community exam 2

what are the three categories of bioterrorism agents & which is the most concerning?

A - most concerning & highest priority, risk to national security due to high mortality rate (ex: smallpox, ebola, anthrax, botulism)

B - 2nd highest priority, moderately easy to disseminate & have high morbidity/low mortality (ex: typhus fever, ricin toxin, diarrheagenic E.coli, west nile)

C - 3rd highest priority, easy to mass produce or have potential for high morbidity/mortality rates (ex: hantavirus, influenza virus, TB, rabies)

what can public health departments in the U.S. do to prevent the spread of disease? (select all that apply)

a. inspect people for disease

b. garnish wages for treatment of disease

c. treat people for disease

d. quarantine people without their consent

a. inspect

c. treat

d. quarantine

what is herd immunity?

protection from a disease due to the immunity of most community members making exposure unlikely

how do you calculate attack rate?

number of people exposed that develop the disease DIVIDED BY total number of people exposed

in community lecture on tuesday, there were 52 people in attendance.10 went to the doctor the next day & were diagnosed with ebola. what is the attack rate?

0.19 (19%)

calculation: 10 / 52

what is incidence rate?

number of new cases of a disease in a given time period DIVIDED BY total population at risk TIMES “per number of people” (if the question asks for that)

as of 3/7/23 there were 50 new cases of varicella at Leverett Elementary School. the total population of the school & number of persons at risk was 271. what is the incidence rate for varicella per 100 people?

18.45

calculation: (50 / 271) x 100

what are the five social determinants of health?

health care access & quality, education access & quality, social & community context, economic stability, neighborhood & built environment

a CHN notices an increased rate of rotavirus in children beyond the expected rate. what is the disease occurrence?

epidemic

what is the difference between an endemic, epidemic, and pandemic?

endemic = disease or condition has a moderate or ongoing/constantly maintained occurrence in a given location

epidemic = rate of disease exceeds usual (endemic) level of the condition in a defined population - increases beyond what is expected

pandemic = epidemic occurs in multiple countries or continents

the community health nurse should include what education for a migrant worker?

• information about local health care resources

• mental health services

• environmental health

• tuberculosis screening

• skin cancer prevention

• dental health

what is disease prevalence?

measure of existing cases of a disease at a particular point in time or over a period of time

what can disease prevalence tell the CHN?

• examine chronic disease rates

• look at multiple years of disease trends

• help plan health care

what is horizontal transmission of disease?

occurs through contact with a person or objects the person has touched, the air, contaminated body fluids, food, & water (vehicles) or living creatures (vectors)

ex: zika (contact with blood, secretions during sexual activity, or vector)

what is vertical transmission of disease?

from parent to offspring - occurs through the sperm (with conception), placenta, vaginal contact during birth, or consuming human milk

ex: chlamydia (contact during birth)

what is an example of tertiary prevention based on epidemiology?

goal: prevent morbidity after disease/injury is established

ex: TB treatment follow-up (monitor patient’s treatment & compliance); link clients to needed community resources in relation to their disease; monitor a hepatitis C patient’s treatment & administration of medications

what are the phases of emotional reaction after a disaster?

heroic phase: high level of activity to help with relief efforts, low level of productivity, intense excitement & concern for survival, rush of assistance from outside the area

honeymoon phase: dramatic shift in emotion, affected individuals begin to bond & relieve their experiences

disillusionment phase: responders can experience depression & exhaustion, people realize limits of disaster assistance, unexpected delays in receiving aid

reconstruction phase: overall feeling of recovery, adjustment to a new reality & continued rebuilding, counseling, looking ahead, working through grief

what is the indian health service?

not health insurance

care provided at their clinics & hospitals

if specialty services are not available the hope is that they qualify for other insurance; if not, contracted care may be available but funding is not always secure & may run out before service is obtained

which health services are most affected by lack of access in rural areas?

• home health

• hospice & palliative care

• mental health

• substance abuse

• obstetric health

• oral health

what are some statistics about the prison population?

• children of incarcerated parents are more likely to enter the system themselves with lower education & poor family relationships

• 2 out of 3 who are released are rearrested & over 50% are incarcerated again

• common health conditions include asthma, TB, & mental health problems

• black & hispanic people are disproportionately arrested & convicted of offenses

what is a disaster?

event that causes human suffering & demands more resources than are available in the community

devastation that cannot be relieved without external assistance

what are some nationally notifiable conditions?

mostly anything that is vaccinated against or STDs or antibiotic resistant bacteria

the nurse reports these first to their local/state health department

ex: anthrax, botulism, cholera, congenital rubella syndrome, diphtheria, giardiasis, hepatitis A/B/C, HIV, influenza-associated pediatric mortality, legionellosis/legionnaire’s, lyme disease, malaria, meningococcal disease, mumps, pertussis (whooping cough), polio (paralytic & nonparalytic), rabies, rubella, salmonellosis, SARS, shigellosis, smallpox, syphilis, tetanus, toxic shock syndrome, TB, typhoid fever, vancomycin-resistant infections, viral hemorrhagic fever

why are nurses important in health care policy?

we are innately health policy experts

roles as change agents, lobbyists, coalitions, & public office

nurses bring communication, nursing process, credibility, & a power in numbers

what are some benefits & limitations of telehealth?

benefits:

• improved access

• improved quality

• cost effective

• see a patient’s home

limitations:

• inability to assess patient’s smell or true appearance

• patient may not have internet access

500 people were newly diagnosed with coronavirus in a population of 450,000. what is the incidence rate for coronavirus per 1,000 people?

1.11

calculation: (500 / 450,000) x 1,000

what are risk factors for developing violent behavior?

• client states they were abused as a child

• client abuses substances regularly

• client states they were spanked as a child

• client had economic stress with unemployment

what are the phases of the disaster management cycle?

prevention/mitigation

preparedness

response

recovery

care coordination is best described as:

organizing patient care activities & sharing information to achieve safer & more effective care

what are some signs & symptoms of intimate partner violence?

• unexplained injury

• chronic headaches

• palpitations

• chronic pelvic pain

• back pain

• appetite disturbances

• stomach pain, IBS

• frequent vaginal infections

• anxiety, depression, PTSD

what puts a person at greatest risk for partner violence?

decision to leave their partner

what groups bear the greatest burden from disaster?

developing countries, at-risk groups, low-resource communities

what are the nurse’s roles in the prevention/mitigation component of the disaster management cycle?

• risk assessment

• awareness & education

• organizing & participating

• advocacy

what are the nurse’s roles in the preparedness component of the disaster management cycle?

• help initiate or update the agency’s disaster plan

• education

• organize disaster drills

• review individual/family disaster plans

• understand available resources in the community

what are the nurse’s roles in the response component of the disaster management cycle?

• assessment - rapid needs assessment of community impacted, clinical & population-based triage, carries into recovery phase

• provide ongoing essential public health services

what are the nurse’s roles in the recovery component of the disaster management cycle?

• use all levels of prevention

• flexibility

• continuing needs assessment

• case finding & referral

what are signs of potential bioterrorism attacks?

• rapidly increasing disease incidence in a normally healthy population

• disease occurring that is unusual for the area

• endemic occurring at an unusual time (ex: outbreak of influenza in the summer)

• large numbers of people dying rapidly with similar presenting symptoms

• individuals presenting with unusual symptoms/manifestations

• unusual numbers of dead/dying animals, or unusual liquids/vapors/odors

what are the core functions of public health & how can they be used in disasters?

assessment: before/during/after disaster, diagnosis of problems (investigate hazards)

assurance: ensure access to care, building & maintaining workforce infrastructure (bring in temporary structures & personnel)

policy development: communicate to inform, mobilize surrounding communities, strengthen policies (evaluate after & decide how to change in the future)

what are the four “P”s needed to have a basic understanding of nursing in politics discussed in the policy podcast?

process

policy

politics

press

what are some reasons nurses are concerned with adolescents & risk taking?

adolescent risk behaviors can lead to significant morbidity & mortality - unintentional injuries are the leading cause of death in adolescents aged 15 to 19

risk behaviors are often interrelated, increasing risk (substance use disorders, STIs, injuries from motor vehicle crashes)

adolescents who participate in multiple risky behaviors have increased rates of depression or other mental illness

what would be a primary prevention action for disasters?

avoidance, prevention, preparedness

ex: bioterrorism planning, vaccines, disaster drills, ensuring availability of antibiotics for exposure prophylaxis, distributing gloves to protect farmworkers’ hands from potential exposures, developing preparedness plan, assess for risk/investigate potential threat of bioterrorism

what would be a secondary prevention action for disasters?

early diagnosis/recognition & treatment, preparedness & response

ex: prepare for reactions to exposures that have already occurred, conduct rapid needs assessment, activate response plan, mobilize first responders, assess disaster victims & triage for care, screen for exposure, educate population to identify manifestations of exposure & management of treatments, containment procedures of a spill, decontamination procedures, monitor mortality & morbidity, treat those exposed

what is a community health worker & how can they help achieve the triple aim goals?

a community health worker serves as a bridge between underserved communities & health care services, improves access to care, improves care quality, & reduces the costs of care

help the client know the resources available, explain resources in native languages, reduce costs by helping the client know where to go for care, improve quality of care by educating on how they should be caring for themselves & which appointments they should go to

what is the triple aim & what are its goals?

framework developed to assist healthcare systems be successful

goals: improve quality, decrease cost, improve access

what would be a tertiary prevention action for disasters?

prevent further complications, response & recovery

ex: rehabilitation of survivors, monitor medication regimens & referrals, evaluate effectiveness & timeliness of plan, participate in home visits to uncover dangers that may cause additional injury or other problems (house fires from faulty wiring, etc.)

triage: patient with 32 respirations per minute, capillary refill less than 2 seconds, & cannot follow simple commands

red

triage: child screaming & running from the nurse with minor lacerations, blood in the ears, RR of 28, & capillary refill less than 2 seconds

green

triage: patient who isn’t breathing, does not have a pulse, & has a crush injury to his right leg

black

triage: patient with RR of 28, positive radial pulse, capillary refill less than 2 seconds, an open fracture of the right arm, & a leg fracture

yellow

what is care coordination & what is its goal?

deliberate organization of patient care activities between two or more participants (including the patient) to facilitate appropriate & safe delivery of healthcare services; tries to bridge gaps in patient care through sharing information

goal: integrate, ensure, & advance a patient’s plan of care to make sure that they have successful transitions in & out of different care settings

what is neglect?

a. failure to meet a person’s basic physical, educational, & emotional needs

b. limiting the victim’s access to their assets

c. deliberately aggressive or violent behavior by one person towards another

d. minimizing one’s self-worth or to humiliate, threaten, or intimidate

a. failure to meet a person’s basic physical, educational, & emotional needs

how can care coordination help achieve triple aim goals?

helps bridge gaps between patient care, making sure patients receive the care they need

what are the four principles of effective public health policy change?

use evidence

consider health equity

design policy with implementation in mind

use proactive research policy translation strategies

which level of government responds first to a disaster?

local

when does effective discharge planning occur?

at admission

what is the epidemiological triangle?

host - agent - environment

examines the relationship between the three