Community Exam #2 (Part 1)

healthy people 2020 and 2030 objectives for women

• reduce reproductive cancer deaths

• increase proportion of intended pregnancies

• reduce rates of pregnancies in 15-17 year olds

• reduce rate of maternal mortality 12.7% to 11.4%

• reduce c-sections in low risk pregnancies

• increase rates of prenatal care

• reduce iron deficiency

maternal mortality globally

• higher in developing and low-middle income countries than developed and high income countries

• highest in non-hispanic black populations

• lowest in hispanic populations

maternal mortality statistics

• Columbia: 75 deaths per 100,000 live deaths

• Bangladesh: 123 per 100,000 live births

• South Sudan: 1,123 per 100,000 live births

• Sweden: 5 deaths per 100,000 live births

men’s health

• men die an average of 5 years earlier than women

• health care use is greater among women than men

• males at a higher risk of death from unintentional injury, homicide, and suicide

• men tend to perceive themselves in better health than women do

• women are more likely to be ill BUT men are at greater risk for death

• men have higher morbidity and mortality rates for conditions that are the leading causes of death

men’s health theory: biological factors

• genetics

• effects of sex hormones

• physiological differences

influenced by genetics, hormones, and environment

men’s health theory: socialization

• men enculturate their sons to believe that risking personal injury demonstrates masculinity

• men are more likely to change health behaviors when supported by female family members

  • females seen as caretakers with more knowledge in health

  • marriage improves outcomes for men since have female caretaker

psychosocial impact on male use of medical care

• men do NOT engage in health protective behaviors as frequently as women

• most men do NOT have routine check-ups or screenings

• men seek ambulatory care LESS often than women

  • men DELAY medical treatment

    • sicker when they do seek health care so they require more intensive medical care

      • men tend to have longer lengths of stay in hospital than females

theories that explain men’s health

1. orientation toward illness and prevention

2. reporting of health behaviors

3. gender-linked behavior

orientation toward illness and prevention

• stereotypical view of men as strong and invulnerable is incongruent with health promotion

• men sometimes lack somatic awareness and are less likely to interpret symptoms as indicators of illness

• men may have a desire to rationalize symptoms and deny their susceptibility to disease (delays treatment)

reporting of health behaviors

• data collection on health behaviors may not be accurate

• males are less likely than females to participate in data collection process (lack of data)

• social pressure for males to be less expressive (suppress their emotions) may help explain gender differences in reporting health behaviors

gender-linked behavior

• largest sex differences in mortality rates occur for causes of death associated with gender-influenced behavior

  • tobacco use: lung cancer, bronchitis, emphysema, asthma

  • substance use: cirrhosis, accidents, homicide

  • poor preventative health habits and stress: heart disease

  • lack of other emotional channels: cirrhosis, suicide, homicide, accidents

men’s health healthy people 2020 and 2023 goals

• prostate health

• reduce unprotected sex

• reduce HIV/AIDS rates

  • 75% of all diagnoses are males

  • rates much higher in males than females

  • highest among black men

• improve veteran’s health

human immunodeficiency virus (HIV)

• virus that attacks the body’s immune system

• if left untreated, can lead to acquired immunodeficiency syndrome (AIDS)

• currently no effective cure

  • have for life once infected

• can be controlled with proper medical care

  • can live long, healthy lives and protect partners if get effective HIV treatment

HIV stages

1. acute

2. chronic

3. AIDS

HIV statistics

• approximately 32,000 new infections occur in the US each year

  • decreases each year

• current HIV continues to be global health issue

  • 86% were unaware of their status in 2017

• only 63% of people who knew that had HIV were virtually suppressed or had the virus under control through effective treatment

HIV transmission

transmitted primarily through unprotected anal and vaginal sex, shared needles, and mother to baby

HIV outcomes

• untreated HIV/AIDS will take 8-10 years until death

• 90% death rate if untreated

  • death rate declined by 48% from 2010-2017

• can live a full life with treatment

• antivirals have side effects that must deal with

PrEP

• reduces risk of getting HIV from sex by about 99% when taken as prescribed (daily)

• MUST be tested for HIV first

• must see health care provider every 3 months

• use is still relative low (especially among black and hispanic males)

role of community health nurse in population health

• primary

  • teaching and health education

  • knowledge of community health resources

• secondary

  • screening

• tertiary

  • rehabilitation

  • early diagnosis

when are screening tests appropriate

1. cost effective (NOT wasting money)

2. safety of administration (benefit and detection outweigh risks)

3. availability of treatment

   1. sometimes will NOT test if no treatment available

   2. EXCEPTIONS: have methods to slow down, caregivers want to know, allow to get affairs in order

4. reliability and validity

US Preventative Services Task Force (USPSTF)

determine if appropriate to screen for certain disorders and conditions based on an ABCDI grading system

screening grading system: A

appropriate to screen

USPSTF recommends service because high certainty that net benefit is substantial

screening grading system: B

appropriate to screen

USPSTF recommends service because high certainty that net benefit is moderate OR there is moderate certainty that net benefit is moderate to substantial

screening grading system: C

USPSTF recommends selectively offering or providing service to individual patients based on professional judgement and patient preferences

• moderate certainty that net benefit is small

benefits and risks vary based on individual patient

• screening may be invasive and have high rates of complications or false positives

• disease may be very slow growing and will die before symptomatic (ex. prostate cancer)

screening grading system: D

screening NOT recommended and treatment may not even be tolerated

USPSTF recommends against service

• moderate to high certainty that service has no net benefit or that harms outweigh benefits

screening grading system: I

USPSTF concludes that current evidence is insufficient to assess balance of harms and benefits

• evidence is lacking, poor quality or conflicting

• balance of harms and benefits cannot be determined

flu vaccine rates

• pretty even coverage across children and adults

• higher rates of vaccination in older adults (more likely to be asked at PCP) and health care workers (required)

• lowest vaccination rates among black and hispanic adults and adults with lower income or education level

communicable disease

an illness caused by a pathogen (virus or bacteria) that people transmit to one another

modes of transmission

• direct

  • droplet

  • bodily fluid contact

• indirect (via reservoir)

  • contaminated food/water

  • airborne

  • vectors (living organisms)

  • vehicles (inanimate objects)

some diseases can be transmitted through both direct and indirect transmission

infection control measure

any behavior or action taken to reduce the spread of communicable disease

Center for Disease Control and Preservation (CDC)

responsible for protecting the US against disease threats within the US or abroad

direct transmission

• direct contact: bodily fluid exchange through physical contact

• droplet: short-range respiratory droplets produced by sneezing, coughing or talking

indirect transmission

• airborne: small aerosols suspended in the air for a long time

• vector-borne: living organisms transmit infection to a healthy person

  • mosquitoes, fleas or ticks

• vehicle-borne: contaminated inanimate objects

  • food or water

vector borne diseases

• ticks

  • lyme disease

  • rocky mountain spotted fever

• mosquitoes

  • west nile virus

  • zika

  • malaria

lyme disease

bacterial infection from borrelia burgdorferi

• infected immature deer tick transmits to humans

  • will be on deer initially and then some second animal to pick up bacteria

• seek medical attention if person develops bull’s-eye rash or fever after tick has been attached for more than 36 hours

rocky mountain spotted fever

bacterial infection from Rickettsia rickettsi

• infected dog ticks and wood ticks

• fatal if left untreated

  • bacteria can attack blood vessels and tissues

• develop flu-like symptoms and spotted rash 3-12 days after tick bite

vector-borne: tick prevention strategies

primary: prevent attachment

• use repellents (DEET containing)

• treat outer clothing with Permethrin

• dress defensively

  • light colored clothing

  • long sleeves/pants

  • tuck pants into socks

primary: control population of ticks

• control deer population via hunting

• maintain walking trails to reduce heavy brush

• treat dogs, cats and deers for ticks

secondary: early detection and removal

• tick checks to remove before they attack

  • check armpits, groin and scalp thoroughly

• early removal of attached ticks

vector-borne: mosquito prevention strategies

primary: prevent biting

• use repellents (containing DEET)

• treat outer clothing with Permethrin

• wear loose-fitting long sleeves and pants

• avoid outdoors during peak mosquito hours (dusk to dawn)

primary: environmental control

• habitat control

  • eliminate standing water

• repair housing to prevent mosquito entry

  • bed nets

  • windows with screens

secondary: early detection

• early recognition of s/s

vehichle-borne diseases: water and food

• bacterial

  • salmonella shigella

  • escherichia coli 0157

  • listeria monocytogenes

• parasites

  • giardia

• viruses

  • norovirus

  • hepatitis A

food and waterborne illness: etiology

• contamination occurs of food or water ingested by healthy humans

• animal waste directly contaminates food or water

  • e. coli from manure fertilization on vegetables

  • animal waste run off into water streams

• unsanitary food handling or practices (fecal-oral)

• improper food storage that allows bacteria to grow

food and waterborne illness: symptoms

irritates GI tract

• N/V

• diarrhea

• bloating

food and waterborne illness: infection

pathogen or bacteria irritates normal GI functioning

may require an antibiotic treatment to correct

food and waterborne illness: intoxication

ingested food contains toxin that causes symptoms

• toxins can remain even in thoroughly cooked food

• requires supportive care

• likely a smaller outbreak because toxin can be linked to a specific source

food and waterborne illness: primary prevention

• hand hygiene

• safe food handling

  • prevent cross contamination

  • sanitize surfaces used for high-risk foods (chicken and eggs)

• cool foods for storage quickly

• policy level changes to reduce farm animal waste runoff or contamination of agriculture

food and waterborne illness: secondary prevention

• early detection and reporting of potential sources or causes

• source tracking and recall action

airborne diseases

tuberculosis

tuberculosis

infection caused by Mycobacterium tuberculosis

transmission: spread from person to person when bacteria is aerosolized into the air

latent tuberculosis

• bacteria lives in body but is inactive

• individuals are asymptomatic and cannot spread to others

active tuberculosis

• bacteria is actively multiplying in the body cause illness

• person is contagious and symptomatic

tuberculosis: symptoms

usually affects lungs

• severe cough

• bloody cough and sputum

• chest pain

• unexplained weight loss and fatigue

• fever

• night sweats

can also affect kidney, brain and spine (extra-pulmonary)

• joint destruction

• impaired kidney function

• meningitis

• improper heart function

tuberculosis: primary prevention

vaccination: Bacille Calmette-Guerin (BCG) vaccine

• used only in high-prevalence countries

tuberculosis: secondary prevention

screening and testing

• 2 step Mantoux Tuberculin skin test

  • individuals who immigrate from other countries may screen false positive on TB skin test

• quantiFERON TB gold blood test

  • measures immune proteins

any positive screening with lead to chest x-ray to rule out active TB

treat latent TB using multi-drug regimen

tuberculosis: tertiary prevention

• contact investigation to prevent further infections

• direct observation therapy (DOT)

  • used to ensure person with active TB takes medications

direct contact and bodily fluid diseases

• hepatitis

• human immunodeficiency virus (HIV)

• sexually transmitted infections

  • chlamydia

  • gonorrhea

• human papillomavirus

HIV: opportunistic infections

• pneumocystis pneumonia (fungal infection)

• tuberculosis

• cytomegalovirus

HIV: primary prevention

• pre-exposure prophylaxis (PrEP)

• barrier methods (condoms)

• harm reduction (sterile needles and syringes)

• post-exposure prophylaxis

  • within 72 hours of exposure

  • victims of sexual assault when HIV status of perpetrator is unknown

HIV: secondary prevention

• US recommended universal HIV testing for everyone ages 13-64

  • testing everyone reduces the stigma around sexual behaviors

  • testing is cheap

  • effective treatment available

    • 90% death rate without treatment

• treatment as prevention

  • taking antiretroviral therapy to achieve undetectable viral load

STIs

• most common STIs

  • chlamydia

  • gonorrhea

• human papilloma virus (HPV)

STIs: symptoms

often asymptomatic

STIs: transmission

through sexual contact of mother-baby

STIs: complications

• pelvic inflammatory disease

• infertility

• infants

  • blindness and pneumonia

antimicrobial resistance is big concern

STIs: primary prevention

• barrier methods

  • condoms

  • dental dams

• thorough sanitation of sex toys

• post-exposure prophylaxis

  • Doxy-PEP

STIs: secondary prevention

• routine STI testing

  • urine test for chlamydia and gonorrhea

• partner testing and treatment

HPV: transmission

spread through skin-to-skin contact during vaginal, anal or oral sex

HPV: complications

• over 100 HPV strains exist

  • high-risk strains increase risk for precancerous lesions

HPV: symptoms

often asymptomatic

• genital warts

  • small bumps or lesions in genital or anal area

HPV: primary prevention

• vaccination

• educating on safe sex practices

  • male and female condoms

HPV: secondary prevention

• routine cervical cancer screening

• treat precancerous cells early

  • loop electrosurgical excision procedure (LEEP)

  • biopsy

  • ablation

lead poisoning: defintion

• lead is a toxic metal

• no safe blood lead level in children

• exposure can impact many body systems

lead poisoning: risk factors

• children under 6 years

• pregnancy and fetus

• families in older-housing

lead poisoning: origin

• lead based paint and dust in homes built before 1978

• contaminated soil

• lead plumbing

• some imported products

lead poisoning: in children

• s/s

  • irritability and behavior changes

  • abdominal pain

  • reduced appetite

• severe toxicity

  • vomiting

  • trouble walking

  • seizures

  • anemia

• long term complications

  • developmental delays

  • lower IQ

  • hearing issues

  • kidney issues

lead poisoning: screening

• lead test may be first clue

• blood test level: 3.5 mcg/dL

lead poisoning: prevention

• wet rags when dusting

• wash toys and hands often

• keep paint intact (no chips)

• use EPA lead-based paint professionals for paint removal

• cold tap water for drinking and cooking

• ensure adequate vitamins and minerals

lead poisoning: nursing priorities

• assess housing, water, hobbies and employment

• education

• coordinate follow-up ad referrals

• chelation is only for severe cases

vulnerability

degree to which a population, individual, or organization is unable to anticipate, cope with, resist, and recover from the impacts of disasters

may include anyone who…

• has difficulty communicating

• has difficulty accessing medical care

• may need help maintaining independence

• requires constant supervision

• may need help accessing transportation

characteristics of a vulnerable population

• heightened risk of adverse health outcomes

• higher mortality rates and lower life expectancy

• less access to health case

  • greater disparities in quality of care

• often uninsured or underinsured

• overall diminished quality of life

vulerable populations

• physical issues

  • chronically ill

  • disability

• psychological issues

  • mental illness

• children

• older adults

• pregnancy

• racial groups

• homeless

• domestic violence victims

• veterans

• prisoners

• immigrants

vulnerable populations conceptual model

1. resource availability

   1. decrease in societal and environmental resources

   2. impacts relative risk

      1. more resources reduces risk

2. relative risk

   1. increased individual risk factors

   2. MUTUAL impact on health status

3. health status

   1. morbidity and mortality

   2. impact on resource availability

      1. less people in community due to poor health so less resources available

         1. less people working to produce resources

relative risk

• lifestyle

• behavior and choices

• health care services

• stress

• genetics

resource availability

availability of socioeconomic and environmental resources

• human capital

• social capital

• social connectedness

• social status

human capital

economic value of the abilities and qualities of labor that influence productivity

• example: education level and skills

social capital

networks of relationships among people who live and work in a particular society and enable the society to function

• status determined in society by connections

social connectedness

experience of belonging to a social relationship or network

• example: nurses in a hospital

social status

person’s standing or importance in relation to other people within a society

• example: doctors have higher social status in hospitals

• higher status allows to have control over life and reduce stress

homelessness

person who lacks a fixed, regular, adequate nightly residence including supervised public or private shelters that provide temporary accommodations

may also reside in institutional settings providing temporary shelter or in public or private places that are not designed for or used as regular sleeping accommodations for human beings

categories of homelessness

• literally homeless

  • sheltered

  • unsheltered

• imminent risk of homelessness

  • going to be losing primary residence within 14 days

• homeless under other federal statutes

  • families of unaccompanied minors with no lease or unstable housing in the past 60 days

• fleeing/attempting to flee domestic violence

  • no stable home during this time

literally homeless: sheltered

• congregate shelters

• transitional housing

• subsidized hotels and motels

  • converted into transitional housing

  • allow people to stay for a couple of months

literally homeless: unsheltered

primary nighttime residence place is NOT meant for human habitation

• tents

• cars

• foreclosed homes

homeless shelter (sheltered) issues

• long waiting lists

  • first must get approved and then must get a bed

• high theft of personal belongings

  • no security

homeless camps (unsheltered)

• utilize many methods of protection from the elements

• hold onto objects without a specific purpose

  • allow to feel a sense of control

  • use as decorations to personalize “home”

  • can have practical applications or may sell in future

cars (unsheltered)

seen as high class on the streets since place to securely store belongings and self BUT can be difficult to find place to park

1991

United Nations declared the right to adequate housing to be a fundamental human right

• 771,480 still experienced homelessness in 2024

• continues to increase every year

homeless statistics

• 6 in 10 people experienced sheltered homelessness

• 4 in 10 people experienced unsheltered homelessness

• 1 in 3 households included children

point in time count

count everyone on the street and in shelters on December 21st and declare that the homeless population

• coldest day of the year

• actually an underestimate

  • more likely to have housing in the winter

homeless population statistics

• increase in first-time shelter residents

• minority populations are more at risk

  • highest rates among native Hawaiian or other pacific islander

  • higher rates among indigenous, black and latino populations

  • lowest rates among asian and white

• more common in males

  • starting to shift due to women facing domestic violence and being pushed onto the street

• gender expansive individuals face greater difficulties access housing and shelters

groups affected by homelessness

• dependents

  • people with disabilities

  • children

  • elderly

• minorities

  • black

  • indigenous

  • trangender

• veterans

  • lack support after returning from service

homelessness: causes

1. poverty

   1. lack of basic resources to support living

2. affordability

   1. increasing housing and healthcare costs

      1. states with higher cost of living and rent have higher rates of homelessness (ex. CA, HI, DC)

3. employment

   1. inability to obtain a job that pays sufficiently

4. unsupported

   1. cuts to federal assistance programs

5. health issues

   1. chronic illness, mental health, and addiction

6. violence

   1. survivors fleeing from domestic violence

health wealth gradient

persons of higher economic status are likely to be healthier than persons of low socioeconomic standing

the more money you make, the healthier you will be

health challenges with homelessness

1. infectious diseases

2. environmental exposures

3. malnutrition

4. skin conditions

5. mental health and substance abuse