Community Final 430

factors that contribute to the vulnerability of health include…

• SDOH - Health conditions - age - geography (where you live and work) - socioeconomic status

Veterans have approximately ___ the suicide rate of non-veterans

double

Screen veterans for suicide risk if they are experiencing

• sedative use disorder - homelessness - military related sex trauma - chronic pain - sleep conditions - recent separation from service (1st year post discharge)

After a public announcement of impending radioactive exposure public health nurses need to

activate the emergency plans and distribute Potassium iodine to those in the fall out area

What does potassium iodine do

saturates the thyroid gland preventing uptake of radioactive iodine. should be given immediately after exposure

Field triage greem

walking > yes > Priority three: delayed

Field triage black

walking > no > breathing > no > breathing restored after manouevre > no > dead

field triage red

walking > no > breathing (when airway opened) > yes > RR (<10 or > 29) > Priority 1 immediate or from RR (10-29) > Circulation > CRT 2+ sec/ P 120+

field triage yellow

walking > no > breathing (when airway opened) > yes > RR 10-29 > circulation > CRT < 2 sec P <120 Priority 2 urgent

What is the antidote to opioids

Naloxone hydrochloride/narcan

Tolerance definition

phenomenon in which the body or brain becomes less responsive to the effects of a substance over time. As a result, individuals need to use larger amounts of the substance to achieve the same desired effect or experience. Tolerance is often seen in people with substance use disorders.

Withdrawal

the physical and psych symptoms that occur when a person reduced/stops using a substance to which they have become physically dependent

Delirium tremens + treatment

form of alcohol withdrawal from someone going cold turkey. Symptoms from 48-72 hrs after last drink was had lasting from 1-8 days. Can start with visually hallucinations and can progress quickly. Treatment is aggressive with benzodiazepines which can be addictive (withdrawal)

Delirium tremens symptoms

confusion, disorientation, hallucinations, fever, hypertension, diaphoresis, and autonomic hyperactivity

Benzodiazepines common uses and severe symptoms

Commonly used to treat anxiety, insomnia, and seizures. Sever symptoms include seizures, mania, and schizophrenia. TAPER OFF

Remission

·       in the context of addiction and substance use disorders refers to when an individual with a diagnosed SUD no longer meets the criteria for the disorder. This could be due to successful treatment, behavioral changes, or other factors. Remission can be partial (some symptoms remain) or full (no symptoms are present).

Who are mandated reporters?

RNs, they must report any case known or suspecting. Document, and reports filed with DCF,Elder Services, or disctrict attorney. Forensic nurses do the interview a reporting nurse asking too many questions may be stressful to the patient

Forensic nurses and District attorny office exclusively

interview, assess. and college evidence

Intimate partner violence

·       is the leading cause of morbidity and mortality for women worldwide. Pregnant women have a significantly higher rate of it versus non-pregnant women. Globally, approximately 25-30% of women have experience it in their lifetime.

Types of elder abuse

physical, emotional, neglect, ad exploitation.

Most cases of elder abuse are by … most cases are … because they live longer. And … are more likely to be affected by abandoment

someone known to the person including staff, women, men

Behavioral cues of potential violence

pacing, restlessness, clenched fists, intense staring, or sudden changes in voice tone or volume. Verbal threats, angry or aggressive statements, or a rapid shift from calm to irritable behavior also suggest escalating risk.

Physiological signs of potential violence

increased muscle tension, flushed face, or agitation may appear as clients lose emotional contr

Safety measures for one self with early identification

·       reduce stimuli, and maintain a safe distance.  In the community setting, it is always acceptable to evacuate an unsafe situation (leave someone’s house during a home visit, leaving a homeless encampment mid-treatment) – abandonment in the community does not apply like in a healthcare facility with other staff and security.

Palliative care and its goal

Focus on comfort and quality of life.  Can be given at any stage of serious illness.  Can be concurrent with curative treatment.  Goal: Relieve suffering, improve QOL.

Hospice Care and Medicare Benefits

Subset of palliative care for end of life.  Prognosis ≤ 6 months (certified by 2 physicians).  Patients choose comfort over curative treatment.  Medicare hospice benefit covers all related care (limited home visits until 72 hours is declared).

Hospice care medication considerations

, morphine has no ceiling dose, doses are titrated based on the client’s comfort and symptom control. However, opioids commonly cause constipation, so a scheduled bowel regimen (e.g., stool softeners + stimulant laxatives) is essential to prevent complications

Physical changes 1-2 wks before death

Increased sleep, disengagement from world, decreased appetite and fluid intake - this is normal, don't force food/fluids

Physical changes days before death

Sleeping most of the time, difficult to arouse, confusion, restlessness, agitation, kidneys shutting down, decreased urine output (concentrated, dark), cool, mottled extremities (circulation decreasing), Cheyne-Stokes respirations (irregular breathing pattern, periods of apnea)

Physical changes hours before death

Unresponsive, "Death rattle" gurgling sound from secretions in throat, NOT distressing to patient who would be unconscious, but family may find distressing - reposition patient, explain process to family, breathing irregular, may have apnea periods, can give anticholinergic (scopolamine, atropine) to dry secretions if breathing is congested, pulse weak, irregular, blood pressure dropping, cyanosis, mottling of skin, decreased blinking, eyes may remain half-open (provide eye drops for comfort)

Physical changes moment of death

No breathing, no pulse, no response to stimuli, fixed, dilated pupils, loss of sphincter control (bowel/bladder release)

Infectious disease vs communicable disease

caused by a germ vs ·       caused by a germ + spreads between people

public health surveillance definition

·       is the process of collecting, analyzing, and interpreting health data to guide public health action and prevent disease. 

PHNs role in infectious/communicable diseases

perform communicable disease case investigations to determine the source of, and contain, outbreaks in the community

healthcare providers roles in infectious/communicable diseases

providers treat individuals with communicable diseases

case investigations definition

interviews that gather information about the source of the disease

Epiglottitis

caused by Haemophilus influenzae type b (Hib), a life-threatening inflammation of the epiglottis. It causes rapid swelling that can block the airway

Epiglottitis s/s

Sudden onset of high fever, severe sore throat and difficulty swallowing, drooling (because the child can’t swallow), tripod position (sitting upright, leaning forward, mouth open), stridor (harsh inspiratory sound), muffled voice (“hot potato” voice

epiglottitis examination

DONT examine the throat it can cause complete airway obstruction (trigger laryngospasm) DO keep child calm and in a comfortable position and activate EMS (911)

Pertussis

droplet precautions (EMERGENCY FOR INFANTS) ·       It is recommended that close contacts to an infant be vaccinated with a Tdap vaccine.  Tdap is an adult vaccine that is recommended every 10 years.

Meningococcal meningitis

droplet precautions, ·       . Close contacts (roommates, intimate partners, anyone with prolonged exposure) must receive urgent prophylactic antibiotics (e.g., rifampin, ciprofloxacin) to prevent disease. This is the critical, time-sensitive public health action in the community.

Bacterial meningitis

(inflammation of the Menges) is caused by Neisseria meningitidis (meningococcal), streptococcus pneumoniae, or Haemophiles influenza type b (HIB).  This is a severe public health emergency in the community.

Viral meningitis

·       is caused by Enteroviruses, HSV, mumps, and measles. Usually milder than other meningitis, and is not usually a significant public health issue.

foodborne diseases

Salmonellosis, Campylobacteriosis, Listeriosis, E. coli, Norovirus, Hepatitis A, Botulism, Toxoplasmosis, Ciguatera Poisoning

Waterborne diseases

Cholera, Typhoid Fever, Hepatitis E, Giardiasis, Cryptosporidiosis, Amoebiasis (Amebic Dysentery), Schistosomiasis, Rotavirus Infection

Listeria

can be transmitted to humans through the consumption of contaminated food, particularly unpasteurized dairy products, deli meats, and certain ready-to-eat foods, such as soft cheeses, smoked seafood, and prepackaged salads.  It is advised that pregnant women avoid these foods because they are suspectable to infection

E. coli

is a type of bacteria that normally resides in the intestines usually harmless. E. coli infections are often transmitted through the consumption of contaminated food or water, particularly undercooked ground beef, unpasteurized dairy products, and raw fruits and vegetables. Person-to-person transmission can also occur (fecal-oral route).

e. coli symptoms + treatment

Symptoms of E. coli infection can include (bloody) diarrhea, abdominal cramps, and vomiting.  In most cases, E. coli infections do not require specific treatment and resolve on their own. The primary focus is on rehydration and symptom management.  Severe cases are usually related to an immune compromised host.

norovirus

is a highly contagious viral illness that affects the gastrointestinal tract. It is a leading cause of foodborne illness outbreaks, as well as outbreaks in settings such as cruise ships, schools, and healthcare facilities. is primarily transmitted through the consumption of contaminated food or water, direct contact with an infected person, or contact with contaminated surfaces. Hosts continue to shed viral agents up to 48 hours after symptoms are resolved. infection can cause sudden and severe symptoms, including nausea, vomiting, diarrhea, and abdominal cramp

norovirus treatment

The primary treatment focus is on rehydration to replace lost fluids and electrolytes, particularly in cases with diarrhea and vomiting.

botulism

is a rare but serious and potentially life-threatening illness affecting the nervous system caused by toxins produced by the bacterium Clostridium botulinum

botulism symptoms

Early symptoms include double vision, blurred vision, drooping eyelids, dry mouth, and difficulty speaking. The most life-threatening complication is respiratory muscle paralysis due to progressive muscle weakness and difficulty swallowing, which can lead to airway obstruction and respiratory failure

botulism treatment

Treatment involves antitoxin administration, which can help neutralize the toxin. Preventing botulism involves proper food preservation techniques, including canning and fermenting, and ensuring that food is heated adequately to destroy botulinum toxins

Cholera

is an acute diarrheal illness caused by infection with the bacterium Vibrio cholerae.

Cholera s/s

It is characterized by severe, watery diarrhea (looks like ‘rice water’) and can lead to dehydration, electrolyte imbalances, and potentially life-threatening complications.

Chlera prevention

Preventing involves improving access to clean and safe drinking water, sanitation, and hygiene. Proper food handling, especially seafood and raw vegetables, can also reduce the risk of infection. The use of cholera vaccines is another preventive measure, especially in areas with endemic cholera. During an, the priority is breaking the chain of transmission. It spreads primarily through contaminated water and food, often due to poor sanitation and hygiene. Hand hygiene and safe water practices are the most effective primary prevention strategies. It remains a significant public health concern, particularly in regions with poor sanitation and water infrastructure. Outbreaks can occur, especially after natural disasters or in conflict-affected areas, and prompt public health measures are essential for control.

Typhoid fever

also known as enteric fever, is a systemic illness that can lead to a range of symptoms and, if left untreated, can become severe and life-threatening, caused by the bacterium Salmonella Typhi. Transmitted through the consumption of food or water contaminated with the feces of an infected person.

Typhoid fever symptoms + treatment

sustained high fever, weakness, abdominal pain, headache, and loss of appetite. Treatable with antibiotics. Commonly used antibiotics include ciprofloxacin and ceftriaxone

bacterial diseases

Diphtheria, tetanus, pertussis (whooping cough), Haemophilus influenzae type b (Hib), pneumococcal disease, meningococcal disease, tuberculosis (TB), cholera, typhoid fever, and anthrax

viral diseases

Measles, mumps, rubella, polio, hepatitis A, hepatitis B, influenza, rotavirus, varicella (chickenpox), herpes zoster (shingles), human papillomavirus (HPV), rabies, yellow fever, Japanese encephalitis, tick-borne encephalitis, Ebola, dengue, COVID-19, mpox (monkeypox), and respiratory syncytial virus (RSV).

Bacterial STIs which are curable with Antibiotics

Chlamydia, Gonorrhea, Syphilis

Viral STIs which are not curable

·       HIV, Herpes, HPV, Hepatitis B (HPV and Hep B are vaccine preventable diseases!)

Many people with HIV do not experience

symptoms in the early stages (long incubation period). As the virus progresses, some individuals may experience flu-like symptoms, including fever, fatigue, and swollen lymph nodes.  Due to the long incubation period, HIV is not detected in laboratory tests for at least 10-90 days after infection onset.  It’s important to give residents this information so they understand their risk and can strategize testing timing.

Core airborne communicable diseases:

Measles, Tuberculosis, and Varicella: ).  All require N95 respirator mask for care or contact, isolation from the community, and well-ventilated living quarters

Chain of infection (wheel kinda)

mode of transmission > portals of entry > susceptible host > infectious agent > reservoirs (people water food), Portals of exit

Active TB

·       is only diagnosed after an abnormal chest x-ray and sputum cultures. These tests are ordered after a positive TB screening which is either an Interferon-Gamma Release Assays (IGRAs) blood test (also known as QuantiFERON-Gold testing) or a tuberculin skin test (TST) also known as a purified protein derivative test (PPD). An IGRAs test has a higher specificity than a PPD test, meaning a PPD tests has a lot of false positives, however, a PPD is an easier screening test to conduct in a community setting because it’s administered intradermally with a syringe using the Mantoux technique, while an IGRAs test requires phlebotomy. 

¼ of the worlds population has

·       latent TB. Latent TB is not an infectious disease.  Only active TB is an infectious disease. Although, people with latent TB can choose to receive treatment to irradicate the bacteria from their system – this will cure the disease and prevent future risk of active TB if they become immune compromised.

Treatment of active tb in MA

not optional.  The state regulations require people to participate in direct observation treatment (DOT) through their city/town public health nurse. Refusal to participate in treatment results in mandatory hospitalization and forced treatment.  This is unique to active TB.

Classic presentation of active tb vs latent

persistent cough, fever, and night sweats vs ·       TB has no symptoms and is treated with Rifapentine and Isoniazid – must watch for liver complications (no alcohol, jaundice)

A positive PPD/TST test for tuberculosis is determined by measuring the

induration (raised, hard area) at the injection site 48-72 hours after the test is placed. The interpretation depends on the person's risk factors

5 mm+ induration is positive for

·        HIV-positive individuals

·        Recent contacts of someone with active TB

·        People with chest X-ray findings suggestive of previous TB

·        Organ transplant recipients and other immunosuppressed patients (taking corticosteroids or TNF-alpha inhibitors)

10 mm+ induration is positive for

·        Recent immigrants (within 5 years) from high-prevalence countries

·        Injection drug users

·        Residents and employees of high-risk congregate settings (prisons, nursing homes, homeless shelters, hospitals)

·        Mycobacteriology laboratory personnel

·        Children under 4 years old

·        Infants, children, and adolescents exposed to high-risk adults

15+ induration is positive for

People with no known risk factors for TB

Inactivated or Killed Vaccines

These contain pathogens that have been killed or inactivated. Example: Polio vaccine.

Live Attenuated Vaccines

These contain weakened live pathogens. Examples include the measles, mumps, and rubella (MMR) vaccine.  Pregnant women cannot receive the MMR vaccine.  Women should be educated not to get pregnant for at least 28 days/a month after receiving the MMR. 

Subunit, Recombinant, or Conjugate Vaccines

·       These contain specific components of the pathogen. Examples include the hepatitis B, Tdap, Dtap, HPV, Pneumococcal, Meningococcal, Shingles à most vaccines!

mRNA Vaccines

A relatively new technology, vaccines like the COVID-19 vaccines (Pfizer and Moderna) instruct cells to produce a harmless piece of the pathogen, prompting an immune response.

Lead, levels, and therapy

Lead poisoning is preventable. The treatment for lead exposure, which is defined as levels over 45mcg/dL or higher, is Chelation Therapy

chelation therapy

This treatment is performed inpatient (short stay) or outpatient with medication, depending on the complexity/acuity of the case.  Community/public health nurses should conduct home visits to evaluate risk of further exposure and perform patient education when a child is diagnosed. 

Primary prevention goal, target

Goal: Prevent disease or injury before it occurs

Target: Healthy individuals

primary prevention examples

• Vaccinations (flu shot, measles vaccine)

• Health education (smoking cessation programs)

• Safety measures (seat belts, helmets)

• Healthy lifestyle promotion (nutrition, exercise)

• Environmental modifications (water fluoridation)

Secondary Prevention goal, target

Goal: Detect and treat disease early, before symptoms appear

Target: Individuals at risk or with early disease

secondary prevention examples

• Screening tests (mammograms, colonoscopies, Pap smears)

• Screening tests performed by school nurses (vision, hearing, BMI, postural – catches diseases early, but after onset)

• Blood pressure checks

• Cholesterol testing

• Tuberculosis skin tests

• Regular health checkups

Tertiary prevention goal, target

Goal: Manage existing disease to slow progression and improve quality of life

Target: Individuals with established disease

tertiary prevention examples

• Cardiac rehabilitation after heart attack

• Physical therapy after stroke

• Diabetes management education

• Support groups for chronic conditions

• Medication compliance programs