Community Health Exam 2

Internal Disasters

occur in the health facility and threaten to disrupt the care environment, such as fire or loss of power or personnel issues (absenteeism)

External Disasters

occur outside the health facility, such as tornado,terrorism, hurricanes, etc

two types of external disasters

• human-made

• natural

Natural disasters

earthquakes, tornadoes, tsunamis, and flooding

Human-Made disasters

include mass bombings/shootings, oil spills, riots, terrorist attacks, and nuclear-reactor
meltdowns

Combination disaster

An external/internal event. The external disaster causes internal
events, such as when Hurricane Katrina caused flooding, which lead to internal power outages. The external flooding also caused internal events of staff being unable to go to work

Assessment

used before, during & after disaster

Assurance

used to ensure access to healthcare and that the workforce is available to
provide healthcare

Policy Development

used in prevention – ensuring that policies are in place to manage the
disaster – communication plans during disaster, policies to provide for public needs, and after during recovery as the disaster response is evaluated. Potentially adding further policies and procedures for the next disaster.

vulnerable

________ groups are most risk during disasters, especially those in developing countries, those who belong to at-risk groups and low-resource communities. These groups experience a disproportionate burden from disaster and are at greatest risk for disruption after a disaster (since they have limited resources to recover)

severity & scope

__________ of a disaster are affected by individual factors & personal response (including social support, resources, resiliency), vulnerability of population, warning time

prevention

done to decrease or remove the negative consequences of hazards.

mitigation

seeks to minimize the impact and consequences of an emergency should it happen.
It includes assessing a community’s threats and identifying risks. Strengthening public health with immunizations (including isolation and quarantine of diseases). Ensuring processes are in place to decrease risk – such as public security

preparedness

Guided by the prevention/Mitigation phase. Nurses evaluate personal, professional and community plans. Communication of plans is vital to preparation. Nurses participate and organize disaster drills.

what is included in a personal/family preparedness plan?

What to do in an evacuation, plan for family pets, and where to meet in case of emergency. Kits include: flashlight w/batteries, batter-powered radio, non-perishable food, 1 gallon of water /person, basic 1st aid supplies, matches in waterproof container, bleach for disinfection, emergency blanket, rain gear/clothing/footwear, RX and OTC meds, toiletries, important documents, money

response phase

Begins immediately after the onset of the disaster and during the emergency. The local government is the first level to respond to a disaster. Then depending
upon the needs of the community, the local government will contact the state government for assistance and the governor would open the EOC. The governor is then in communication with the federal government for assistance as needed

Federal Gov. role in disasters

enact laws and provide funding to support local and state governments.

Emergent/Red (triage)

immediate threat to life; do not delay treatment; R> 30, capillary
refill >2 sec, unable to follow simple commands

Urgent/Yellow (triage)

major injuries that require treatment; R<30, capillary refill <2 sec,
can follow simple commands

Nonurgent/Green (triage)

able to walk on command and no major injuries R < 30; capillary
refill <2 sec; can follow directions

Expectant/Black (triage)

no respirations after repositioning airway, expected and allowed to die;
prepare for morgue

recovery phase

Involves all agencies pulling together to rebuild. Case finding and referral are two public health services (from the Intervention Wheel) that are used during
disasters. It includes nurses identifying who needs help and referring them as needed

Effects of disasters on community

• Economy

• Overworked public service personnel

• Lifelines interrupted

• Depleted resources

• Building damage

• Social & Psychological effects

emotional reaction phases a community experience after a disaster:

Heroic, honeymoon, disillusionment, and reconstruction phases

Heroic phase

high level of activity with low level of productivity. Assistance is
present. “I am going to cut down a tree, everyone is here to help. The news crews want
to talk to us.”

Honeymoon phase

Shift in emotion with feelings of gratitude for surviving. Affected individuals bond and relive their experiences. “I can’t believe we survived; I am so grateful. Did you see what happened to my house?”

Disillusionment phase

depression and exhaustion can occur. People realize the limits of
assistance. Often there are delays in receiving aid. Can last up to a year and the
anniversary can bring back events and cause more emotional lows. “I am tired and don’t
think I’ll ever be able to fix everything.”

Reconstruction phase

overall feeling of recovery. Involves adjustment to a new reality
and continued rebuilding of the area. Offer counseling as needed, those affected look
toward the future and work through grief. “Things will never be the same, but we will
find a way to go on.”

Bioterrorism agents

Category A, B, & C

Category A agents

are the highest priority agents, posing a risk to national security. This category has high mortality rates. Examples include smallpox, viral hemorrhagic fevers (Ebola), plague, botulism, anthrax, tularemia, and the plague

Category B Agents

the 2nd highest priority because they are moderately easy to disseminate & have high morbidity and low mortality.

• Examples include: diarrheagenic E. coli, West Nile virus, Typhus fever & ricin toxin

Category C agents

the 3rd highest priority comprising of emergency pathogens that can be engineered for mass dissemination because they are easy to produce, and/or
have potential for high morbidity & mortality rates. -

• Examples include hantavirus,
  influenza virus, tuberculosis, and rabies virus

How to recognize a bioterrorism incident

• Is there a rapidly increasing disease incidence in a normally health population?
• Is a disease occurring that is unusual for the area?
• Is an endemic occurring at an unusual time? For example – is there an outbreak
of influenza in the summer?
• Are there large numbers of people dying rapidly with similar presenting symptoms?
• Are there any individuals presenting with unusual symptoms/manifestations?
• Are there unusual numbers of dead or dying animals, unusual liquids/vapors/odors?

Primary Prevention (Disaster Management)

Avoidance & Planning
• Prevention and Preparedness

• Prepare with bioterrorism drills, vaccines, and ensuring availability of antibiotics for exposure prophylaxis.

• Design a bioterrorism response plan using the most probable biological agent in the local area.

• Identify the chain of command for reporting bioterrorism attacks.

• Define the nursing roles in the event of a bioterrorism attack.

• Set up protocols for different levels of infection control and containment.

Secondary Prevention (Disaster Management)

Recognition
• Early Diagnosis & Treatment

• Activate the bioterrorism response plan in response to a bioterrorism event.

• Immediately implement infection control and containment measures, including decontamination, environmental disinfection, protective equipment, community education/notification, and quarantines.

• Screen the population for exposure, assessing rates of infection and administering vaccines as available.

• Assist with and educate the population regarding identification of manifestations and management (immunoglobulin, antiviral, antitoxins, and antibiotic therapy, depending on the agent).

• Monitor mortality and morbidity.

Tertiary Prevention (Disaster Management)

Rehabilitation
• Prevent further complications

• Monitor medication regimens and referrals.

• Evaluate effectiveness and timeliness of the bioterrorism plan.

Epidemiology

the study of the distribution and determinants of health and illness/disease in human populations, and conditions related to health status

How nurses use epidemiology

• To study trends and evaluate populations and their risk factors

• To look at the population’s Social Department of Health to evaluate if they influence the disease or illness in the population. It is used to determine needs for health status.

• Nurses provide education about not just about infectious diseases, but
  also about chronic diseases and accidental deaths

• Look at the cause and distribution of infectious diseases, chronic diseases and accidental deaths.

Surveillance

an ongoing, systematic collection, analysis and interpretation of health-related data essential to the planning, implementation, and evaluation of public health practice”

Disease & Health Event Investigation

systematically gathers and analyzes data regarding threats to the health of populations, ascertains the source of the threat, identifies cases and others at risk, and determines control measures

Incidence

Measures new cases of a disease that develop over a period of time. It is
a good indicator of the number of newly diagnosed cases of disease.

Prevalence

Measures existing cases of a disease at a particular point in time or over
a period of time. It is a good measure of the overall burden of a disease. It evaluates
rates of chronic disease, disease trends, and needs for healthcare services & facilities

Morbidity

Refers to an illness or the amount of the disease in a population. Proportion
of illness in a population. Examples of morbidities would be heart disease, cancer,
stroke, suicide

Mortality

refers to incidence or number of deaths in a population

Rate

a measure of frequency of a health/disease event per unit of time

Incidence rate formula

Number of new cases in the population at a specific time ÷ population total x 1,000 = _____ per 1,000

prevalence rate formula

Number of existing cases in the population at a specific time ÷ population total x 1,000 = _____ per 1,000

attack rate (risk) formula

Number of people exposed to a specific agent who develop the disease ÷ total number of people exposed.

Epidemiologic Triangle

looks at the relationship between the host, the agent, and the environment.

Agent

the physical (noise/temperature), infectious (viruses/bacteria), or chemical
(drugs/toxins) factors that causes the disease.

Host

the living being that an agent or the environment influences. Factors that can affect
the host include age, sex, genetics, ethnicity, immunological status, physiological state
and occupation

Environment

The setting or surrounding that sustains the host. The physical and social
environment can affect the host and agent. Considerations about the physical environment
include geography, water/food supply, presence of reservoirs/vectors. Considerations about the social environment include access to healthcare, high-risk working conditions, & socio-economic factors.

Endemic

when a disease or condition has a moderate or ongoing/constantly maintained
occurrence in a given location or geographical area. COVID is now endemic here in the US.

• other ex: flu, lyme disease

epidemic

occurs when the rate of disease exceeds the baseline (endemic) level of the
condition in a defined population – it increases beyond what is expected

Pandemic

occurs when an epidemic occurs in multiple countries or continents. Example:
COVID

Vertical transmission

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

Horizontal Transmission

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

airborne

Particles transmitted by to susceptible host via droplets or particles.
Example: varicella, tuberculosis, measles, Covid-19, flu, pertussis, common cold

foodborne

Food infection (bacterial, viral, parasitic infection of food).

• Example: salmonellosis, hepatitis A, norovirus, E. coli

waterborne

fecal contamination of water.

• Example: cholera, typhoid fever

vector-borne

via a carrier (vector), such as a mosquito, tick, fly.

• Example: Lyme disease, zika virus, West Nile virus, Malaria

direct contact

transmission of infectious agent from infected host to susceptible host via
direct contact

• ex: HIV/AIDS, genital herpes, Hep B, C, D; impetigo, lice, scabies, common cold

active immunity

develops through actual exposure to an infectious agent. It involves the production of antibodies by the body in response to infection or immunization with a
specific antigen

passive immunity

the transfer of antibodies to the host either trans-placentally from
mother to baby or through transfusions of immunoglobulins, plasma proteins
or antitoxins.

natural immunity

natural defense mechanisms of the body to resist specific antigen or
toxins. (skin barrier, acidic environment in the stomach, immune system everyone is born
with per ATI readings). In other readings, it is also referred to as when your body develops
antibodies for an infection after exposure.

Herd immunity

protection due to the immunity of most community members making
exposure unlikely.

social epidemiology

seeks to understand the ways in which social, political, cultural, and
economic circumstances influence our chances for a healthy ______. It asks what social factors affect health (like the SDOH) and why not everyone exposed to a germs become infected or develop disease

nationally notifiable diseases

include most sexually transmitted diseases (HIV, Chlamydia, Gonorrhea, Syphilis, Hepatitis B & C), most diseases that are vaccinated against (polio, tetanus, typhoid, meningococcal disease), foodborne bacteria (salmonellosis, hepatitis A)

Mandatory Treatment, Isolation, & Vaccination:

States have “Police Powers”: authority to impose restrictions on individual rights for the sake of public welfare, order, and security

Disease Screening & Surveillance

can cause concerns about privacy, discrimination, and
stigmatization

Emergency Response

There are many people to treat but only so many resources; decisions
about who receives treatment are an ethical issue

Primary Prevention (Epidemiology)

When there is no evidence of exposure, the goal is to avoid exposure – prevent the occurrence of disease. Examples: education (symptoms, diseases present in countries they are visiting (including mandatory vaccination), disease prevention (universal precautions, proper food handling, condoms) and vaccination

Secondary Prevention (epidemiology)

Screening or monitoring. Exposure has occurred, but the client is
asymptomatic. The goal is to mitigate the risk of developing disease. Post-exposure prophylaxis. Examples: Treatment for Hepatitis A vaccine after exposure, Rabies vaccine after dog bite, antibiotic treatment after exposure to Anthrax

Tertiary Prevention (epidemiology)

Goal is preventing morbidity. Disease or injury is established, and actions aim to minimize disability/death and maximize functional capacity. Examples: treat diseases, rehabilitation, monitor compliance to therapy/medications, and link clients to needed community resources

vulnerable population

a population that has aggravating factors that place them at greater risk for
ongoing poor health status.

5 SDOH

Neighborhood & Built environment, Health care / access quality, social & community context, education access & quality, economic stability

Health Disparities

significant differences in health status and access to health services across varied
groups that are linked closely with economic, social or environmental disadvantage.

poverty

_________ a primary cause of vulnerability.

Federal Poverty income levels

used to determine who qualifies for Medicaid and Marketplace Insurance (and other government programs).

Low socioeconomic status

_________ has been found to be related to higher rates of chronic illness, higher mortality.

Homelessness

Families with children are the fastest growing group affected by _________

Veterans

50-75% of _________ receive health care OUTSIDE of the VHA (often due to availability & access of care and perceived quality.)
Suicide rates in _______ are nearly double that of non-_________.

Veterans have higher rates of: (compared to non-veterans)

• Mental illness

• Depression

• Substance Abuse Disorders

• PTSD

• Chronic pain

• Hazardous exposures

• Amputations

Disability

________ can result in isolation, altered family role, increased risk for abuse, comorbidities.

Mental illnesses

Those with _______ experience high levels of stigma & discrimination

Chronic/Toxic Stress

Overtime __________ can weaken the immune system and even damage blood vessels and neurons

Adolescent Health

Unintentional injuries (including motor vehicle accidents, homicide, and suicide) are the leading cause of death (mortality) in adolescents aged 15 to 19.

Rates of Teen Pregnancy

higher in US compared to those in other developed countries.

Nurse’s Role with Vulnerable Populations

empowerment, facilitating support, evidence-based rate, advocacy

Primary Prevention (vulnerable populations)

fair access policies, birth control, stress reduction education, access to health care

• Educate at-risk populations about mental
  health.

• Teach stress-reduction techniques.

• Implement parenting classes.

• Organize bereavement support groups.

• Promote protective factors and reduce risk
  factors

Secondary prevention (vulnerable populations)

screenings, assess needs, early prenatal care

• Screen for mental health disorders.

• Form therapeutic relationships with at-risk individuals, families, and groups.

• Conduct crisis intervention.

Tertiary Prevention (vulnerable populations)

rehabilitation and recovery, support groups, comprehensive case management, medication management

• Medication monitoring.

• Mental health interventions.

• Referrals to support groups.

• Maintain client function to prevent relapse or rehospitalization.

• Identify triggers for relapse.

• Help plan a regular lifestyle and reduce stress.

• Educate clients and families about medication side effects and interactions.

Empowerment

•Focus on the person, not just the health problem.
•Emphasize strengths rather than solely focusing on challenges and build resilience.
•Support confidence and self-management of health

Facilitating Support

•Connect clients to community resources and services.
•Collaborate with other professionals and organizations.
•Reduce isolation by linking clients to social supports.

Evidence-Based Care

•Use best available evidence to guide care.
•Assess client needs holistically – physical, emotional, social, and environmental

Advocacy

•Protect client rights and promote health equity
•Speak up against barriers to care and unfair policies

rural populations

• mostly white, oung (6-17 yo), and old (> 65)

• more likely to be married or widowed

• fewer years of formal education

• tend to be poorer

• at higher risk of being underinsured or uninsured

• poorer perception of health, less preventative behavior, exposed to more hazards

• higher rates of maternal morbidity, infant mortality, female sexual abuse victims

• higher rates of mental illness, suicide, and chronic illnesses

• less likely to seek care

preventative care

a solution to lack of access to healthcare in rural areas, so hospitalization would not be needed.

nursing care in rural & vulnerable populations (benefits)

• Confidentiality/Lack of anonymity

• Scarcity of resources

• Scope of practice issues

• Heavy workload, Isolation 

nursing care in rural & vulnerable populations (challenges)

*Care across the lifespan – care for all ages from babies to the elderly

*Greater independence/autonomy – often on your own and not hindered by others

*Flexibility – in your role

*Status in the community – you are more likely to be held in high regard – others will look up to you