Community Final Exam

Vulnerability of health Factors

1. social determinants of health

2. health conditions

3. age

4. geography (where you live and work)

5. socioeconomic status. 

Veterans vs Non-veterans

Veterans have approximately double the suicide rate of non-veterans.

  Screen veterans for suicide risk

o sedative use disorder

o    homelessness

o   a military related sexual trauma

o    chronic pain

o   sleep conditions

o    recent separation from service (first-year post-discharge)

Positive for suicide screening

Always offer support services for positive screens

Role of Public Health Nurse in Radioactive Exposure

Public health nurses will need to activate emergency plans to distribute Potassium Iodine (PI) for those in the defined fallout area. 

What occurs first in a potential radioactive exposure

Public announcement

Potassium Iodine (PI)

Saturates the thyroid gland to prevent uptake of radioactive iodine

When and who should you give Potassium Iodine (PI)

Given to those in the fallout area before or immediately after exposure.

Antidote to opioids

naloxone hydrochloride/Narcan

Tolerance

body or brain becomes less responsive to the effects of a substance over time- individuals need to use larger amounts of the substance to achieve the same desired effect or experience

Withdrawal

physical and psychological symptoms that occur when a person reduces or stops using a substance to which they have become physically dependent

Common Withdrawal Symptoms

discomfort, cravings, and potentially life-threatening complications in severe cases

Delirium tremens (DTs)

severe form of alcohol withdrawal that can occur when someone with alcohol use disorder suddenly stops drinking

How long until Delirium Tremens start

Symptoms typically appear 48-72 hours after the last drink

How long to Delirium Tremens symptoms last for

last 1-8 days

Delirium tremens (DTs) symptoms

confusion, disorientation, hallucinations, fever, hypertension, diaphoresis, and autonomic hyperactivity

Delirium tremens (DTs) Treatment

aggressive treatment with benzodiazepines

Benzodiazepine withdrawal syndrome

occurs when a person who has developed a physical dependence on benzodiazepines reduces or stops their intake abruptly

Prescribed and Illicit Use of these Medications

treat anxiety, insomnia, and seizures

Severe symptoms of Benzodiazepine withdrawal

 seizures, mania, and schizophrenia.

Reduce Benzodiazepine withdrawal syndrome

to taper off benzodiazepines to avoid severe symptoms

Abstinence

refraining from using or consuming a particular substance (e.g., alcohol or drugs) or engaging in a specific behavior (e.g., gambling) that one is addicted to or has had problems with

Common Goal in Addiction Treatment and Recovery

Abstinence

Remission in SUD

An individual with a diagnosed SUD no longer meets the criteria for the disorder

Causes of Remission SUD

successful treatment, behavioral changes, or other factors

Partial Remission

some symptoms remain

Full Remission

no symptoms are present

Mandated reporters

must report any case of known or suspected abuse and neglect in children, vulnerable adults, and elders

When to File

Suspicion alone is enough to file-do not collect evidence

Document the suspicion and that a report was filed with the DCF/Elder Services/the District Attorney

Role of  Forensic nurses and the district attorney office

   interview, assess, and collect evidence in cases of abuse or neglect

Intimate Partner Violence (IPV)

  leading cause of morbidity and mortality for women worldwide

Pregnant women vs non-pregnant women

Pregnant women have a significantly higher rate of IPV versus non-pregnant women.

Global Percentage of women who have experience IPV

approximately 25-30% of women have experience IPV in their lifetime

Types of elder abuse

 physical abuse

emotional abuse

neglect

Exploitation.

Who usually causes elder abuse

Most cases of elder abuse is perpetrated by someone known to the person, which includes residential facility staff.

Which sex has higher rates of elder abuse cases

Because women live longer than men and are more likely to live in a residential facility, woman experience a higher percentage of elder abuse cases.

What type of elder abuse to men more commonly face

abandonment

early warning signs of potential violence

o   Pacing

o    Restlessness

o   clenched fists

o   intense staring

o    sudden changes in voice tone or volume

o   Verbal threats

o    angry or aggressive statements

o    a rapid shift from calm to irritable behavior also suggest escalating risk

Physiological signs of Potential Violence

  increased muscle tension

  flushed face

 agitation

Early identification of potential violence

allows the nurse to intervene quickly with de-escalation techniques, reduce stimuli, and maintain a safe distance

community setting- Unsafe situation

it is always acceptable to evacuate an unsafe situation (leave someone’s house during a home visit, leaving a homeless encampment mid-treatment) – abandonment in the community does not apply like in a healthcare facility with other staff and security

Palliative Care

Focus on comfort and quality of life, Goal: Relieve suffering, improve QOL

When is Palliative Care given

o   Can be given at any stage of serious illness.

o    Can be concurrent with curative treatment

Hospice Care

Subset of palliative care for end of life, Patients choose comfort over curative treatment

When is Hospice Care given

o   Prognosis ≤ 6 months (certified by 2 physicians)

o   Patients choose comfort over curative treatment

Coverage of Hospice

Medicare hospice benefit covers all related care (limited home visits until 72 hours is declared).

Hospice Morphine

No ceiling dose

o   doses are titrated based on the client’s comfort and symptom control

Morphine needs what other type of medication

scheduled bowel regimen (e.g., stool softeners + stimulant laxatives) is essential to prevent complications.

1-2 Weeks Before Death

Increased sleep, disengagement from world, decreased appetite and fluid intake - this is normal, don't force food/fluids

Days Before Death

Sleeping most of the time, difficult to arouse, confusion, restlessness, agitation, kidneys shutting down, decreased urine output (concentrated, dark), cool, mottled extremities (circulation decreasing), Cheyne-Stokes respirations (irregular breathing pattern, periods of apnea)

Hours Before Death

Unresponsive, "Death rattle" gurgling sound from secretions in throat, NOT distressing to patient who would be unconscious, but family may find distressing - reposition patient, explain process to family, breathing irregular, may have apnea periods, can give anticholinergic (scopolamine, atropine) to dry secretions if breathing is congested, pulse weak, irregular, blood pressure dropping, cyanosis, mottling of skin, decreased blinking, eyes may remain half-open (provide eye drops for comfort)

Moments of Death

No breathing, no pulse, no response to stimuli, fixed, dilated pupils, loss of sphincter control (bowel/bladder release)

Infectious Disease

caused by a germ

Communicable Disease

caused by a germ + spreads between people

Public Health Surveillance

process of collecting, analyzing, and interpreting health data to guide public health action and prevent disease

Public Health Nurses

communicable disease case investigations to determine the source of, and contain, outbreaks in the community.

Healthcare providers

treat individuals with communicable diseases

role of public health professionals

investigate the case and protect the whole population

What population should public health professional look into more

those residents that are more vulnerable and susceptible to disease

Case investigations

interviews that gather information about the source of the disease

Haemophilus influenzae type b (Hib)

Epiglottitis- Sudden onset of high fever, severe sore throat and difficulty swallowing, drooling (because the child can’t swallow), tripod position (sitting upright, leaning forward, mouth open), stridor (harsh inspiratory sound), muffled voice (“hot potato” voice)

Do not examine the throat

·       Pertussis (whooping cough)

  deadly for infants-Tdap is an adult vaccine that is recommended every 10 years.

Meningococcal meningitis

o   respiratory droplets

o    Close contacts (roommates, intimate partners, anyone with prolonged exposure) must receive urgent prophylactic antibiotics (e.g., rifampin, ciprofloxacin) to prevent disease.

Bacterial meningitis (inflammation of the Menges)

o    caused by Neisseria meningitidis (meningococcal), streptococcus pneumoniae, or Haemophiles influenza type b (HIB).

o    This is a severe public health emergency in the community.

Viral meningitis

o   Enteroviruses, HSV, mumps, and measles

o   Usually milder than bacterial meningitis, and is not usually a significant public health issue.

Foodborne diseases

o   Salmonellosis, Campylobacteriosis, Listeriosis, E. coli, Norovirus, Hepatitis A, Botulism, Toxoplasmosis, Ciguatera Poisoning

Waterborne diseases

o   Cholera, Typhoid Fever, Hepatitis E, Giardiasis, Cryptosporidiosis, Amoebiasis (Amebic Dysentery), Schistosomiasis, Rotavirus Infection

Listeria

o   can be transmitted to humans through the consumption of contaminated food

o   unpasteurized dairy products, deli meats, and certain ready-to-eat foods, such as soft cheeses, smoked seafood, and prepackaged salads. 

It is advised that pregnant women avoid these foods because they are suspectable to infection

  Escherichia coli (E. coli)

o   Normally resides in the intestines of humans and animals and is usually harmless.

o   infections are often transmitted through the consumption of contaminated food or water

o   undercooked ground beef, unpasteurized dairy products, and raw fruits and vegetables.

o   Person-to-person transmission can also occur (fecal-oral route).

o   Symptoms: (bloody) diarrhea, abdominal cramps, and vomiting. 

o   Treatment: rehydration and symptom management.

o    Severe cases are usually related to an immune compromised host.

·       Norovirus infection ("stomach flu" or "winter vomiting bug,")

o   is a highly contagious viral illness that affects the gastrointestinal tract

o   It is a leading cause of foodborne illness outbreaks, as well as outbreaks in settings such as cruise ships, schools, and healthcare facilities

o   transmitted through the consumption of contaminated food or water, direct contact with an infected person, or contact with contaminated surfaces.

o    Hosts continue to shed viral agents up to 48 hours after symptoms are resolved.

o   Norovirus infection can cause sudden and severe symptoms, including nausea, vomiting, diarrhea, and abdominal cramps.

o    The primary treatment focus is on rehydration to replace lost fluids and electrolytes, particularly in cases with diarrhea and vomiting.

·       Botulism

o    a rare but serious and potentially life-threatening illness

o    affecting the nervous system

o    caused by toxins produced by the bacterium Clostridium botulinum.

o    Early symptoms include double vision, blurred vision, drooping eyelids, dry mouth, and difficulty speaking

o   . The most life-threatening complication is respiratory muscle paralysis due to progressive muscle weakness and difficulty swallowing, which can lead to airway obstruction and respiratory failure. 

o   Treatment involves antitoxin administration, which can help neutralize the toxin.

o   Preventing botulism involves proper food preservation techniques, including canning and fermenting, and ensuring that food is heated adequately to destroy botulinum toxins.

Cholera

o   acute diarrheal illness

o    caused by infection with the bacterium Vibrio cholerae.

o   It is characterized by severe, watery diarrhea (looks like ‘rice water’)

o   can lead to dehydration, electrolyte imbalances, and potentially life-threatening complications.

o   Preventing cholera involves improving access to clean and safe drinking water, sanitation, and hygiene.

o   Proper food handling, especially seafood and raw vegetables

o    The use of cholera vaccines is another preventive measure, especially in areas with endemic cholera.

o   During a outbreak, the priority is breaking the chain of transmission

o   spreads primarily through contaminated water and food, often due to poor sanitation and hygiene.

o   Hand hygiene and safe water practices are the most effective primary prevention strategies.

o   remains a significant public health concern, particularly in regions with poor sanitation and water infrastructure.

o     outbreaks can occur, especially after natural disasters or in conflict-affected areas, and prompt public health measures are essential for control.

·       Typhoid fever (enteric fever)

o   is a systemic illness that can lead to a range of symptoms and, if left untreated, can become severe and life-threatening. 

o   Typhoid fever is caused by the bacterium Salmonella Typhi.

o    Typhoid fever is typically transmitted through the consumption of food or water contaminated with the feces of an infected person.

o   Symptoms of typhoid fever can include a sustained high fever, weakness, abdominal pain, headache, and loss of appetite. 

o   Typhoid fever is treatable with antibiotics (ciprofloxacin and ceftriaxone)

Bacterial diseases Vaccines

Diphtheria, tetanus, pertussis (whooping cough), Haemophilus influenzae type b (Hib), pneumococcal disease, meningococcal disease, tuberculosis (TB), cholera, typhoid fever, and anthrax.

Viral diseases Vaccines

·       Measles, mumps, rubella, polio, hepatitis A, hepatitis B, influenza, rotavirus, varicella (chickenpox), herpes zoster (shingles), human papillomavirus (HPV), rabies, yellow fever, Japanese encephalitis, tick-borne encephalitis, Ebola, dengue, COVID-19, mpox (monkeypox), and respiratory syncytial virus (RSV).

  Bacterial STIs            

which are curable with Antibiotics: Chlamydia, Gonorrhea, Syphilis

· Viral STIs

o   which are not curable: HIV, Herpes, HPV, Hepatitis B (HPV and Hep B are vaccine preventable diseases!)

Herpes

o   is not cured with antivirals, but antivirals can reduce the frequency and intensity of outbreaks.

·       HIV

o   do not experience symptoms in the early stages (long incubation period)

o    may experience flu-like symptoms, including fever, fatigue, and swollen lymph nodes. 

o   Due to the long incubation period, HIV is not detected in laboratory tests for at least 10-90 days after infection onset. 

o   It’s important to give residents this information so they understand their risk and can strategize testing timing.

Core airborne communicable diseases

·       Measles, Tuberculosis, and Varicella (remember by the cue MTV). 

airborne communicable diseases PPE

o   All require N95 respirator mask for care or contact, isolation from the community, and well-ventilated living quarters.

Community nurses Intervention for Airborne Dieases

o   – increase ventilation, isolation of residents, findings affordable housing for residents that are doubled/tripled/quaded up (2,3, or 4 families sharing one apartment). 

Varicella’s symptoms

o   disseminated weeping lesions.  Until they are crusted over, these lesions create aerosol mode of transmission.  It’s important in the community to teach people to cover the lesions with clothes or dressings for larger lesions.

Infectious Agent

Micro-organism capable of causing diseases or illness

Reservoirs

Places in which infectious agents live, grow, and reproduce

Portals of Exit

Ways in which infectious agent leaves the reservoir

Modes of Transmission

Ways in which the infectious agent is spread from the reservoir to the susceptible host

Portals of Entry

Ways in which the infectious agent enters the susceptible host

Susceptible Host

Individuals may have traits that affect their susceptibility and severity of diseases

Active TB Diagnosed

abnormal chest x-ray and sputum cultures

TB Screening

o   Interferon-Gamma Release Assays (IGRAs) blood test (also known as QuantiFERON-Gold testing) or a tuberculin skin test (TST) also known as a purified protein derivative test (PPD).

IGRAs vs PPD

o   IGRAs test has a higher specificity than a PPD test, meaning a PPD tests has a lot of false positives, however, a PPD is an easier screening test to conduct in a community setting because it’s administered intradermally with a syringe using the Mantoux technique, while an IGRAs test requires phlebotomy. 

Latent TB

not an infectious disease, ¼ of the world’s population has latent TB,

choose to receive treatment to irradicate the bacteria from their system – this will cure the disease and prevent future risk of active TB if they become immune compromised.

PT with Active TB In Massachusetts

o   The state regulations require people to participate in direct observation treatment (DOT) through their city/town public health nurse.

o    Refusal to participate in treatment results in mandatory hospitalization and forced treatment. 

Presentation of Active TB

persistent cough, fever, and night sweats

Latent TB Treatment and symptoms

no symptoms and is treated with Rifapentine and Isoniazid – must watch for liver complications (no alcohol, jaundice)

Positive PPD/TST Test

measuring the induration (raised, hard area) at the injection site 48-72 hours after the test is placed-interpretation depends on the person's risk factors:

PPD 5 mm or more is positive

·       HIV-positive individuals

·       Recent contacts of someone with active TB

·       People with chest X-ray findings suggestive of previous TB

·       Organ transplant recipients and other immunosuppressed patients (taking corticosteroids or TNF-alpha inhibitors)

PPD 10 mm or more is positive

·       Recent immigrants (within 5 years) from high-prevalence countries

·       Injection drug users

·       Residents and employees of high-risk congregate settings (prisons, nursing homes, homeless shelters, hospitals)

·       Mycobacteriology laboratory personnel

·       Children under 4 years old

·       Infants, children, and adolescents exposed to high-risk adults

PPD 15 mm or more is positive

·       People with no known risk factors for TB