ATI Community Health | Will also include questions from Med-Surge, Fundamentals, Pharmacology, Pediatrics | Download To Score that A

ATI Community Health *Will also include questions from Med-Surge, Fundamentals, Pharmacology, Pediatrics, etc.). *Take practice exams! Chapter 1 Community Health Nursing Theories 1. Nightinga le’s Theory of the Environment a. Impact of a person’s environment on their health b. PREVENTATIVE CARE i. Washing hands ii. Maintain a clean environment 2. Health Belief Model a. Assumes a person’s primary motivation in taking positive health actions is to AVOID getting a disease b. Likelihood that they are going to take these positive health actions is based on i. Modifying variables (age, gender, race, economy, education) 1. Depending on where they fall, they may or may not be inclined to take positive health actions ii. Perceived severity and susceptibility of getting a disease 1. They perceive that the disease is very serious and that they can get it, they’re going to be more motivated to take action iii. Perceived benefits vs. barriers of taking action 1. If they see more benefits than barriers, they’re more likely to take action 2. If they see more barriers than benefits, they’re more likely to take action iv. Cues to action 1. Getting advice from Dr.? 2. Are they seeing media campaigns (i.e. smoking cessation)? 3. If they see these cues, there is an increased likelihood that they will take a positive action to improve their health Community Health Nursing (contains both community-based nursing and community-oriented nursing) Difference between community-based nursing vs. community-oriented nursing Community Health Nursing -The client is community/population as opposed to an individual Community-Based Nursing -Providing illness care -Helping to take care of patients with acute/chronic conditions -Treating individuals and families -Hands-on specific nursing care for individuals and families Examples: 1. Home health nurse providing wound care 2. School nurse providing an EpiPen injection for a patient Community-Oriented Nursing -NOT focused on illness care -They are focused on disease prevention, education, and trying to improve the collective health of the community Focus on: 1. Health education 2. Health promotion 3. Disease prevention Public health nurses are community-oriented nurses -Not providing illness care -Not treating individuals and families -They are focused on the population and the community as a whole -Focused on disease prevention, health promotion, and education Four ethical principles 1. Respect for autonomy a. Respecting patient’s right to self-determination 2. Non-Maleficence a. Not doing harm to the patient 3. Beneficence a. Doing what is best for the patient b. Maximize benefits 4. Distributive Justice a. Fair allocation of resources in the community Epidemiology – The study of the spread, transmission, and incidence of disease and injury Epidemiology Triangle – they interact to either increase/decrease someone’s chance of getting a disease 1. Agent a. Thing that is causing the disease i. (bacteria, toxin, noise, pollution) 2. Host (human or animal) that is being affected by the disease 3. Environment i. Physical – water, food supply, geography ii. Social – Access to healthcare, work conditions, poverty) Incidence -# of new cases of a disease/injury in a population during a specified time period Prevalence -# of all cases (new and pre-existing) in a population during a specified time period Community-Health Education Obstacles: 1. Age 2. Culture 3. Illiteracy 4. Language Barriers 5. Lack of access 6. Lack of motivation Education -Understand that people have different learning styles 1. Visual – videos, presentations 2. Auditory – verbal lecture or discussion 3. Tactile – Hands-on demonstration and a return-demonstration to demonstrate understanding Healthy People 2020 Examples of Goals: 1. Care of people with diabetes 2. Cancer 3. Older Adult Health 4. LGBT Health Primary Prevention 1. Actions that help prevent initial occurrence of a disease 2. Immunizations/Vaccines 3. Providing education (Prenatal classes) a. Make sure it is written at an eighth-grade level or lower to accommodate a variety of education backgrounds 4. Nobody has the disease YET Secondary Prevention 1. Focused on the early detection of the disease and limiting the severity of the disease, 2. SCREENING or Disease Surveillance 3. Helping to control the outbreaks 4. Checking people for the disease at this point Tertiary Prevention 1. They have the disease already 2. Maximizing the recovery after an injury/illness 3. Rehabilitation, Physical Therapy, Occupational therapy, support groups Chapter 2 Factors that influence Community Health Acculturation – someone adopts the traits of a different culture Ethnocentrism – The belief that one’s own culture is superior to all others -They view the world from their own cultural viewpoint Culture assessment 1. Patient’s ethnic background 2. Religious preferences 3. Family Structure 4. Food patterns 5. Health practices Incorporate patient preferences into care plan whenever possible When we need to use an interpreter, do NOT use a family member -Interpreters need to have knowledge of medical terminology -Certified medical interpreter Patient teaching: -available in patient’s primary language Environmental Risks 1. Toxins (lead, pesticides, asbestos, and radon) 2. Air pollution (Carbon monoxide, tobacco smoke, airborne lead contamination 3. Water pollution (waste products and chemical runoff from the soil) Assessments on environmental risks ASK: 1. What the condition of their housing 2. Are they doing any remodeling activities 3. Water heater temperature set up? a. Want less than 120 degrees 4. Occupation a. Exposure to chemicals/toxins i. Hairdresser? ii. Coal mine worker (Risk for black lung) 5. Is tobacco smoke present in the home? 6. Quality of their drinking water Lead Exposure Ask a patient and their family when their house was built -pre-1978 housing is at high risk for lead-based paint -If lead issue is suspected, screen children ages 6 months-5 years for their blood lead levels Provide teaching points -Have children AVOID playing right outside their home because paint/residue might be in the soil -Instruct them to wet mop their floors rather than vacuuming -Make sure families are using wet sanding technique rather to dry sanding technique -Make sure their children are getting enough iron and calcium in their diet -helps to decrease absorption of lead in the body -Encourage them to use cold water -lead dissolves more quickly in hot water -If a mom is preparing a bottle formula for the baby, use cold water because it’s safer Medicare eligibility 1. People over 65 years old 2. Receiving disability for at least 2 years 3. Diagnosed with ALS or ESRD and receiving dialysis Medicare Part A: Covers inpatient hospital expenses limited skilled nursing facility services and home health care Medicare Part B: outpatient care including diagnostic services, PT, & OT Medicare Part C: combines A and B and offered through private insurance companies Medicare Part D: Prescription drug coverage Medicaid 1. Low socioeconomic status 2. No other insurance 3. Based on household size and income level Agencies State Department of Health -manages WIC (Woman, Infants, and Children) program -Oversee the CHIP (Children’s Health Insurance Program) program -Manage Medicaid program for the state -Report notifiable communicable diseases to the CDC (all those is voluntary for them) State Board of Nursing -Licenses LPNS and RNs -oversee state schools of Nursing -Develop state nursing practice acts Local Health Department -Helps meet the health needs of the community -they report notifiable communicable diseases to the State Department of Health Chapter 3 Community Health Program planning Community Assessment – assessing the people and the environment When assessing the people, you want to look at the: 1. Demographic (density and distribution of people) 2. Biological factors (race, age, gender, and health and disease status) 3. Social factors (occupations, education, income, and crime rates) 4. Cultural factors (history, customs, religion) When assessing the environment, you want to look at the: 1. Physical factors (geography, locations of health services, housing) 2. Environmental factors (climate, topography, Pollutants/toxins) Data collection 1. Informant interviews a. Direct conversations with people in the community to gather data 2. Community forums a. Public meetings i. It may be difficult to get participation 3. Secondary data a. Getting existing data i. Birth certificates, morbidity data, health records that have already been created 4. Participant observation 5. Windshield survey a. Drive through community and check things out b. Assessing c. Noticing general appearance d. Signs of violence and mental illness e. Are there drug abuse? f. Look at the quality of the housing g. Good access to health care facilities? h. What are they types of availability of grocery store? i. Public transportation? 6. Focus groups a. Meet with a representative sample of the community 7. Surveys a. Written b. Expensive c. Low-response rate After gathering data into a database, making sure it’s complete, synthesizing the data, and identifying themes and community needs, and setting priorities. Develop community health plan! -Pre-planning stage (brainstorm) -Assessment -Diagnosis (analyze data and determine health needs and set priorities -Planning (establish goals, identify responsibilities, and set budget) -Implementation (execute plan) -Evaluation (determine effectiveness of intervention) Chapter 4 Practice settings and aggregates 1. Home health nurses a. Provide direct health care in the patient’s home or in assisted living facilities or nurses home b. Provide patient education, direct nursing care, care coordination (case manager) i. Provide referrals and help coordinate care like a case manager c. Assess the home for safety i. No scatter rugs ii. House is free of clutter iii. Adequate lighting on the stairs iv. Colored tape on step edges v. Alzheimer’s – keep locks or alarms on exit door 1. Do not lock bathroom 2. Hospice Nurses a. Provide palliative care to dying patients b. Focus on symptom management only i. Helping them to manage symptoms and supporting patient and family through dying process 3. Parish Nurses a. Work with pastoral staff to improve health and wellness of faith community b. Provide health education c. Facilitate support groups d. They DO NOT provide bedside nursing care i. Not hands-on 4. Occupational health nurse a. Promote health and wellness of employees and help prevent workplace illness and injury b. Through surveillance, they help identify risk within the work environment c. Identify ways to decrease or eliminate workplace hazards i. Primary prevention – provide safety education to the employees ii. Secondary prevention – screenings iii. Tertiary prevention – help provide limited duty programs to employees who have been hurt d. Need to keep closely informed about OSHA standards so that workplace is meeting standards 5. School Nurses a. Direct nursing care to children at the school b. Provide health education c. Case manager for children who have health needs i. Make referrals ii. Schedule appointments iii. Coordinate services for these children d. Primary Prevention – assessing immunization status of all the children e. Secondary Prevention – Providing a number of screenings i. Vision and hearing ii. Screen for oral health iii. Scoliosis iv. Lice/scabies infestations v. Assess for neglect and abuse f. Tertiary prevention – help administer medications, provide nursing care with chronic diseases, and help assess children who have disabilities Key health concerns for certain populations Infants SIDS – put children to sleep on their back Children -Make sure they’re getting their immunizations -make sure they’re free from injuries -encourage use of helmets -use seatbelt in care Adolescents -MVA = big risk -seatbelts -assess risk of substance abuse (includes smoking) -risks associated with sex -safe sex -mental health (depression, anxiety, suicide risk) Women -osteoporosis (after menopause) -engage in weight-bearing exercises -adequate consumption of calcium and vitamin D -Heart disease -diabetes -cancer prevention -mammograms and pap smears Men -heart disease -cancer prevention -prostate cancer screening -testicular self-exams -lung disease due to smoking -liver disease r/t excess alcohol intake -* 45-64 years old = highest risk of suicide Older adults -heart disease -CVAs -COPD -PNA -Polypharmacy -using different medications that may interact with each other -Metabolism is impaired – higher risk of toxicity -cancer -injury preventions -falls Families -Times of transition -birth/adoption of a child -death -major illness -divorce -loss of income Times of transition create high risk for family Assessment: 1. Genogram- graphical representation of the relationship within the family and patterns of illness 2. Eco-map – graphical representation of family interactions with outside groups and organizations a. Provides information about the family support network Chapter 5 Care of special populations Violence -Homicide r/t substance abuse -victim is known to perpetrator -males are at higher risk than females -Rape -Intimate Partner Violence -underreported -Counseling – tell victim not the bathe following the assault as this can destroy medical evidence -receive medical care to collect evidence -Suicide -Highest in men (45-64 years old) and those over 65 years old -Abuse 1. Physical 2. Sexual 3. Emotional humiliation, intimidation 4. neglect – failure to provide food, shelter, emotional care, medical care, or education to someone that you’re responsible for 5. Economic abuse – misuse of money, failure to provide for the needs of the victim despite adequate funds or theft of the money Community factors that increase the risk of violence 1. Unemployment 2. Poverty 3. Social isolation 4. Child abuse is more common when spousal abuse is present a. S/S of child abuse: presence of wounds or injuries in various states of healing, unexplained bruises/injuries, unusual fear of others from the child, small round burns that could be cause be cigarettes, forearm spiral fractures b. S/S of child neglect: poor hygiene, inappropriate dress for the weather, signs of malnourishment, withdrawal, and school absences Substance abuse Alcohol abuse -There are many things that affect a body’s metabolism of alcohol -size and weight of drinker -time elapsed while drinking -gender -presence of food in their stomach Manifestations of alcohol withdrawal typically appear within 4-12 hours after last drink S/S: Tachycardia, hypertension, n/v, headache, anxiety and irritability, diaphoresis, tremors, and seizures *find out when they had their last drink Primary: public education campaigns and school education Secondary: screening individuals for signs of abuse Tertiary: referral to AA/NA; also help to promote better coping skills and lifestyle changes Homelessness -families with children -risk: those who are unemployed, migrant workers, veterans, those suffering from mental illness/substance abuse, HIV/AIDS patients (highest risk), and at risk-youth Key Health issues: TB, infestations (scabies/lice), substance abuse, HIVAIDs, and mental illness Key health issues of veterans: mental health issues (PTSD, depression), substance abuse, suicide, traumatic brain injury, SCI, and amputations Migrant workers -at risk for TB, dental disease, skin cancer, DM, obesity, suicide, increase work-related injuries d/t exposure to pesticides and injuries from machinery Primary: provide with education on reducing exposure to pesticides and accident prevent & provide with preventative care such as immunizations and dental care Secondary: screen for skin cancer, pesticide exposure, and communicable diseases (TB) Tertiary: provide ER, or primary care services including treatment of symptoms of pesticide exposure Chapter 6 Communicable diseases Mode of transmission: 1. Airborne: Chicken pox, measles, TB, pertussis, and influenza 2. Food borne: Salmonella, Hepatitis A (which is spread through the fecal-oral route), E. coli, and botulism 3. Waterborne- Cholera and typhoid fever 4. Vector borne – spreads through a mosquito/tick – Lyme disease, malaria, and Rocky Mountain spotted fever 5. STDs: HIV, hepatitis B, C,D, syphilis, HPV, and gonorrhea 6. Direct contact: lice, scabies, impetigo, mononucleosis (spread through saliva) Immunity Herd immunity – most community members have immunity against a disease and helps protect the individuals in the community that can’t be vaccinated (if they’re getting chemotherapy or immunocompromised or too young) -concept is being threatened because more people are not getting vaccinated -vulnerable people are a higher risk of getting those diseases -makes exposure unlikely because most community members are immune and vaccinated 1. Active natural immunity – body produces antibodies in response to exposure to a live pathogen a. Next time you’re exposed, body is ready to fight off pathogen more effectively 2. Active artificial immunity – get a vaccine with a dead/weakened pathogen that causes body to produce antibodies 3. Passive natural immunity –antibodies are passed from the mom to the baby through breast milk/placenta 4. Passive artificial immunity – immunoglobulins are administered to an individual after they have been exposed to the pathogen Reporting requirements for communicable diseases -mandates by state and local regulations. Not a nationally regulated thing -State notification to the CDC is voluntary primary: providing education on immunizations, encouraging hand hygiene, teaching proper food handling, and advising patients of risks of infectious diseases when traveling to other countries (Hepatitis A) Secondary: screening for communicable diseases, quarantine patients when needed, and need to refer suspected cases for definitive diagnoses Tertiary: monitor treatment compliance and may require direct observation therapy If patient is non-compliant and not taking their medications, they pose a risk to society if they spread their diseases Nationally notifiable diseases 1. Anthrax a. Peron who has been exposed is recommended to get IV ciprofloxacin after exposure 2. Lyme disease a. S/S white center where tick was and get a bullseye red ring around 3. Meningitis a. As you send kids to college, it’s recommended to get the meningitis vaccine b. Recommended to other individuals are who going to a crowded environment such as dorm, barracks, jail cell 4. Pertussis a. S/S violent whooping cough b. If child is diagnosed, they need to stay home until their cough is gone c. May need erythromycin for 7 days for those exposed and family members need to be treated prophylactically d. Check immunization status of other children in school 5. Small pox a. Starts as a rash on the face and moves down the body 6. Syphilis a. Early sign is sore on genitals (canker) Disaster Management 1. Disaster prevention a. Surveillance, inspections, immunizations, education, and risk assessment 2. Disaster preparedness a. Creating a disaster action plan, identifying evacuation routes, creating a disaster kit, identifying a meeting place and a communication plan, and performing disaster drills!! 3. Disaster response a. Disaster has occurred b. Assess the extent of disaster, perform triage, and direct those affected, coordinate evacuations, and help coordinate quarantines (depending on disaster) 4. Disaster recovery a. Begins when there is no longer danger present b. Coordinate care in shelters and homes and start the process of recovery Bioterrorism 1. Category A a. Smallpox, botulism, anthrax, and play 2. Category B a. Typhus and cholera 3. Category C a. Hantavirus Inhaled anthrax S/s: severe dyspnea, fever, shock, and muscles aches -administer IV Ciprofloxacin for those exposed or those who have a high risk of exposure Smallpox: starts with rash on the face that moves down the body S/S: high fever, headache, and vomiting Prevention is through vaccination Chapter 7 Consultations -provider puts out a request to another provider or another resource who can provide expert advice and/or services for the patient -hospital setting: Dr. sends out consultations to wound nurse Referrals -provider request or recommends management of one or more of the patient’s concerns or issues to another provider or they can recommend support services (support groups, churches, transportation services, and meal delivery services) -case management will provide referrals Case managements/Care Coordinators -instrumental in helping the patient move from acute care to home/skilled nursing facility, making sure they have everything they need (Equipment), making sure they have their follow- up appointments identified Responsibilites 1. Evaluate the patient’s medical needs, psychosocial issues, and financial constraints a. Work with patient’s insurance to see what’s covered and what’s going to work best 2. Collaborate with the patient, family, insurance companies, health care providers, medical service, and equipment providers to meet the healthcare needs of the patient 3. They help facilitate discussion of the patient’s needs with an interprofessional team a. Working with Drs, bedside nurses, wound care nurses, b. Provide referrals as needed for support services Informatics – incorporates nursing and IT and communication technology to develop and support nursing practice and improve patient outcomes Telehealth – delivary of healthcare through technology vs in person. Helpful in rural areas where they lack specialists -connect with specialists through telehealth Nursing roles in health policy -act as advocate for changes in health policy -help lobby legislators -serve in public office and help form coalitions (collaborations of group to achieve a goal) in the hopes to improve community’s health and wellness Show Less