234 FINAL EXAM (copy)

What has the greatest impact on our health?

Healthy behaviors (50%), environment (20%), genetics (20%), access to care (10%)

What is upstream thinking?

Looking upstream where the real problem is happening
Googled definition: taking wise collective action to ensure better outcomes rather than simply responding to, and being overwhelmed by, crises we could have foreseen

Know examples of upstream thinking.

- Postpartum nurses teaching new mothers about safe sleep habits for baby to decrease infant mortality
- American heart association offering cooking classes to teach about the importance of heart healthy meals (mainly with diabetics)
- Nurses teaching teachers suicide prevention courses since teachers are on the frontline to see the signs most of the time
- Super shots immunizing as many kids as possibly to lower child disease rates

What are health disparities?

- systemic, potentially avoidable health differences that adversely affect socially disadvantaged groups
- Disparities in health care delivery: bias and stereotyping, unequal treatment with racial/ethnic groups

What groups of individuals tend to experience health disparities? Know which groups of individuals are considered to be vulnerable populations.

Poverty stricken people, racial/ethnic groups, uninsured people, children and elderly, lack of education

What is Healthy People 2030?

A plan based on the past 5 previous healthy people initiatives (1979-2020)

What are social determinants of health?

Social determinants of health are shaped by the distribution of money, power, and resources throughout the local communities, nations, and the world (Income, education, housing, job security, food security, transportation, geography, and social support --> Where people are born, grow up, live, work, and age, as well as systems put in place to deal with illness)

What is the Health Belief Model and what does it describe?

Analyzes the probability of making changes to improve health→ used to describe why some people take actions to prevent a disease and others don't

What patient perceptions are important before one will be willing to take action or make a change?

Perceived susceptibility, and severity of disease, risk factors, perceived benefits of health action, and perceived barriers

What is self-efficacy and why is it important?

- When A patient believes in one's ability to complete a task or meet a challenge (“won't try if you don't think you can do it!”)
- You want the patient to be empowered with these decisions so they will go through the stages of this model

What is health coaching?

- Working together to form a plan to have the patient work to reach full potential health → partnering with clients in a thought provoking and creative process that inspires them to maximize their personal and professional potential
- We want to keep track of patients health to see if there's changes through the models

What is a risk factor?

Something that increases the chances of developing a disease

Know which risk factors are modifiable and which are non-modifiable for heart disease.

Modifiable factors: to help fix hypertension→ exercise, diet, or medication
Non-modifiable: age or gender or ethnicity cannot be modified to fix hypertension

What is a SMART goal?

An acronym that stands for: specific, measurable, achievable, realistic, and timely -->

How many minutes each week should an adult exercise if exercising moderately?

150 minutes a week

How many minutes each week should an adult exercise if exercising vigorously?

75 minutes a week

What are the key attributes of Care Coordination (CC)?

- Interprofessional team
- proactive plan of care
- evidence based care
- targeted set of purposeful activities
- proactive follow up
- efficiency
- communication

What population groups/diagnoses benefit from care coordination?

all of them??

What is SBAR

SBAR: situation, background, assessment, request/recommendation
- Situation: what’s the situation right now?
- Background: what the clinical background
- Assessment: what the problem
- Recommendation: what do i recommend/request be done

what is ISBARR

ISBARR: identify, situation, background, assessment, recommendation, repeat
- Identify: introduction yourself
- Situation: state the purpose
- Background: tell the story
- Assessment: state what you think is going on, your interpretation, a focused assessment: relevant data
- Recommendation: what you'd like to see done
- Repeat: read back and verify

Define advocacy and Know examples of advocacy.

Act of speaking for others to assist them to meet needs and its an expectation for all who assume the role of the professional nurse

What is health literacy?

Capacity to read, comprehend, and follow through on health information

At what reading level should patient education material be?

5th-6th grade level

What are the negative impacts of low literacy skills?

- People are at increased risk for poor health
- lower income
- limited education
- more chronic health conditions

What are some possible indicators of low health literacy?

- Excuses: “i forgot my glasses”
- Lots of papers folded up in purse/pocket
- Lack of follow through
- Seldom ask questions
- Questions asked are basic in nature (indicates poor teaching from last facility)
- Difficulty explaining medical concerns, plan of car, medications

What is the teach-back method and when should it be used?

a way of checking understanding by asking patients to state in their own words what they need to know or do about their health

Know examples of macronutrients.

protein, carbs, and fats

How many calories are in each gram of carbohydrates within the daily value

Carbohydrate (45% to 65% daily calories) → found in starchy foods

How many calories are in each gram of proteins within the daily value

Proteins (10% to 35% of daily calories)

How many calories are in each gram of fats within the daily value

Fats (20% to 35% of daily calories)

what're the calories within a carbohydrates

4 calories per gram

what're the calories within a protein

4 calories per gram

what're the calories within a fat

9 calories per gram

What is the Basal Metabolic Rate (BMR)?

The energy needed to maintain life- sustaining activities for a specific period of time at rest

How is BMI calculated in an adult

- When calories in = calories out , weight will stay the same
- If someone wants to lose weight calories out should be more than calories in or vice versa for gaining weight
- EQUATION: BMI = (Weight in pounds divided by Height^2 ) x 703 --> HEIGHT IS IN INCHES

What are the percentiles/numbers on the BMI chart for underweight, healthy weight, overweight and obese

- underweight: less then 18.5
- healthy weight: 18.5 to 24.9
- overweight: 25.0 to 29.9
- obese: anything 30.0 or greater

what is SNAP

SNAP: monthly allotment to help low-income families buy nutritious foods

what is WIC

WIC: supplemental foods and nutrition education to low income pregnant/postpartum women and at risk children > 5 years old , nutrition assessments, and food voucher, formula assistance

what is meals on wheels

Meals on wheels: provides nutritious meals, a quick safety check and much-needed human connection to homebound seniors or older adults

What four major causes of deaths in the US can be attributed to poor diets

Cardiovascular disease, diabetes, some cancers, obesity

What is a realistic and healthy goal for weight loss (how many pounds per week)

loosing 1-2 pounds a week

What is food insecurity

Insecurity: the state of being without reliable access to a sufficient quantity of affordable, nutritious food

What is a food desert

Desert: an urban area in which it is difficult to buy affordable or good-quality fresh food

Besides smoking, what are other ways to get nicotine into one’s system?

Chew, dip, mouth sprays, snuff

What health risks are seen in women over 35 who smoke 15 or more cigarettes a day

Develop heart attacks, strokes, and blood clots

What is primary prevention? Know examples

Health promotion and specific prevention (before the disease process starts)
- Goal: maintain/improve general health of the individual/family/community
- examples: Immunization, education, change in diet

What is secondary prevention? Know examples

Having a diagnosis but trying to stop it
- Goal: identify individuals in early, detectable stage of disease
- Screenings or any kind (BP, Diabetes, cholesterol, or colorectal)

What is tertiary prevention? Know examples

Helps to restore and rehabilitate (helps to manage/minimize the disease)
- Goal: focus on rehabilitation to help people attain and retain an optimal level of functions
- PT after a surgery or taking medications

At what age should women start getting Pap smears

21

What age group finds the best benefits from colonoscopies

45 years old

What does a ‘D” rating from the US Preventative Taskforce (USPSTF) tell you about the benefit of a particular health screening

D rating means that it is not a recommended screening to get done

what is a live/attenuated vaccine and examples of them

use a weakened form of the virus which grows and replicates but doesnt cause illness
- Intranasal flu, mmr, rotavirus, varicella,

what is an inactivated vaccine and what are some examples of them

contain viruses whose genetic material; has been destroyed by heat, chemicals, or radiation so they cannot infect cells and replicate, but still can trigger an immune response (a dead microorganism)
- Hep A, injectable flu, and rabies

Who should not get a live vaccine?

Severely immunocompromised people as well as pregnant women → any slight disease could hurt an immunocompromised person and the live disease could hurt the fetus

What is herd immunity and why is it so important and what percent of immunization is needed for herd immunity

- when majority of population is vaccinated it works or has developed immunity
- It makes it possible to protect the population from a disease including unvaccinated people

what is active immunity and examples of it

Immunity which results from the production of antibodies by the immune system in response to the presence of an antigen (produced by a person's own immune system)
- Vaccine immunization or surviving an infection

what is passive immunity and some examples of it

short term immunity which results from the introduction of antibodies from another person or animal (immunity given by another person)
- When a baby receives a mothers antibodies through the placenta or breast milk

Who should get the flu shot?

EVERYONE 6 MONTHS OF AGE AND OLDER SHOULD GET A FLU VAX EVERY SEASON

What is the recommended age(s) to receive the HPV vaccine?

- Girls and boys get 2 doses at age of 11-12 (recommened)
- If girl or boy is over 15 they get 3 doses

what is the HEP B vax

prevents viral infection transmitted through blood or body fluids (3 injections and IM)

whats the ROTAVIRUS (RV) vax

prevents disease that causes diarrhea, vomiting, fever, abdominal pain, and dehydration ( 2 dose given orally) → live vax

whats the DTAP vax

a 5 dose series given IM → TDAP booster given)
- Diphtheria: breathing problems and paralysis
- Tetanus: lockjaw (muscles tightness in jaw)
- Pertussis: whooping cough and pneumonia

whats the HAEMOPHILUS INFLUENZAE TYPE B CONJUGATE (HIB) vax

prevents the haemophilus influenzae bacterium that can cause meningitis, pneumonia, epiglottis, and death (3 or 4 dose round given IM) → DOES NOT CAUSE THE FLU

whats the PNEUMOCOCCAL VACCINE (PCV)

prevents against pneumococcal bacterial infection that can cause pneumonia, meningitis, endocarditis, and death (4 dose round given IM)

whats the MEASLES, MUMPS, RUBELLA, (MMR) vax

2 dose rounds given subcutaneously (SQ) → airborne!!1
- Measles: rash, fever, ear infection, pneumonia, seizures
- Mumps: fever, headache, deafness, meningitis, and death
- Rubella: rash, fever, arthritis, miscarriage, birth defects

whats the INACTIVATED POLIO (IPV) vax

prevents polio which causes fever, nausea, vomiting, fatigue, paralysis, death (attacks central nervous system) (4 does rounds given IM or subcutaneous)

whats the VARICELLA vax

prevents chickenpox which is airborne (2 dose, live vax, given subcutaneously)

whats the HUMAN PAPILLOMAVIRUS (HPV) vax

prevents asymptomatic virus that spreads through skin to skin via sexual contact (2 round given IM at 11-12 y/o or 3 doses after 15th bday)

whats the FLU vax

prevents getting the flu by using an inactivated vaccine given every flu season (airborne, given IM)

whats the MENINGOCOCCAL CONJUGATE (MCV4) vax

prevents strains A,C,W,Y which cause meningitis (vax given IM)

whats the MENINGOCOCCAL B vax

Separate from Men. Conjugate vax (men ACWY) → only prevents against serogroup B meningococcal disease

whats the HEP A vax

prevents Hep. A which causes jaundice, diarrhea, fever, and weakness (2 dose given IM)

whats the COVID 19 vax

SARS virus prevention and is a one dose with a lot of boosters due to other strains

age range for infants

birth to 12 months

age range for toddlers

1-3 years old

age range for preschoolers

3-5 years old

age range for school age

5-12 years old

age range for adolescents

12-18 years old

age range for young adults

18 - 35 years old

age range for middle adults

35-65 years old

age range for older adults

65 years or older

What types of things are assessed when looking at growth

(per summersett via email) --> an increase in size; we measure this through measuring length, weight, head circumference, etc

NOT A QUESTION BUT A REMINDER FOR ANYONE USING: for what to expect in terms of physical, developmental, cognitive, and psychosocial development for the various developmental stages

this is the infant through older adult information from exam 2 that we all made flashcards or note pages from the 70 slide presentation

What percentage of birth weight may be lost the first few days of life and When should it be regained by?

10% is lost and is regained within 2 weeks

what is the birth weight calculations

1. convert the birth weight pounds into OUNCES (multiply by 16)
2. add left over ounces to the pounds just converted
3. convert the weight lost into ounces if needed
4. divide the ounces LOST over the BIRTH WEIGHT
5. multiply #4 answer by 100
6. if its over 10% it is too much lost

An infant's birth weight be what by 6 months and what by 12 months?

At 6 months it should double and at 12 months it should triple

what the 6 and 12 month weight calculations

1. KEEP POUNDS AND OUNCES SEPARATE
2. multiply given weight by 2 (6 lb 5ox: 6x2=12 and 5x2=10)
3. #2 answer is the 6 month weight (12 lb 10oz)
4. multiply given weight by 3 (6lb 5oz: 6x3=18 and 5x3=15)
5. #4 answer is the 12 month weight (18 lb 15oz)

What is anticipatory guidance?

the advice pediatricians provide to avoid problems that could occur in the future (preventive couseling)

What foods should be avoided to prevent choking in infants younger than 12 months?

Nuts, cereals, hard veggies or fruits (blueberries or peas)

Why should cow’s milk be avoided in infants younger than 12 months?

Does Not obtain good iron amounts (use breastmilk or formula for iron needs)

Why should honey be avoided in those younger than 12 months?

Risk of botulism poisoning (and foods with honey in them)

Why should bedtime bottles be avoided?

- It can promote erosion of tooth enamel
- Contributes to extra weight gain
- If bottles been given IN BED the liquid can enter into their lungs and choke them

What are some causes of SIDS

Sleeping on stomach or side, overheating, and toys or pillows in the bed

what're risk reducers for SIDS

- flat on back
- no toys in crib
- appropriate heat and clothing
- proper education before discharge

Why are toddlers at risk for choking?

Because they like to put things in their mouth alot

What is parallel play?

Doing the same things next to one another

What are warning signs of child abuse?

- Any injuries that are unusual
- Depression,anxiety, unusual fears
- Changes in behavior: aggression, anger, hostility, hyperactivity
- Neglecting things like food, clothing, shelter, affection

What are warning signs of suicide risk in adolescents?

- Changes in eating and sleeping patterns
- loss of interest
- withdrawal from friends
- alcohol and drug use
- unnecessary risk taking
- obsession with death
- acting out behaviors or running away

what is delirium

- ACUTE condition with a cause (UTI) and limiting condition
- Results in confusion and other disruptions in thinking and behavior (changes in perception, attention, mood, and activity level)
- More abrupt confusion, emerging over days or weeks
- Fluctuating menta; status is important to identify because it ofte signals a need for additional treatment
- NEED TO KNOW THE BASELINE MENTAL STATE

what is dementia

- Not specific disease (wide range of sym[potms) → associate with a decline in memory or other thinking skills severe enough to reduce person's ability to to ADLS
- Caused by damage to brain cells and the damage interferes with the ability of brain cells to communicate with each other
- Must have at least 2 of the following core functions significantly impaired to be considered with dementia: memory, communication and language, inability to focus and pay attention, reasoning and judgment, visual perception, disorientation
- Alzhiemers is most common illness then there's multi-infarct dementia
- Most used assessment tool: mini mental state exam
- NO CURE