Community Health Exam 3

What are the fastest ways to spread a biological agent?

Inhalation

What is a disaster?

An event that causes any level of destruction, death or injury that affects the abilities of the community to respond to the incident using available resources.

Define a mass Causality

• 100+ individuals

• One or more person than you have resources for

Define a multiple casualty

Involves 2-99 individuals

What are the classifications for casualties & explain them.

Direct victim: physically affected

Indirect victim: emotionally, financially or socially affected

Displaced: someone forced to leave their home

Refugee: a person to flees to another country for safety

What are the phases of stress reactions in a community?

1. Heroic: immediate response, rescue efforts

2. Honeymoon: optimism and gratitude for the help

3. Disillusionment: frustration and exhaustion

4. Reconstruction: long term rebuilding

START color code triage

Green: walking wounded

Yellow: systemic but not life threatening complications

Red: life threatening that need stabilization with a high probability of survival.

Black: deceased or expectant: injuries are too extensive

Hazmat tag: contaminated

Define immigrant

a person who moves to another country for permanent or long term due to work, family or better opportunity.

What is an NA-TECH diaster?

a natural disaster that creates or results in widespread technological problem

• Because they live in an area that is at high risk for tornadoes, Dale and his team have been preparing for such a disaster and putting prevention strategies in place for their own community. Example of a primary prevention strategy for a tornado includes all of the following except:

  • A. bringing protective equipment to the scene for search and rescue teams.

  • B.  ensuring the local hospital has a triage plan in place for victims.

  • C.  conducting tornado drills at the elementary school.

  • D.  testing the tornado warning system weekly during tornado season.

A

• Dale and his team are assigned to perform disaster triage. Which of the following is true regarding disaster triage?

  • A.  A full systems assessment is required to determine the triage classification of the victim.

  • B.  Disaster triage of an injured victim should take at least 5 minutes.

  • C.  People with minor injuries can be used to assist in the triage process.

  • D.  Red tags are applied to the deceased or those with non-survivable injuries.

C

• Dale and his colleagues are finishing up their week at the scene of the tornado. They have bonded with other disaster teams and are reminiscing about their experiences this past week. This phase of disaster response is known as

  • A.  heroic phase.

  • B.  recovery phase.

  • C.  honeymoon phase.

  • D.  rebuilding phase.

C

• What level of prevention was being addressed as the county planned how to spend its grant funds?

  • A. Primary prevention

  • B. Secondary prevention

  • C. Tertiary prevention

  • D. Disaster prevention

A

• What agency would be the first to respond to this disaster?

  • A. Centers for Disease Control and Prevention (CDC)

  • B. Federal Emergency Management Agency (FEMA)

  • C. U.S. Department of Homeland Security (DHS)

  • D. Office of Emergency Management

D

• Which phase of disaster management was underway when the committee distributed information about how to assemble a disaster emergency kit?

  • A. Prevention stage

  • B. Preparedness/plan stage

  • C. Response stage

  • D. Search and rescue

B

• One of the essentials for baccalaureate-prepared nurses to understand is disaster preparedness. What is the purpose of an adequately prepared nurse?

  • A.  It is a regulatory requirement that nurses participate in disaster planning.

  • B.  Adequately prepared nurses can assist the public quickly so that they may return to their families.

  • C.  Adequately prepared nurses can serve as leaders and enable others to have a smoother recovery phase.

  • D.  Community health nurses serve as role models and mentors to the community in a disaster.

C

What is a vulnerable population at risk for?

Poorer health status and health care access

Why are vulnerable population more likely to develop health problems and what is that called?

Exposure to multiple risk factors (web of causation)

What is ACE’s? What are the three types? What are the risks that come with it?

Adverse childhood experiences

• Abuse: physical, emotional and sexual

• Neglect: physical and emotional

• Household dysfunction: mental illness, incarcerate relative, mother treated violently, substance abuse and divorce

Increased health risks: the rougher your childhood the higher risk fro various health problems later.

Poverty in the United States in the strongest predictor of?

• Poor health

• Early mortality

• Disability

What causes accidents and injuries in agricultural workers?

• Environmental condition

• Geographic isolation and working alone

• Machinery

• Delayed access to emergency or trauma care

What are some acute and chronic illnesses that agricultural workers face?

• Musculoskeletal discomfort

• Acute and chronic respiratory conditions

• Hearing loss

• Hypertension

• Chemical exposure

What are some vulnerabilities with migrant and seasonal farm workers?

• Poor health

• Low income

• No access

• Cultural barriers

• Little or no preventative care

What did the Migrant Health Act OF 1962 produce?

Migrant Health Centers

Barriers for nurses in rural areas

• Higher poverty rates

• Cultural and social norms

• Low health literacy

• Language and education barrier

• Limited transportation

• Unpredictable work hours

• Low population density

• Resource limitation

• Poor access to healthy food and exercise

Positives of health care in rural areas

• Holistic care

• Everyone knows everyone

  • Close relationships with community and coworkers

• Rural lifestyle

• Autonomy and professional status

• Values by agency and community

What are some indicators for IPV in pregnancy?

• Delay in seeking prenatal care

• Unexplained bruising or damage to breasts or abdomen

• Use of harmful substances (cigs, alcohol and drugs)

• Recurring psychosomatic illnesses

• Lack of participation in prenatal education

Risk factors for suicide

• Psych disorders: major depression, bipolar and/or schizophrenia

• Substance abuse

• PTSD

• Bulimia or anorexia nervosa

• Past attempt of suicide

• Genetic

• Age: older white males highest rate

• History of sexual abuse

How does a nurse work with vulnerable populations?

• Build trust

• Avoid assumptions

• Coordinate care

• Advocate

• Focus on prevention

• Empower patients

• Utilize resources

• Be supportive

• Mr. Schmidt is treating a 52-year-old man for a possible eye infection. While the patient is at the clinic, Mr. Schmidt also requests a dental evaluation and educates the patient about diet and exercise, smoking and alcohol cessation counseling, and the importance of follow-up for influenza immunization at a future clinic. What type of nursing approach is being used?

  • A.  Holistic

  • B.  Comprehensive services

  • C.  Wrap-around services

  • D.  Family-centered services

B

• When working with the vulnerable populations, it is imperative that the nurse:

  • A.  Provides culturally and linguistically appropriate health care.

  • B.  Refers clients to the hospital emergency department when appropriate.

  • C.   Provides free or low-cost health care.

  • D.  Develops a plan for providing comprehensive health services

A

• In partnering with vulnerable clients, which of the following techniques will create a more successful interaction with the individual client? (Select all that apply.)

  • A.  Demonstrate trustworthiness and dependability.

  • B.  Direct the care of the client so that they feel that the nurse is in control.

  • C.  Develop programs and policies for populations of vulnerable persons.

  • D.  Foster a cycle of dependency so the nurse feels needed.

  • E.  Create a partnership with the client through careful assessment.

A, C, E

Define Health Professional Shortage Area

Region, population group or facility with shortage of healthcare providers in primary care, dental care or mental health services.

People from rural areas are more likely to experience what chronic conditions?

• Heart disease

• Hypertension

• Cardiovascular disease

• Diabetes

• cancer

• COPD

• Arthritis and rheumatism

Healthcare providers in rural areas…

• Typically serve the community for decades

• Serve patients across multiple counties

• Small teams for large populations

• work in HPSA

Where are the highest rates of smoking, alcohol abuse and obesity? Why?

Rural areas-because they do not take preventive measures

• Garth understands the following to be true when it comes to access to care for rural residents:

  • A. Most rural residents are insured through their employer.

  • B. Availability of primary care services for rural residents is increasing, while availability of specialty care is declining.

  • C. In general, the uninsured in rural areas have fewer access-to-care barriers than the uninsured in urban areas.

  • D. There is far less access to mental health services in urban areas than in rural areas.

C

• Nina is a migrant farm worker. Health disparities among migrant farm workers include all of the following except this:

  • A. Migrant farm workers may have the poorest health of any aggregate in the United States.

  • B. Of all aggregates, migrant farm workers have the least access to affordable health care.

  • C. Migrant farmworkers are more likely to delay seeking medical care until it becomes an emergency.

  • D. Migrant farmworkers get most of their preventative care through migrant health clinics.

D

• Garth serves on a task force that is looking at ways to increase health care access for migrant farm workers. Appropriate community level interventions include all of the following except this:

  • A. Keep the clinic open for longer hours in the evenings.

  • B. Deploy mobile clinics to work sites.

  • C. Provide social and health services in one building.

  • D. Provide education to migrant workers on prevention of pesticide exposure.

D

• Janelle Garcia is a nurse who works for the public health department and is assigned to the rural health clinic. The clinic serves a largely Hispanic population with many migrant farmworkers, who are primarily male. The town Ms. Garcia serves is approximately 45 miles from the nearest densely populated city. It is located within farm residency. Many of the large farms have housing quarters known to be occupied by undocumented workers. The farms are situated within fields of grape vines and peach orchards. As a public health nurse working in rural practice, what are some of the professional challenges Ms. Garcia may encounter?

  • A. Diversity in clinical experiences

  • B. Close relationships with clients and coworkers

  • C. Lack of resources with other health professionals to interact with

  • D. Greater autonomy of practice

C

• Janelle Garcia is working primarily with Mexican immigrants. What cultural health beliefs and practices is Ms. Garcia expected to encounter when dealing with this population?

  • A. Mexican immigrants prefer not to be touched in encounters.

  • B. The woman in the household is considered the health care decision maker.

  • C. Mexican clients are more likely to listen to the health care provider for information.

  • D. Mexican clients may appear to understand information by nodding.

D

• Jose Aguilar is a 48-year-old man who works in the grape fields for 12 to 13 hours per day. He is responsible for picking fruit and packing and moving crates to be picked up for delivery. What are the primary health concerns for this client? (Select all that apply.)

  • A. Tractor fall

  • B. Green tobacco sickness

  • C. Chronic neck and back pain

  • D. Eye problems related to dust and chemicals

  • E. Skin cancer

C, D, E

What are two ways to determine if someone is homeless?

• Point-in time counts: volunteers go out at night and count sheltered and unsheltered

• Period prevalence counts: counts over weeks and moths through service providers, surveys and shelter records

• When Denise informs the home health curse that she did not go to her scheduled appointments, what is a cultural attitude the nurse may consider?

  A. This patient is noncompliant and uncooperative

  B. The patient must have insufficient resources

  C. The patient did not listen to instructions

  D. The patient did not feel respected

A

• The nurse informs Denise that her doctor has ordered daily blood pressure monitoring. She informs the patient that she should obtain a portable monitor. What approach does the nurse use to assess the patient’s ability to obtain a machine?

  A. “Without checking your blood pressure every day, you will definitely end up back in the hospital.”

  B. “The doctor would like for you to monitor your blood pressure. Are you able to purchase a machine?”

  C. “You have to go to the pharmacy every morning to check your blood pressure on their machine.”

  D. “If you don’t purchase a machine, I will not be able to help you.”

B

• A community health nurse is involved in disaster preparedness planning for a local neighborhood prone to flooding. Which action by the nurse best demonstrates a focus on disaster mitigation?

  • A) Conducting regular community meetings to educate residents about evacuation routes and emergency shelters. 

  • B) Collaborating with local authorities to develop a comprehensive flood response plan for the neighborhood. 

  • C) Organizing a neighborhood cleanup day to remove debris that could obstruct drainage systems during floods. 

  • D) Providing educational sessions on disaster preparedness and first aid techniques to community members.

C

• Which of the following interventions is a tertiary prevention measure related to disaster management?

  • A.  Participating in developing a disaster management plan for the community

  • B. Providing respiratory supplies for response to bioterrorism

  • C. Assessing disaster victims and providing triage for care

  • D.  Participating in home visits to uncover dangers that may cause additional injury to victims or rescue personnel

D

• What are the considerations for the nurse in responding to a disaster? (Select all that apply.)

  • A.  Advance personal and family preparation can help ease some of the conflicts that arise and allow nurses to attend to client needs sooner.

  • B.  The nurse assisting in disaster relief efforts must be as healthy as possible, both physically and mentally.

  • C.  Young children should not be involved in disaster preparedness because they might experience undue stress and anxiety.

  • D.  One way a nurse can ensure that her family is protected is by providing them with the skills and knowledge to help them cope with a disaster.

  • E.  The nurse maintains awareness that disaster drills are a requirement of the state and not a necessity.

A, B, D

SALT triage for mass Casuality

S: sort walker, wavers and still

• Walkers go to one side

• Who ever can hear you will wave and be grouped

• Then there is a group that can not move

Assess: performed in 1 minute

Life saving intervention: if you can do something right then adn there do it or get help

Treatment/transfer: send them for help

START Triage System

• When is it used?

• How long does it take?

• “Simple Triage and Rapid Treatment”

• Used in Multi Causality and Mass Casualty

• One minute

  • Respirations

  • Perfusion

  • Mental Status

  • Breathing? Bleeding?

• Minorly injured people need to assist (walkers)

• Person tagged with color

• Victims moved to treatment

What Is the Migrant and seasonal farm worker enumeration profile study?

It assess migrant and seasonal farm worker population to improve healthcare access.

What are some barrier for migrants when it comes to receiving health care?

Cultural, linguistic, economic and mobility barriers.

What is drug abuse?

Use of illicit or prescription drugs

What is addiction?

Overwhelming and compulsive use of drug

• They keep a high supply

• High tendency to relapse if the drug is removed (they are experiencing the uncomfortableness of withdrawal symptoms)

What is dependence?

The psychological change in teh CNS from chronic drug use that result in the need to prevent symptoms of withdrawal.

What is mainstream smoke?

Smoke inhaled by the smoker

What is side stream smoke/secondhand smoke?

smoke inhaled by other in the vicinity of people smoking

Psychoactive drugs affect?

Mood, perception and thought

What are the effects on the CNS when comparing depressants and stimulants?

Depressants: reduce activity in the CNS

Stimulants: increased activity in teh CNS causing wakefulness

Signs and symptom of depressants

• Lower the body energy level, reduce sensitivity to outside stimulation and high doses induce sleep.

• Decrease: HR, RR, muscle coordination, energy and induce coma

What are some examples of depressants?

Alcohol, barbiturates, benzodiazepine and opioids

What are some symptoms of stimulants?

Coronary artery constriction, relaxes smooth muscles and decreases insulin sensitivity

What are some example of stimulants?

Caffeine (coffee and energy drinks), cocaine, nicotine

What is fetal alcohol syndrome?

Mother drinks while pregnant which results in cognitive and developmental delay.

Do genetic play a role in the development of alcohol use disorders?

Yes

What are some alcohol related diseases?

Liver disease and pancreatitis

One drink contains how much alcohol?

14 g

12oz of beer is how much alcohol?

5%

5oz wine is how much percent of alcohol?

12%

1.5 oz of distilled spirits have how much alcohol content?

40%

What opioids do we see people overdose and die from?

Herion, fentanyl and prescription opioids

Where is fentanyl made and what is it mixed with?

It is cheaply made in Mexico and mixed with Herion

Fentanyl is the?

Single most deadly drug and 50x stronger than heroin and 100x stronger than morphine

Who can tolerate more alcohol, men more women?

Men

What are the 3 factors that contribute to drug abuse?

1. Drug, what kind?

2. Set: the individual using the drug (fam hx)

3. Setting: the influence of the physical, social or cultural environments within which the use occurs.

Primary prevention in a disaster focuses on…

Mitigation: reducing the risk and minimizing the damage

What is the non disaster stage?

period before the disaster occurs

Who warns the population of the incoming diasters?

National Incident mangement system

What types of evacuation is there?

Voluntary or mandatory

What are some methods to warn the population of a disaster?

• News

• Siren

• Phones

• Police knock on doors

Pre disaster stage

Actions taken when a disaster is pending

When is secondary prevention implemented in a disaster?

After the disaster to prevent further injury or destruction

For first responders during a disaster we need to understand what motto?

Safety before search and rescue.

What are some safety areas during a disaster?

School, gym, shelter, basement and churches in the community

What does tertiary prevention look like in a disaster?

Recovering and restoring the community to previous levels of function including their residents.

• Debriefing meetings often will happen as well to make revisions to responses to prevent more destruction down the road.

What can be done to prevent ACE’s (acute childhood experiences)?

• Parent support programs for teens and teen pregnancy prevention programs

• Mental illness and substance abuse treatment

• High-quality child care

• Sufficient economic support for families with lower incomes

• Home visiting to pregnant women and families with newborns

• Parenting training programs

• Intimate partner violence prevention

• Family-friendly work

Why is homelessness expensive?

Because most care homeless receive is from the emergency room

Pregnant teens are considered…

High risk so we need to detect early problems with pregnancy

Who has the highest risk for suicide?

Males 10-24

What are some characteristics for homeless children?

Food insecurity, increased school absences and depression

Temporary assistance to needy families

provides financial help to low income families with children 

Supplemental Nutrition Assistance program

Food assistance to low income individuals and families 

Women, infants and children program

support pregnant women, new mothers and young children with nutritious food, healthcare referrals and education. 

Head start

Early childhood education, nutrition and healthcare for low income children to promote school readiness. 

What is methadone used for?

Blocks the effect of the opioids during withdraws/craving

Who are some high risk drug users?

• Adolescents

• Older adults

• Injection drug users

• Drug use during pregnancy

• Use of illicit drugs

• Codependency and family involvement

• Enabling

What are some support groups for drug users?

• Alcoholics Anonymous (AA)

• Al-Anon and Alateen

• Narcotics Anonymous (NA)