NURS 410 - Exam 3

ways to keep a community safe by checking risk factors for violence

home environment, past abuse, substance abusers in the home, parent-child connectedness, positive academics, involvement in purposeful activities

factors that trigger violence

unemployment, school conflict, media, religion, population characteristics

primary prevention for violence

advocating for policy change, building self-esteem, intervening early if risk factors are seen

secondary prevention for violence

careful physical exams, teaching appropriate parenting skills, teaching stress reduction techniques, teaching childcare skills, being involved with transitional shelters

tertiary prevention for violence

referrals to safe and anonymous housing, providing menu of options, reviewing plan of escape

homicide

public health issue b/c it is a major cause of death in the US; majority are carried out by someone the victim knew; CHNs are in a position to strengthen relationships among individuals and their families/communities

rape

considered a crime of violence; underreported due to fear of speaking out and not having anyone believe them; majority of cases are intimate partner violence; defining issue is lack of consent

lowering risk factors for violence

education about healthy conflict resolution, providing resources, support

characteristics of gangs

common name or symbol, clothing or skin markers, associated with violent acts that may become more deadly, average age is 17 to 18, half of youth gang members are 18 or older, tenure tends to be brief in 50-65% of cases, male teens predominate, nearly 40% of gangs report female

reasons youths join gangs

seek thrill and excitement; seek prestige, protection, or chance to make money; seek a belonging, love, structure, and discipline; seek recognition and power; seek companionship; seek acceptance; family tradition

risk factors for gangs

poverty, lack of support network including a stable home environment, media influence

protective factors for violence

build self-esteem and personal responsibility; curb impulsivity; teach alternative ways to cope; teach problem-solving skills; advocate for after-school programs and recreational activities; teach appropriate conflict resolution techniques

substance use disorder

condition in which one or more substances leads to clinically significant impairment or distress

normalizing substance abuse

not considered a disease of will - people do not intend to become alcoholics and/or addicts; not a sin or moral failing; relapse is a part of recovery; public health issue

stages of substance abuse disorders

experimental use, misuse, abuse, dependence, addiction

experimental use stage of substance abuse

curiosity; adolescents are most vulnerable to this stage

misuse stage of substance abuse

social context; often times it is planned out in advance when they will misuse substances in a social setting

abuse stage of substance abuse

seeking to affect the mood, perceptions, and thoughts

dependence stage of substance abuse

brain's neurons adapt to repeated use; avoid negative withdrawal symptoms; stage leads to addiction if not treated

addiction stage of substance abuse

loss of control when abstaining from use; disease of the brain

risk factors for substance abuse

substance abuse by a parent, physical or sexual abuse, smoking tobacco, family dysfunction/chaos, peer influence, age of onset of use, early persistent antisocial behavior, rebelliousness, academic failure, poverty, favorable attitudes to alcohol and drugs, mental health issues

primary prevention for substance abuse

focus on how to resist getting involved in substance abuse; education about drugs and guidelines for appropriate use; promotion of healthy lifestyles and alternatives to relieve stress; development of prevention programs focused on communities

secondary prevention for substance abuse

institute early detection programs in school and workplace; screen all patients over age of 12 for potential substance abuse problems; screen patients at every healthcare visit; conduct thorough/careful assessment of client’s use of tobacco, alcohol, and/or drugs; drug testing; awareness of high-risk groups (pregnant women, IV drug abusers, illicit drug users, adolescents, elderly, military)

tertiary prevention for substance abuse

develop programs to help people reduce or end their substance abuse; harm reduction; detoxification; addiction treatment; smoking cessation programs; support groups

high risk groups for substance abuse

adolescents and elderly

adolescents are a high risk group for substance abuse

earlier the onset, the increased risk of dependence; underage drinking common; common misused drugs - Vicodin, Oxycontin, Adderall, Ritalin, Valium, & Xanax

pharming

mixing a ton of prescription medications with alcohol at social events

elderly are a high risk group for substance abuse

prescribed 1/3 of all meds in the US; interactions between alcohol and meds; challenges of aging & coping; slower metabolic rates; effects of alcohol mimic degenerative brain disease such as dementia and is often overlooked; depression rates are higher which leads to substance use

Antabuse (disulfiram)

blocks an enzyme involved in metabolizing alcohol intake; produces unpleasant side effects when mixed with alcohol in the body (flushing, N/V, sweating, increased BP)

common products that contain small amounts of alcohol

aftershave, cologne, perfume, antiperspirant, mouthwash, antiseptic astringent skin products, hair dyes

harm reduction approaches for substance abuse

addiction is a health problem not a criminal problem; any psychoactive drug can be abuse; accurate information can help people make responsible decisions; people with addiction can be helped; promote safe needle exchange

role of CHN in substance abuse

seek root causes, plan realistic actions, provide non-judgmental, holistic, and positive care

fetal alcohol syndrome

low birth weight/failure to thrive, difficulty sleeping and sucking, small head, small jaw, short/turned-up nose, thin upper lip, smooth skin between nose and lip, flat cheeks, small eye openings, joint/limb irregularities, vision/hearing problems, simian crease, hyperactivity, short attention span, impulsivity, talkative, developmentally delayed, learning disabilities, mental retardation, low IQ

methamphetamine

very powerful type of amphetamine that can be smoked, injected, snorted, or swallowed; makes individuals alert, talkative, and twitchy

short-term effects of methamphetamine

causes dopamine release; increased HR, BP, RR; tremors; pupil dilation; increased sex drive; decreased fatigue and appetite

long-term effects of methamphetamine

paranoia; irritability; depression; confusion; poor memory; hallucinations & delusions; suicidal thoughts; weight loss; damaged blood vessels in brain with possible stroke; damaged brain cells; fatigue; seizures; hypothermia

symptoms of opioid withdrawal

craving, restlessness, muscle/bone pain, insomnia, diarrhea, vomiting, goosebumps, kicking movements

pharmacotherapy of opioid overdose

Naloxone (Narcan): displaces opiate from receptor and reverses overdose; quickly restores breathing of individual who overdosed; also uses Naltrexone, Methadone, and Buprenophrine

methadone

schedule II narcotic; long-acting (24 to 36 hrs); daily dose; effective at appropriate dose; used with behavioral therapies; decreases criminal behavior, HIV, mortality

buprenophrine

schedule III narcotic; dose qd or qod; requires physician waiver; minimal respiratory depression and effects on BP; lower toxicity at higher doses; lower dependence than full agonists; has mild withdrawal symptoms

epidemiology

the study of distribution and determinants of events in specific populations

descriptive epidemiology

distribution of the event is the particular pattern; the who, what, when, where, and why; tells the “story” of the event; description of the disease pattern should take into account the size of the population and the risk for developing the disease

analytical epidemiology

factors that influence the pattern or distribution; examples include length of exposure to a germ, characteristics of the germ, how the germ spread, etc.; “determinants” and “analytical epidemiology” = SAME THING

case definition

make it possible for reporting and monitoring of diseases in a uniform, standardized way; include clinical symptoms, lab values, and epidemiological data

risk

probability that an event will occur

example of no risk

population of men who will develop ovarian cancer

example of low risk

population of men who will develop breast cancer

example of high risk

population of substance abusers who will develop HIV

example of unknown risk

population of women unaware that their male sexual partners are not monogamous

probability

found by looking at the number of people at risk for exposure over a given time; # of cases = numerator & # of people at risk = denominator; tells how serious the disease is affecting the population; range is 0-1

rate

measure of the frequency of a health event in a defined population in a specific time period; # of events = numerator & # of people at risk & time = denominator; disease rates define how fast the disease is moving in the community; rates may exceed 1

incidence

the number of new cases in a population at risk during a specified time period; more accurate in terms of what is happening "right now"

prevalence

the measure of existing disease in a population at a particular time

attack rate

the number of people who develop the disease in proportion to the number of people who are exposed to that disease

case fatality rate

the proportion of people diagnosed with a disease who die within a certain time; need to be clear how many people died - cannot predict numbers

infant mortality rate

most sensitive health indicator in a community; infant deaths divided by number of live births in the population over a period of 1 year; number is multiplied by 1000 to make it statistically significant

agent

that which causes the disease/condition

host

the person or animal in which the agent resides

environment

the world around us; surroundings that sustain the host; cause reproduction

incubation period

a time interval between the invasion of the agent upon the host and the time of the first clinical sign/symptom; time agent enters host, replicates, and presents with the first symptom

communicable period

time during which the agent is able to transfer from one infected person to another non-infected person

endemic

constant presence of a disease within a geographic area or population

epidemic

occurrence of disease in excess of normal expectancy

pandemic

an epidemic that occurs worldwide, affecting large populations

screenings

type of secondary prevention effort; involves testing a group of people who are at risk but are asymptomatic; goal is early detection and treatment

validity

sensitivity (how accurate the test is for people with the disease) & specificity (how accurate the test is for people without the disease)

reliability

consistency, repeatability, accuracy

disease surveillance

process of gathering data for the story to be told; who got the disease, when they got it, what is the cause, where did they get it, and why they got it

active surveillance

interviewing clients in a community; gathering information first-hand; asking questions

passive surveillance

part of the law that states healthcare providers, veterinarians, and labs must report known cases of certain diseases to the Local Health Department to the State Health Department & then to the CDC

steps in an outbreak investigation

• surveillance/detection of symptoms

• develop a working case definition

• case finding and case counting

• describe cases according to time, place, person

• ID the source and mode of transmission & susceptible populations

• implement control measures

• make recommendations about prevention and control

infectivity

ability of agent to enter a host and multiply

pathogenicity

ability of agent to produce a clinical reaction after infection occurs

virulence

ability of an agent to produce a severe pathologic reaction

toxicity

ability of agent to produce a poisonous reaction

invasiveness

ability of agent to penetrate and spread (snake bites, spider bites, hemolytic strep)

antigenicity

ability of agent to stimulate an immunologic reaction

tuberculosis

mycobacterial disease that is the 2nd leading cause of death world-wide; testing - Mantoux test (TST, PPD) and DOT/DOPT

pharmacologic treatment of TB

pyrazinamide, isoniazid, ethambutol, rifampin (remember PIER)

stages of HIV/AIDS

primary infection, clinical latency, symptomatic disease

emerging infectious diseases

infectious disease with incidence rates on the rise over the recent past; diseases that were thought to be gone but are resurging

agents of bioterrorism

used in terrorist acts and have a high mortality rate; disseminate in the population well and cause illness, panic, social disruption, and death

anthrax

an acute disease caused by a spore-forming bacterium; types - cutaneous, GI, and inhalation; huge threat to human population

small pox

high degree of susceptibility among humans and has a high case fatality rate; lesions are deep-ceded, fluid-filled vesicles; if able to be ruptured, they do not collapse; distribution of rash – face and extremities (mainly lower)

chicken pox

vesicles are fluid-filled and flatten quickly if ruptured; superficial lesions; distribution of rash – face and trunk A&P

food infection

bacterial, viral, or parasitic infection of food

food intoxication

caused by toxins, chemical contaminants, and naturally-occurring substances

vector-borne diseases

transmitted by a carrier or vector; usually an arthropod (mosquito, tick, or fly)

plague

vector-borne illness that is caused by a flea bite; leads to lymphadenitis, particularly in the inguinal nodes (bubonic plague named b/c of lymph nodes called buboes); high case fatality rate; can be aerosolized

stage 1 of lyme disease

bulls-eye skin lesion that begins as a red area surrounding tick attachment; spreads outwards; often goes unnoticed

stage 2 of lyme disease

bulls-eye rash is gone; persistent headache and neurological deficits; may have cardiac abnormalities

stage 3 of lyme disease

recurrent attacks of arthritis and arthralgia, especially in the knees

zoonoses

infections transmitted by a vertebrate; animal bites, inhalation, direct contact; rabies is common with this condition; bites or scratches; generally not transmitted human to human; example – tularemia (rabbit fever)

parasitic diseases

disease that depends on a host in order to survive (can be animal or human)

pinworm

common parasitic infection that occurs in children; children at greater risk b/c they are playing outside in the dirt/ground; fecal-oral transmission; flashlight & tape diagnosis; oral vermicides are used as treatment