Hammad- ATI (PT 1)

Care for Special Populations

Vulnerable populations are subject to which issues?

◯◯ Violence
◯◯ Substance abuse
◯◯ Mental health
◯◯ Homelessness
◯◯ Rural and migrant health

What factors affect individuals in vulnerable populations?

◯◯ Poverty
◯◯ Poor self esteem
◯◯ Young or advanced age
◯◯ Chronic stress
◯◯ Emotional instability
◯◯ Environmental factors

What are some health care goals to address for vulnerable populations?

◯◯ Encouraging people to use primary care providers for medical services.
◯◯ Increasing the number of people with health insurance.
◯◯ Making access to health care easier for the immigrant population.

What is neglect?

☐☐ Physical care, such as feeding
☐☐ The emotional care and/or stimulation necessary for a child to develop
normally, such as speaking and interacting with a child
☐☐ An education for a child, such as enrolling a young child in school
☐☐ Needed health or dental care

What is economic maltreatment?

☐☐ Failure to provide the needs of a victim when adequate funds are available
☐☐ Unpaid bills when another person is managing the finances, resulting in
disconnection of heat or electricity

What are factors that influence an individual's potential for violence?

■■ History of being abused or exposure to violence
■■ Low self-esteem
■■ Fear and distrust of others
■■ Poor self-control
■■ Inadequate social skills
■■ Immature motivation for marriage or childbearing
■■ Weak coping skills

What are signs and symptoms of potential child abuse?

◯◯ Unexplained injury
◯◯ Unusual fear of the nurse and others
◯◯ Evidence of injuries not mentioned in history (old burns, scars, ecchymosis, human
bite marks)
◯◯ Fractures, including older healed fractures
◯◯ Subdural hematomas
◯◯ Trauma to genitalia
◯◯ Malnourishment or dehydration
◯◯ General poor hygiene or inappropriate dress for weather conditions
◯◯ Considered to be a "bad child"

What are signs and symptoms of potential elder abuse?

◯◯ Unexplained or repeated physical injuries
◯◯ Physical neglect and unmet basic needs
◯◯ Rejection of assistance by caregiver
◯◯ Financial mismanagement
◯◯ Withdrawal and passivity
◯◯ Depression

What are some social and community factors that influence violence?

◯◯ Work stress
◯◯ Unemployment
◯◯ Media exposure to violence
◯◯ Crowded living conditions
◯◯ Poverty
◯◯ Feelings of powerlessness
◯◯ Social isolation
◯◯ Lack of community resources (playgrounds, parks, theaters)

What are some primary prevention methods for reducing societal violence?

• Teach alternative methods
of conflict resolution
• Organize parenting classes to
provide anticipatory guidance
of expected age-appropriate
behaviors, appropriate
parental responses, and forms
of discipline.
• Educate clients about
community services that
are available to provide
protection from violence.
• Promote public
understanding about the
aging process and about
safeguards to ensure a safe
and secure environment for
older adults in the community.
• Assist in removing or reducing
factors that contribute to
stress by referring caretakers
of older adult clients to
respite services, assisting an
unemployed parent in finding
employment, or increasing
social support networks for
socially isolated families.
• Encourage older adults
and their families to
safeguard their funds
and property by getting
more information about a
financial representative trust,
durable power of attorney,
a representative payee, and
joint tenancy.
• Teach individuals that no one
has a right to touch or hurt
another person, and make
sure they know how to report
cases of abuse.

What are some secondary prevention methods for reducing societal violence?

• Identify and screen those at
risk for abuse and individuals
who are potential abusers.
• Assess and evaluate any
unexplained bruises or
injuries of any individual.
• Screen all pregnant women
for potential abuse. This may
be the one time in some
women's lives that they may
access the health care system
on a regular basis.
• Refer sexual assault or rape
victims to a local emergency
department for assessment
by a sexual assault abuse
team. Caution the client
not to bathe following the
assault because it will destroy
physical evidence.
• Assess and counsel anyone
contemplating suicide or
homicide and refer the
individual to the appropriate
services.
• Support and educate the
offender, even though a
report must be made.
• Assess and help offenders
address and deal with the
stressors that may be causing
or contributing to the abuse,
such as mental illness or
substance abuse.
• Alert all involved about
available resources within the
community.

What are some tertiary prevention methods for reducing societal violence?

• Establish parameters for
long-term follow-up and
supervision.
• Make resources in the
community available to
the client (telephone
numbers of crisis lines
and shelters).
• If court systems are
involved, work with
parents while the child is
out of the home (in foster
care).
• Refer to mental health
professionals for longterm
assistance.
• Provide grief counseling
to families of suicide or
homicide victims.
• Develop support groups
for caregivers and victims
of violence.
• Advocate for legislation
designed to assist older
adult independence
and caregivers and to
increase funding for
programs that supply
services to low-income,
at-risk individuals.

What steps must the nurse take when caring for clients who experience violence?

◯◯ Build trust and confidence with a client.
◯◯ Focus on the client rather than the situation.
◯◯ Assess for immediate danger.
◯◯ Provide emergency care as needed.
◯◯ Develop a plan for safety.
◯◯ Make needed referrals for community services and legal options.
◯◯ If abuse has occurred, complete mandatory reporting, following agency guidelines.

What is substance abuse?

the use of any substance (including legal and prescribed) that threatens
an individual's health or social and economic functioning

What is addiction?

a pattern of pathological, compulsive use of substances that can involve
physiological dependence

What are the cardinal signs of addiction?

tolerance and withdrawal

What may be included in denial?

■■ Defensiveness
■■ Lying about use
■■ Minimizing use
■■ Blaming or rationalizing use
■■ Intellectualizing

What health problems can be included with ETOH, tobacco and other drug use?

◯◯ Low birth weight
◯◯ Congenital abnormalities
◯◯ Accidents
◯◯ Homicides
◯◯ Suicides
◯◯ Chronic diseases
◯◯ Violence

How the body processes ETOH is dependent on what?

☐☐ The size and weight of the drinker
☐☐ Gender (affects metabolism)
☐☐ Carbonation (increases absorption)
☐☐ Time elapsed during alcohol consumption
☐☐ Food in the stomach
☐☐ The drinker's emotional state

How quickly does the body process ETOH?

Alcohol is filtered by the liver at about 1 oz per hr.

What are ETOH withdrawal s/sx?

☐☐ Irritability
☐☐ Tremors
☐☐ Nausea
☐☐ Vomiting
☐☐ Headaches
☐☐ Diaphoresis
☐☐ Anxiety
☐☐ Sleep disturbances

What are some s/sx of substance abuse?

■■ Vital signs - Blood pressure, pulse, and temperature can be elevated, while
respirations can be rapid, shallow, and depressed.
■■ Appearance - Individual can appear disheveled with an unsteady gait.
■■ Eyes - Pupils can appear dilated or pinpoint, red, also poor eye contact.
■■ Skin - Can be diaphoretic, cool, and/or clammy; needle track marks or spider
angiomas may be visible.
■■ Nose - Can be runny, congested, red and/or cauliflower-shaped.
■■ Tremors - Fine or coarse tremors may be present.

What are some primary prevention strategies for substance abuse?

• Increase public awareness,
particularly among young
people, regarding the
hazards and addictive
qualities of substance abuse
(e.g., public education
campaigns, school
education programs).
• Encourage development of
life skills.

What are some secondary prevention strategies for substance abuse?

• Identify at-risk individuals
and assist them to reduce
sources of stress, including
possible referral to social
services to eliminate
financial difficulties or other
sources of stress.
• Screen individuals for
excessive substance use.

What are some tertiary prevention strategies for substance abuse?

• Assist the client to develop
a plan to avoid high-risk
situations and to enhance
coping and lifestyle
changes.
• Refer the client to
community groups, such as
Alcoholics Anonymous (AA)
and Narcotics Anonymous
(NA).
• Monitor pharmacological
management.
• Provide emotional support
to recovering abusers and
their families, including
positive reinforcement.

What are some factors that contribute the mental health of aggregates?

◯◯ Individual coping abilities
◯◯ Stressful life events (exposure to violence)
◯◯ Social events (recent divorce, separation, unemployment, bereavement)
◯◯ Chronic health problems
◯◯ Stigma associated with seeking mental health services

What are some primary prevention strategies related to mental health?

• Educate populations
regarding mental health
issues.
• Teach stress-reduction
techniques.
• Provide parenting classes.
• Provide bereavement
support.
• Promote protective factors
(coping abilities) and risk
factor reduction.

What are some secondary prevention strategies related to mental health?

• Screen to detect mental
health disorders.
• Work directly with
individuals, families,
and groups through the
formation of a therapeutic
relationship.
• Conduct crisis
intervention.

What are some tertiary prevention strategies related to mental health?

• Perform medication monitoring.
• Provide mental health
interventions.
• Make referrals to various groups
of professionals, including
support groups.
• Maintain the client's level of
function to prevent relapse or
frequent rehospitalization.
• Identify behavioral,
environmental, and biological
triggers that may lead to
relapse.
• Assist the client in planning a
regular lifestyle and minimizing
sources of stress.
• Educate the client and family
regarding medication side
effects, potential interactions

What are some characteristics of homeless populations?

◯◯ Adults who are unemployed, earn low wages, or are migrant workers
◯◯ Female heads of household
◯◯ Families with children (fastest growing segment)
◯◯ People who are mentally ill (large segment)
Care of Special Populations
RN Community Health nursing 73
◯◯ People who abuse alcohol or other substances
◯◯ Abandoned children
◯◯ Adolescent runaways
◯◯ Older adults with no one to care for them

What are common health conditions of homeless persons?

◯◯ Upper respiratory disorders
◯◯ Tuberculosis
◯◯ Skin disorders (athlete's foot) and infestations (scabies, lice)
◯◯ Alcoholism/drug abuse
◯◯ HIV/AIDS
◯◯ Assault and rape
◯◯ Mental illness
◯◯ Dental caries
◯◯ Hypothermia and heat-related illnesses
◯◯ Malnutrition

What are some primary prevention strategies for homelessness?

Prevent individuals and families from becoming homeless by assisting them in
eliminating factors that may contribute to homelessness.
■■ Refer those with underlying mental health disorders to therapy and counseling.
■■ Enhance parenting skills that may prevent young people from feeling the need to
run away.

What are some secondary preventions strategies for homelessness?

Alleviate existing homelessness by making referrals for financial assistance, food
supplements, and health services.
■■ Assist homeless clients in locating temporary shelter.
■■ Assist clients in finding ways to meet long-term shelter needs.
■■ If homeless shelters are not provided in the community, work with government
officials to develop shelter programs.

What are some tertiary prevention strategies for homelessness?

Prevent recurrence of poverty, homelessness, and health problems that result in
conditions of poverty and homelessness.
■■ Advocate and provide efforts toward political activity to provide needed services
for people who are mentally ill and homeless.
■■ Make referrals for employee assistance and educational programs to allow clients
who are homeless to eliminate the factors contributing to their homelessness.

What are some health status considerations of rural residents?

◯◯ Higher infant and maternal morbidity rates
◯◯ Higher rates of chronic illnesses (heart, lung, hypertension, cancer, diabetes mellitus)
and motor vehicle crash-related injuries
◯◯ Higher health occupational risks (machinery accidents, skin cancer, respiratory
problems due to chemical exposure)
◯◯ Higher rates of suicide
◯◯ High risk of trauma and injuries (falls, amputations, crush injuries, pesticide exposure)
◯◯ Less likely to seek medical care

What are some barriers to health care in rural areas?

◯◯ Distance from services
◯◯ Lack of personal/public transportation
◯◯ Unpredictable weather and/or travel conditions
◯◯ Inability to pay for care/underinsured/uninsured
◯◯ Shortage of rural hospitals/health care providers

What are common health problems of migrant workers?

◯◯ Dental disease
◯◯ Tuberculosis
◯◯ HIV
◯◯ Depression and other mental health problems
◯◯ Domestic violence
◯◯ Lack of prenatal care
◯◯ Higher infant mortality rates

What are some migrant health issues?

◯◯ Poor and unsanitary working and housing conditions
◯◯ Less access to dental, mental health, and pharmacy services
◯◯ Inability to afford care
◯◯ Availability of services (distance, transportation, hours of service, health record
tracking)
◯◯ Language (majority speak Spanish) and cultural aspects of health care

What are some primary preventions strategies for migrant health care?

• Educate regarding measures
to reduce exposure to
pesticides.
• Teach regarding accident
prevention measures.
• Provide prenatal care.
• Mobilize preventive services
(dental, immunizations).

What are some secondary preventions strategies for migrant health care?

• Screen for pesticide
exposure.
• Screen for skin cancer.
• Screen for chronic
preventable diseases.
• Screen for communicable
diseases.

What are some tertiary preventions strategies for migrant health care?

• Treat for symptoms of
pesticide exposure.
• Mobilize primary care and
emergency services.

Vunerable populations

Violence, substance use disorders, mental health issues, poverty and homelessness, rural residency, migrant employment, veteran status, disability

Facts about homicide

1. often related to substance use
2. Most homicides are committed by someone known to the victim and occur during an argument
3. Violence often precedes homicides within families
4. Rates of homicide are increasing amoung adolescents more than in other age groups

Facts about assault

Males are more likely than females to be assaulted and youths are at a significantly increased risk

Rape

1. Most incidences of rape are spousal or acquaintance rape
2. Rapes often occur 8 p.m. - 2 a.m , weekends, summer months

Facts about suicide

1. highest btwn 45-65 years of age
2. Females are more likely to attempt and Males are more likely to follow through
3. Caucasions most likely to commit suicide
Risk factors for suidice: depression, mental health, substance use, firearm, partner violence, neglect issues

Neglect

includes the failure to provide:
1. Physical care
2. Emotional care
3. Education for a child
4. Needed health or dental care

Individual risk factors for violence

1. Hx of being abused or exposed to violence
2. low self-esteem
3. fear and distrust of others
4. poor self-control
5. inadequate social skills
6. Minimal social support
7. Immature motivation for marriage or childbearing
8. Weak coping skills

Potential child abuse

1. unexplained injury
2. unusual fear of the nurse and others
3. injuries/wounds not mentioned in history
4. fractures, including older healed fractures
5. Presence of injuiries/wounds/fractures in various stages
6. subdural hematomas
7. trauma to genitalia
8. malnourishment and dehydration
9. General poor hygiene or inappropriate dress for weather
10. Parent considers child to be a "Bad child"

Recognizing elder abuse

1. unexplained or repeated physical injuries
2. Physical neglect and unmet basic needs
3. Rejection of assistance by caregiver
4. Financial mismanagement
5. Withdrawal and passibity
6. depression

What are factors within the community that lead to social and community violence?

1. work stress
2. unemployment
3. Media exposure to violence
4. crowded living conditions
5. poverty
6. feelings of isolation
7. lack of community resources (playgrounds, parks, theaters)

Caring for clients who experience violence

1. build trust and confidence
2. Focus on the client rather than on the situation
3. Assess for immediate danger
4. Provide emergency care as needed
5. Work with client to develop a plan of safety
6. Make needed referrals for community services and legal options
7. If abuse has occured, complete mandatory reporting, following state and agency guidelines

Substance use disorders

1. involve the maladaptive use of substances resulting in threats to an individual's health or social and economic functioning
2. Substance use disorders have significants effects on family dynamics, and often lead to codependency
3. negatively affect family life, public saftey, and the economy

Dependence

1. cardinal indicators: tolerance and withdrawal
2. Denial: defensiveness, lying about use, minimizing use, blaming or rationalizing use, intellectualizing

Substance use leads to health problems like

1. low birth weight
2. congenital abnormalitites
3. accidents
4. homicides
5. Suicides
6. Chronic diseases
7. Violence
8. disability

Withdrawal

1. following prolonged use, usually appear within 4-12 hr
2. Important to determine last drink when dealing with withdrawal

Physical assessment findings: withdrawal

Vital signs: tachycardia, elevated BP

appearance: disheveled with an unsteady gait

Eyes: dilated or pinpoint, red, and with poor eye contact

Skin: Diaphoretic, cool, clammy

Nose: runny, congested, cauliflower shaped

Tremors: Fine or coarse tremors can be present

Individual assessment: substance abuse

1. establish rapport. be nonjudgemental. use therapeutic communication
2. frequency, quantity, methods of use
3. Elicit information about consequences expericned
4. Determine if the individual perceives a substance use problem

Factors affecting mental health

individual coping skills, stressful life events, social events, chronic health problems, stigma associated with seeking mental health servies

Homeless population characteristics

1. Adults who are unemployed, earn low wages, or are migrant workers
2. Female head of household
3. Families with children
4. People who have a mental illness (largest segment)
5. Veterans
6. People who have substance use disorders
7. unaccompanied youth
8. adolescent runaways
9. survivors of biolence or neglect
10. people who have HIV and AIDS
11. Older adults who have no place to go and no support system

Health issues of homeless populations

1. URD
2.TB
3. skin disorders
4. substance use disorders
5. HIV/AIDS
6. trauma
7. mental health disorders
8. Dental caries
9. Hypothermia and heat-related illnesses from environmental exposure
10. malnutrition

Strategies for preventing homelessness and assisting those who are homeless

1. Prevent individuals and families from becoming homeless
2. alleveiate existing homelessness
3. Prevent recurrence of poverty, homlessness, and health problems

Health status of Rural Residency

1. Higher infant and maternal morbidity rates
2. Higher rates of DM
3. Higher rates of obesity
4. Less likely to meet physical activity
5. Higher rates of suicde
6. Increased trauma
7. Increased occupational-associated risks
8. Less likely to seek preventive care
9. Increased risk of skin cancer from sun exposure
10. higher rates of respiratory complications
11. Risk for stress-related health problems

priority needs for rural health

1. cancer prevention and care
2. Mental health care
3. substance use prevention and treatment
4. immunization programs
5. family planning\`

Migrant health act

provides funding for migrant health centers across the U.S., which serve about one-fifth of the migrant worker population. The department of Labor has regulations regarding standards for migrant and seasonal agricultural workers

health problems for migrant workers

dental disease, tuberculosis, chronic conditions, stress, leukemia, iron anemia, Cancers (stomach, uterine, cervical), lack of prenatal care, higher infant morality rate, STIs HIV/AIDS

Complications of pesticide exposure

cancer, reproductive problems, parkinson's disease, liver damage, impaired fetal development even from secondary exposure

Issues in migrant health

1. food insecurity
2. inconsistent income with yearly cycles of unemployment
3. Poor and unsanitary working and housing conditions
4. Exposure to evironmental pesticies
6. Less access to dental, mental health, and pharmacy services
7. inablity to afford care
8. Reduced ability of services
9. Language barriers and cultural aspects of health care
10. Discrimination
11. immigrant status

Veterans health issues

1. mental health
2. substance use disorders
3. suicide
4. infectious diseases
5. exposure to radiation
6 Traumatic brain injuries
7. Spinal cord injuries
8. Traumatic amputations
9. Cold injury
10. Military sexual trauma
11. Hearing impairments
12. Visual impairments

Immigrants

often have a waiting period to receive financial assistance for medical care

Unauthroized immigrants are only eligible for immunizations, school lunch, treatment for communicable disease, and emergency care

Refugees

Eligible for temporary assistance for needy families, medicaid, and supplemental security income

Incarcerated populations

1. Increased rates of mental health disorders
2. Increased incidence of rape and assault in the prison system
3. Health care regulated through the Federal Bureau of Prisons to promote rights of inamates
4. Increased rates of chronic disease, when compared with the general population

Vunerable populations

Violence, substance use disorders, mental health issues, poverty and homelessness, rural residency, migrant employment, veteran status, disability

Facts about homicide

1. often related to substance use
2. Most homicides are committed by someone known to the victim and occur during an argument
3. Violence often precedes homicides within families
4. Rates of homicide are increasing amoung adolescents more than in other age groups

Facts about assault

Males are more likely than females to be assaulted and youths are at a significantly increased risk

Rape

1. Most incidences of rape are spousal or acquaintance rape
2. Rapes often occur 8 p.m. - 2 a.m , weekends, summer months

Facts about suicide

1. highest btwn 45-65 years of age
2. Females are more likely to attempt and Males are more likely to follow through
3. Caucasions most likely to commit suicide
Risk factors for suidice: depression, mental health, substance use, firearm, partner violence, neglect issues

Neglect

includes the failure to provide:
1. Physical care
2. Emotional care
3. Education for a child
4. Needed health or dental care

Individual risk factors for violence

1. Hx of being abused or exposed to violence
2. low self-esteem
3. fear and distrust of others
4. poor self-control
5. inadequate social skills
6. Minimal social support
7. Immature motivation for marriage or childbearing
8. Weak coping skills

Potential child abuse

1. unexplained injury
2. unusual fear of the nurse and others
3. injuries/wounds not mentioned in history
4. fractures, including older healed fractures
5. Presence of injuiries/wounds/fractures in various stages
6. subdural hematomas
7. trauma to genitalia
8. malnourishment and dehydration
9. General poor hygiene or inappropriate dress for weather
10. Parent considers child to be a "Bad child"

Recognizing elder abuse

1. unexplained or repeated physical injuries
2. Physical neglect and unmet basic needs
3. Rejection of assistance by caregiver
4. Financial mismanagement
5. Withdrawal and passibity
6. depression

What are factors within the community that lead to social and community violence?

1. work stress
2. unemployment
3. Media exposure to violence
4. crowded living conditions
5. poverty
6. feelings of isolation
7. lack of community resources (playgrounds, parks, theaters)

Caring for clients who experience violence

1. build trust and confidence
2. Focus on the client rather than on the situation
3. Assess for immediate danger
4. Provide emergency care as needed
5. Work with client to develop a plan of safety
6. Make needed referrals for community services and legal options
7. If abuse has occured, complete mandatory reporting, following state and agency guidelines

Substance use disorders

1. involve the maladaptive use of substances resulting in threats to an individual's health or social and economic functioning
2. Substance use disorders have significants effects on family dynamics, and often lead to codependency
3. negatively affect family life, public saftey, and the economy

Dependence

1. cardinal indicators: tolerance and withdrawal
2. Denial: defensiveness, lying about use, minimizing use, blaming or rationalizing use, intellectualizing

Substance use leads to health problems like

1. low birth weight
2. congenital abnormalitites
3. accidents
4. homicides
5. Suicides
6. Chronic diseases
7. Violence
8. disability

Withdrawal

1. following prolonged use, usually appear within 4-12 hr
2. Important to determine last drink when dealing with withdrawal

Physical assessment findings: withdrawal

Vital signs: tachycardia, elevated BP

appearance: disheveled with an unsteady gait

Eyes: dilated or pinpoint, red, and with poor eye contact

Skin: Diaphoretic, cool, clammy

Nose: runny, congested, cauliflower shaped

Tremors: Fine or coarse tremors can be present

Individual assessment: substance abuse

1. establish rapport. be nonjudgemental. use therapeutic communication
2. frequency, quantity, methods of use
3. Elicit information about consequences expericned
4. Determine if the individual perceives a substance use problem

Factors affecting mental health

individual coping skills, stressful life events, social events, chronic health problems, stigma associated with seeking mental health servies

Homeless population characteristics

1. Adults who are unemployed, earn low wages, or are migrant workers
2. Female head of household
3. Families with children
4. People who have a mental illness (largest segment)
5. Veterans
6. People who have substance use disorders
7. unaccompanied youth
8. adolescent runaways
9. survivors of biolence or neglect
10. people who have HIV and AIDS
11. Older adults who have no place to go and no support system

Health issues of homeless populations

1. URD
2.TB
3. skin disorders
4. substance use disorders
5. HIV/AIDS
6. trauma
7. mental health disorders
8. Dental caries
9. Hypothermia and heat-related illnesses from environmental exposure
10. malnutrition

Strategies for preventing homelessness and assisting those who are homeless

1. Prevent individuals and families from becoming homeless
2. alleveiate existing homelessness
3. Prevent recurrence of poverty, homlessness, and health problems

Health status of Rural Residency

1. Higher infant and maternal morbidity rates
2. Higher rates of DM
3. Higher rates of obesity
4. Less likely to meet physical activity
5. Higher rates of suicde
6. Increased trauma
7. Increased occupational-associated risks
8. Less likely to seek preventive care
9. Increased risk of skin cancer from sun exposure
10. higher rates of respiratory complications
11. Risk for stress-related health problems

priority needs for rural health

1. cancer prevention and care
2. Mental health care
3. substance use prevention and treatment
4. immunization programs
5. family planning\`

Migrant health act

provides funding for migrant health centers across the U.S., which serve about one-fifth of the migrant worker population. The department of Labor has regulations regarding standards for migrant and seasonal agricultural workers

health problems for migrant workers

dental disease, tuberculosis, chronic conditions, stress, leukemia, iron anemia, Cancers (stomach, uterine, cervical), lack of prenatal care, higher infant morality rate, STIs HIV/AIDS

Complications of pesticide exposure

cancer, reproductive problems, parkinson's disease, liver damage, impaired fetal development even from secondary exposure

Issues in migrant health

1. food insecurity
2. inconsistent income with yearly cycles of unemployment
3. Poor and unsanitary working and housing conditions
4. Exposure to evironmental pesticies
6. Less access to dental, mental health, and pharmacy services
7. inablity to afford care
8. Reduced ability of services
9. Language barriers and cultural aspects of health care
10. Discrimination
11. immigrant status

Veterans health issues

1. mental health
2. substance use disorders
3. suicide
4. infectious diseases
5. exposure to radiation
6 Traumatic brain injuries
7. Spinal cord injuries
8. Traumatic amputations
9. Cold injury
10. Military sexual trauma
11. Hearing impairments
12. Visual impairments