocate for strengthening the VA system

• Work w/ veterans and community agencies to help the veteran transition to civilian life and utilize necessary resources

Working w/ Homeless Veterans

Best to set up health mobile clinics and change the clinic site frequently to reach as many people as possible

Chickenpox-Varicella Zoster Virus: Transmission

Airborne droplets or direct contact w/ vesicle fluid

Chickenpox-Varicella Zoster Virus: Contagious Period

1-2 days before onset of symptoms to 5 days after lesions have crusted

Prevention of Chickenpox-Varicella Zoster Virus

2 doses of vaccine (live vax)

- 1st dose: 12-15 mths of age

- 2nd dose: 4-6 yrs of age

Varicella & CDC

It's on the Nationally Notifiable Infectious Condition List

Caring for a pt w/ Chickenpox-Varicella Zoster Virus

Should be placed in a neg-pressure airflow room

- airborne isolation

Nurses should wear N-95 while in care of pt

- designate stethoscope for that pt use

- antipyretic meds administered PRN

Shingles

Caused by Varicella-Zoster Virus

- shingles lies inactive in nerve tissue near cord & brain

- years later, virus reactivities

- pain is usually the first symptom

Shingles Rash

Develops as a stripe of blisters that wraps around ether the left or right side of torso

- can also be on the eye, neck or face

- can pass it to anyone w/o chickenpox

Shingles Vax: Zostavax

Offers protection against singles for ~ 5 yrs

- Live vax (given as single injection)

- not recommended until age 60

Shingles Vax: Shingrix

Preferred alt to Zostavax

- offers protection beyond 5 yrs

- non-living vaccine & given in 2 doses, within 2-6 months between doses

- approved and recommended for people aged 50 and older

Streptococcus Pneumonia

Often found in respiratory passages of health persons

- spread through indirect and direct contact

Pneumococcal Conjugate Vaccination

Recommended for:

- all babies and children younger than 2 yrs old

- people 2 yrs and older w/ certain medical conditions

Pneumococcal Polysaccharide Vaccination

Recommended for:

- all adults 65 yrs or older

- adults 19 - 64 yrs old who smoke cigarettes

Influenza A

Most common type

• can cause pandemics (global outbreaks)

• subtypes include H1N1, H3N2, and H5N1 (bird flu)

Tx for Influenza A

Antiviral meds are administered to individuals who have been exposed to Influenza type A

- providing immediate protection and prevent outbreak

Pertussis (Whooping Cough)

Highly contagious repsir. infection

- spread through air

- caused by bacterium Bordetella pertussis

- characterized by coughing spells w/ whooping sound

Infant & Young Children w/ Pertussis (Whooping Cough)

Are @ highest risk for severe complications

Older children & adults w/ Pertussis

Can also be infected & spread the disease

- even w/ milder symptoms

Vaccination & Pertussis

Most effective way to prevent getting it

- vaccination for all people, from babies to older adults

Tx for Pertussis

1. Instruct parents to keep child @ home for 2 wks until coughing stage has passed

2. Obtain prophylactic tx in families

- w/ with erythromycin, clarithromycin, or azithromycin

3. Check classmates vaccination status

Tuberculosis

Mycobacterium tuberculosis

- airborne

- onset of symptoms may be immediate or can be latent for years

- S&S: fever, nigh sweats, weight loss, cough

Testing for Tuberculosis

1. Quanifiteron - blood test for TB

2. TB Skin test (PPD)

TB Skin Test PPD

0.1 mL of purified protein derivative to form wheat

- 5 mm: people who are immunosuppressed or direct contact w/ active disease

- 10 mm: positive result - indirect exposure to TB

TB Testing: Chest C-Ray

Shows sign of lung damage & infection

- irregular patches

- cavities

- nodules

Active TB

TB Sputum Culture

Determibes active disease

Tx for TB

INH (isoniazid) for 6 to 9 mths

Precautions for TB

Airborne precaution w/ negative pressure room & keep door closed

- Nurses wear N95 mask

What about the household members w/ TB?

Household members are at risk for developing TB --> should take isoniazid prophylactically for @ least 6 mths

HIV/AIDS: Direct Contact

Spreads:

- person to person

- mother to fetus

- mother to infant during birth

- mother to infant during breastfeeding

HIV/AIDS: Indirect Contact

Spreads:

- contact w/ blood or body fluids (from contaminated needles to transplanted organs)

1-3 months of HIV

Before antibodies are detectable

1-10 years of HIV

Before it becomes symptomatic

People Today w/ HIV

They have access to tx that makes HIV no longer a "terminal illness"

- considered to be a "chronic disease"

Antiretroviral Therapy (ART)

Reduces amount of HIV in blood to undetectable levels

- also prevents the virus from being sexually transmitted

Tx of HIV/AIDS: Pregnant Women

Should be taking antiretrovirals

Avoid breastfeeding

Deliver baby via c-section

Tx of HIV/AIDS: IV Drug Users

Needle exchange programs

Other forms of tx for HIV/AIDS

Safe sec

Encourage autologous blood transfusions

Tx as early as possible

PrEP

Pre-Exposure Prophylaxis

- medication that is taken before potential exposure to HIV (reduces chances of getting it)

Who is PrEP for?

For sexually active adults or adolescents who are HIV -

HIV/AIDS Complications: Pneumocystis Pneumonia (PCP)

Fungal infection that causes severe illness

- most common cause of pneumonia in people w/ AIDS

HIV/AIDS Complications: TB

Leading opportunistic infection associated w/ HIV

- leading cause of death among people w/ AIDS

HIV/AIDS Complications: Kaposi's Sarcoma

Tumor of blood vessel walls

- usually appears as pink, red or purple lesions on the skin & mouth

- on people w/ darker skin, lesions appear to be dark brown or black

HIV/AIDS Complications: Wasting Syndrome

Untreated HIV/AIDS can cause:

- significant weight loss

- diarrhea

- chronic weakness

- fever

HIV/AIDS Complications: Neurological Complications

Confusion

Forgetfulness

Depression

Anxiety

Difficulty walking

HIV-Associated Neurocognitive Disorders (HAND)

HIV-Associated Neurocognitive Disorders (HAND)

Can range from:

- mild symptom of behavioral changes and reduced mental functioning

- severe dementia causes weakness and inability to function

Hepatitis A Transmission

Primarily spread through fecal-oral route (contaminated food or water)

Hepatitis A Duration

Usually short term, acute infection

- recovery happens w/o long-term liver damage

Tx of Hep A

Vaccine is available for prevention

- Supportive care (rest + hydration) & cleaning the bathrooms w/ 10:1 water to bleach

Hepatitis B Transmission

Spread through contact w/ infected blood or bodily fluids

- ex. semen or vaginal fluids

Hep B Duration

Can be acute or chronic

- chronic can lead to long-term liver damage, including cirrhosis and liver cancer

Tx for Hep B

No cure

- a vaccine is available for prevention

- antivirals meds can help manage chronic hep b

Hepatitis C Transmission

Primarily spread through contact with infected blood and sexual contact

- ex. sharing needles, unsafe medical procedures

Hep C Duration

Can be acute or chronic

- can lead to long term liver damage

- there is NO vaccine

Tx of Hep C

Curable w/ highly effective antiviral meds

- must abstain from sexual intercourse until negative