Community ATI

West Nile Virus Prevention

  • Eliminate sources of standing water at least once per week

  • No known immunization

  • Transmitted person to person through blood, breast milk, or organ transplantation


Smallpox transmission (smallpox is disfiguring)

  • Direct contact: bodily fluids, blood, vomit, contaminated objects, bedding and clothing.

  • Inhalation of droplets: cough

  • Appears on the FACE

  • Disaster preparedness plan for smallpox → priority individuals are mortuary workers.
    Mortuary workers receive prophylaxis immunization due to high risk of exposure to smallpox


RSV

  • Spread through contact with respiratory secretions from an infected person


Measles

  • Unvaccinated children contracted measles it is best to → report this information to the state health department

  • Incubation is 10-20 days. Child remains isolated from 4-5 days after the rash


Varicella (chicken pox) AIRBORNE precautions (Nationally notifiable infectious conditions)

  • Negative pressure room

  • N95 masks

  • Designated stethoscope 

  • Prescription for antipyretic


Rotavirus

  • Peaks during the winter months of the year

  • Symptoms: fever, vomiting, watery diarrhea


Influenza type A outbreak

  • Administer antiviral medication to clients at the facility


Scabies outbreak

  • First action: Determine incidence rate (Determine the number of new cases of scabies in the community for comparison to prior incidence data in order to monitor for an increase)


Tuberculosis

  • Household members should take Isoniazid for 6 months

  • Client with active TB receives chest x-ray for future screenings

  • TB Administration

  • Insert at a 5-15 degree angle

  • Inner forearm 

  • 0.1 ml of purified protein derivative

  • Wheal should be 6 mm in diameter


Pertussis

  • Transmitted through airborne droplets

  • Child with pertussis (what actions to take)

  • Tell the parent to keep the child home for 2 weeks after initial symptoms

  • Encourage family members to obtain prophylactic treatment

  • Check the immunization status of the child’s classmates


Anthrax virus

  • Anthrax infects the skin, GI tract, or the lungs.

  • After Anthrax is inhaled it is treated with antibiotics for 60 days

  • Immunization is given in a 6 month dose series, not given to children

  • First stage of anthrax is flu like symptoms



Meningococcal vaccine

  • For clients in crowded areas in dorms

  • 8 weeks and older



Hepatitis A

  • Spread through oral-fecal contamination, contaminated food or water

  • Clean bathroom fixtures with chlorine

  • NO SHARING BATH TOWELS and SEX until test is negative


Hepatitis C

  • Abstain from sex until antibody tests are negative

  • Transmitted through blood and bodily fluids

  • Consume diet high in carbs and calories


PATHOGENS

Vector: A mode of transmission for the disease

Pathogen: The microorganism that causes the infection 

Reservoir: The environment where the pathogen can survive the reservoir

Susceptive host: A client who is susceptible to infection


Ciprofloxacin is an antibiotic prescribed for a wide range of serious skin infections

  • Do not take with antacid

  • Avoid caffeine 

  • Avoid sun exposure

  • Avoid taking ciprofloxacin along with dairy products


How can you meet the NEEDS of the local community?

  • Identify prevalent health problems in the community


PUBLIC HEALTH AGENCY


Public health core function of policy development

  • Updating local policies to support community health efforts


Public health core function of assessment

  • Investigating local health hazards


Public health core function of assurance

  • Collaborating with community agencies to improve availability of services

  • Ensuring competence of healthcare workforce


Public health nurse participating in a disaster preparedness plan should have a 

  • List of areas within the community where residents speak multiple languages


Community health nurse: Which method yields direct data?

  • Informant interviews


Which methods yield secondary data?

  • Health surveys

  • Medical records

  • morbidity/mortality statistics


Task force nurse

First: Review community-specific epidemiological data


What is Comorbidity?

  • Presence of multiple diseases or health conditions


What is somatization disorder?

  • A psychiatric condition manifesting a physical compliant

  • Internal psychological conflicts are unconsciously expressed as physical manifestations


What healthcare is absent in a rural setting?

  • Tertiary care

  • Tertiary care is obtained following a referral from primary care provider

  • Specialist provide tertiary care and work in large medical centers


Clinical depression vs Grief

  • Clinical depression

  • Persistent state of sadness

  • Disturbed self esteem

  • Hopelessness

  • Grief

  • They will experience anger, guilt, shame, and doubt. 

  • Ability to openly express your anger


Examples of Primary prevention

  • Annual influenza immunizations

  • Teaching a group of clients about work environmental risks

  • “Discussing stress reduction techniques with employees at an industrial site”

  • “Providing support programs for new parents”

  • Demonstrate proper handwashing techniques


Examples of secondary prevention (early detection of a health problem)

  • Yearly mammography examinations

  • Identify the condition early 

  • “ Provide employers handouts on recognizing pesticide toxicity”

  • “Create handouts on identifying skin cancer in multiple languages”

  • “Screening a client whose partner recently died for suicide risk”

  • Vision and hearing screening

  • Report suspected child neglect

  • Recognizing and reporting suspected maltreatment to the appropriate protective services



Examples of tertiary prevention (care of established disease)

  • Periodic pulmonary function tests

  • Reviewing the appropriate use of oxygen in the home

  • Working with members of the population who have diabetes to decrease the number of work days lost due to complications

  • Advocating for the expansion of mental health rehabilitation facilities with community leaders

  • Provide nutritional counseling for students who have diabetes

  • Administer antiviral medications within 48 hours to clients who have manifestations of influenza


Emergency Treatment


A client who has an ileus following spinal surgery requires 

  • Nasogastric suctioning and cannot be discharged following an earthquake


Immediate treatment

  • Use Unstable versus stable priority-setting framework → Unstable clients are the priority. 

  • Threats or problems include : Airway, breathing, circulatory status 

  • Clients whose vital signs or laboratory values indicate a risk for becoming unstable

  • Ex: A report of severe epigastric and left arm pain accompanied by diaphoresis is a manifestation of a myocardial infarction.


What should nurses do first when they receive notification of a massive explosion?

  • Activate the emergency response plan

  • Follow facility policy to activate the disaster plan

  • Clear the department of all non-urgent clients and move those awaiting admission to a holding area


TRIAGE

Triage nurses responsibilities

  • Priority is assessment and control of client flow

  • Fostering positive public relations for the facility

  • Performing a comprehensive client assessment

  • Preventing cross-contamination of infectious client


Triage nurses priority

  • A client who has tracheal deviation and SOB


BLACK TAG: Extensive injuries, minimal chance of survival. Ex: Client who is unresponsive and 3rd degree burns over 75% of her body

RED TAG: Injuries that are life-threatening to indicate survival is expected with minimal interventions

YELLOW TAG: Significant injuries but can wait hours before treatment

GREEN TAG: Minor injuries and treatment can be delayed for multiple hours to days



Triage phases

  • Preparedness phase: provide disaster training to school personnel

  • Prevention phase: identifying potential hazards

  • Response phase: provide hands on care, coordinating first aid response team, serve as counselor to those in needs

  • Recovery phase: serving as a liaison between resources and those in need


Clients who have extensive injuries and 0 chance of survival do NOT receive treatment. 

  • Ex: person with open occipital wound, RR 6, capillary refill 4.5, nonresponsive to pains stimuli should be turned to left semi-fowler's position and begging assessing the next client


What blocks the thyroid uptakes of radioactive iodine

  • Potassium iodide → Can reduce the risk of thyroid cancers and other diseases

  • Ex: Nurse is teaching a community group who lives near a nuclear power plant about safety precautions related to radiation exposure.


HIV Exposure

  • Administer prophylactic medications for 4 weeks to prevent the virus from replicating within the body

  • Client should return for testing at 4-6 weeks, 3 months, and 6 months


Respite care

  • Provides family members with temporary relief from caregiving


Community groups 

  • Provides family caregivers with social support in a setting


Growth Failure: Protein deficit

  • Thin limbs

  • Protuberant abdomen

  • Dry and dull hair


Failure to thrive: Chronic hypoxemia

  • Clubbed nail beds

  • Polycythemia

  • Failure to thrive


Anemia

  • Pallor

  • Fatigue

  • Weakness


Fluid overload

  • Edema

  • Extreme fluid overload (Anasarca) Gross, generalized edema


What group is most at risk for suicide

  • Older adult male clients ages 75-90 years old


Developmental task of ADOLESCENT (12-18)

  • Identity vs role confusion

  • Preoccupied with with their changing bodies and how their bodies appear to others (Adjusting to dramatic changes in body image)


Piaget’s stage of formal operational thought

  • Characterized by the development of logical and hypothetical reasoning in ADOLESCENTS.


Early adulthood

  • Intimacy vs isolation


Smoking during pregnancy is associated with what in infants?

  • Infant developmental delays

  • Premature birth

  • Low birth weight

  • Sudden infant death syndrome

  • Bronchitis

  • Pneumonia


Tai Chi

  • Improves balance

  • Consists of a series of slow, gentle, continuous movements

  • Older clients improve their balance and physical strength and reduce risks of falls


Naturopathic medicine

  • Treats the whole client and promotes health


Magnet therapy

  • Aids chronic pain and musculoskeletal disorders


Progressive relaxation therapy

  • Lowers blood pressure and HR

  • Increases wellbeing

  • Decreases muscle tension


Prevalence proportion

  • Calculated by using the number of people who were AFFECTED at a given time and the TOTAL population


Prevalence rate

  • Number of OLD and NEW cases of a specified disease or condition existing at a particular time within a given population


Incidence rate

  • Number of NEW cases of a specific disease or condition within a specific population over a specific period of time


Age specific death rate

  • Number of deaths within an age group over a specific period of time


Cause-specific death rate

  • Number of deaths from a particular cause over a specific time period



Demographic data as part of community assessment

  • Racial distribution

  • Marital information

  • Population density

  • Death and birth rates


Demographic data as part of family assessment

  • Family genograms


Cultural assessment focuses on

  • Beliefs

  • Values

  • Meanings

  • Behavior of people within a clients cultural, ethnic, or religious group

  • Food preferences


Rural community

  • Health care providers have greater independence and work more autonomy in providing client care 

  • Residents are no less likely to be interested in health promotion than members of urban communities

  • Rural residents rely on community networks for support. 


What are barriers to healthcare for residents in rural areas

  • Unavailability of outreach services


Education for rural community (Farm workers)

  • Provide environmental health info

  • Refer the client for TB screening

  • Provide skin cancer info

  • Recommended dental health screening

  • Occupational health risks: respiratory disorders, dermatitis, dental problems, stress and anxiety.


Genogram

  • Tracks biological risk factors


Environmental risk assessment

  • Obtains information regarding social risks, high-stress environments, high-crime neighborhoods, economic risks → relationship between family resources.


Alcohol use disorders

  • Tell the client to take naltrexone daily


Opiate withdrawal

  • Buprenorphine next 9-12 months


Tracheostomy care

  • Use tap water to clean inner cannula

  • Use a square knot to secure tracheostomy ties

  • Leave old ties in place until new ones are secured to prevent displacement

  • Fold 4 inch by 4 inch gauze dressing before placing it at the site.


Community-oriented approach

  •  Consult with local school nurse to schedule yearly vision screenings for students


Community-based approached 

  • Teach a client who has vision loss about safety in the home environment, provide genetic counseling to the family of a newborn has has congenital cataracts, develop a plan of care for a client who has newly diagnosed with glaucoma)


Children

Child maltreatment

  • Common in homes where partner violence is present

  • Client has changed providers three times during their pregnancy


Rinne test

  • “After I place this tuning fork behind your ear, tell me when you no longer hear the sound”

  • Compares air conduction and bone conduction of sound


Weber's test

  • Evaluates lateralization of sound

  • Tuning fork on scalp, tell me if you hear the sound better in one ear or the same in both ears


Snellen letter chart

  • Allow child to keep their glasses on during test

  • Stand or sit 10 feet away from the chart


Older adult neglect

  • Taking outdated prescriptions


violence

  • I should determine whether a client who has been sexually assaulted requires a rape kit 

  • Develop a safety plan

  • Document the name of the person the client accuses of the violence in the medical record

  • Assess for violence every visit

  • Partner violence RIsks include

  • Client states they are leaving their partner


Pregnant ladies


What vaccines are safe to administer to pregnant ladies

  • TDAP

  • NO HERPES ZOSTER, VARICELLA, MMR


Types of therapy


Acupuncture for menopause

  • Effectiveness is by showing a reduction in hot flashes


Palliative care

  • Provides support and management. Helps with pain control


Psychomotor domain of learning

  • Requires coordination and the use of motor skills


Affective domain of learning

  • Encourage the client to discuss their feelings of self-worth


Cognitive domain of learning

  • “Show the client a video about how to monitor blood glucose levels”

  • “Review a color diagram of the food pyramid with the client”