West Coast University: NURS 340 Public Health Proctor Study Guide,100% CORRECT

West Coast University: NURS 340 Public Health Proctor Study Guide - Fundamentals o Ethical Principles ▪ Autonomy • The right to make one's own personal decisions even when those decisions might not be in that person's own best interest ▪ Beneficence • Action that promotes good for others without any self interest ▪ Fidelity • fulfillment of promises ▪ Justice • Fairness in care delivery and use of resources ▪ nonmaleficence • A commitment to do no harm ▪ Veracity • A commitment to tell the truth o Infection control ▪ Immune defenses • Native immunity o Restricts entry or immediately respond to a foreign Organism regardless of previous exposure • passive immunity o Antibodies are produced by an external source • specific adaptive immunity o Allows the body to make antibodies in response to a foreign Organism • active immunity o Antibodies are produced in response to an antigen ▪ Chain of infection • Causative agent • Reservoir • Portal of exit means for leaving o Droplet or airborne o GI tract o Genitourinary tract o Skin or mucous membranes o Blood or body fluids o Transplacental • Mode of transmission • Portal of entry • Susceptible host ▪ Stages of an infection • Incubation o Interval between the pathogen entering the body and the presentation of the first symptom • Prodromal stage o Interval from onset of general symptoms to more distinct symptoms . During this time the pathogen is multiplying • Illness stage o Interval when symptoms specific to the infection occur • Convalescence o Interval when acute symptoms disappear. Total recovery could take days to months ▪ Standard precautions ( tier one ) • Applies to all body fluids (except sweat), nonintact skin an mucous membrane • Alcohol-based waterless antiseptic is preferred unless the hands are visibly dirty then soap must be used ▪ Transmission precautions ( tier two ) • Airborne o Measles, Varicella, Pulmonary or laryngeal tuberculosis o Required ▪ N95 or HEPA mask ▪ Negative pressure airflow exchange at least 6 to 12 exchanges per hour ▪ If splashing or spraying full face protection is needed • Droplet o Streptococcal pharyngitis or pneumonia, Hemophilus, influenza type B, scarlet fever, rubella, pertussis, mumps, mycoplasma pneumonia, meningococcal pneumonia and sepsis, pneumonic plaque o Required ▪ 3 to 6 ft from the client • Contact ▪ Private room or with someone with same infection ▪ Masks o Respiratory syncytial virus, shigella, enteric diseases caused by micro-organisms, wound infections, herpes simplex, impetigo, scabies, multidrug-resistant organisms o Required ▪ 3 ft of the client ▪ Private room or with someone that has the infection ▪ Gloves and gowns • Protective o Requires ▪ Private room ▪ Positive airflow 12 or more per hour ▪ HEPA filtration for incoming air ▪ Mask on client when they leave room ▪ Guidelines for cleaning contaminated equipment • Rinse first in running cold water • Wash article with warm water and soap • Use brush to wash • Rinse well in warm water • Dry ▪ Herpes zoster (shingles) • Shingles is usually preceded by a prodromal period of several days, during which pain, tingling or burning might occur along the involved dermatome • Expected findings o Paresthesia o Pain that is unilateral and extends horizontally along a dermatome o Vesicular, unilateral rash o Rash that is erythematous, vesicular, pustular or crusting ( depending on stage) o Rash that usually resolves in 14 to 21 days o Low grade fever • Nursing care o Use of air mattress or bed cradle for pain prevention and control of affected areas o Isolate the client until the vesicles have crusted over o Strict wound care precautions o Use lotions to help relieve itching and discomfort • Medications o Analgesics o Antiviral agents • Complications o Postherpetic neuralgia ▪ Characterized by pain that persists for longer than 1 month following resolution of the vesicular rash ▪ Common in adults older than 60 years of age o Home safety ▪ Infants and toddles • Aspiration o Do not feed the infant hard candy, peanuts, popcorn or whole or sliced pieces of hot dog • Suffocation • Poisoning • Falls • Motor vehicle injury o Rear-facing car seat until 2 years of age o Car seat with a five-point harness • Burns ▪ Preschoolers and School-age children • Drowning • Motor vehicle injury o Use booster seats for children who are less than 4 feet 9 inches tall and weigh less than 40 lbs. o If care has a passenger air bag, place children under 12 years In the back seat • Begin sex education • Firearms • Play injury • Burns • Poison ▪ Adolescents • Motor vehicle and injury • Burns ▪ Young and middle age adults • MVA • Occupational injuries • High consumption of alcohol • Suicide ▪ Older adults • Implement home safety ▪ Additional risks in home and community • Carbon monoxide o Symptoms ▪ N/V, headache, weakness, and unconsciousness ▪ Primary survey • Rapid assessment of life-threatening conditions • Should not take longer than 60 seconds • Use ABCDE ▪ Basic first aid • Done after primary survey • Includes treating o Bleeding o Fractures and splinting o Sprains o Heat stroke ▪ Body temperature above 104 ▪ Symptoms • Hot, dry skin; hypotension, tachypnea; tachycardia; anxiety; confusion; unusual behavior; seizures and coma. The client does not sweat ▪ Interventions • Remove a client's clothing • Place ice packs over the major arteries ( axillae, chest, groin and neck ) • Cold water bath • Wet the client body then fan with rapid movement of air • Do not allow clients to shiver if the client starts to shiver cover them with a sheet o Frostnip and frostbite ▪ Common sites are the earlobes, the tip of the nose, fingers and toes ▪ White waxy areas on exposed skin ▪ Administer a tetanus vaccination o Burns ▪ Administer fluids Anna tetanus toxoid o Altitude-related illnesses ▪ Expected findings • Throbbing headache, nausea and vomiting , dyspnea, anorexia ▪ Administer oxygen and promote rest o Health promotion ▪ Tests • Dental : Every 6 months • Tuberculosis : Every year if at risk or health care provider • Blood pressure : Every 2 years • Blood cholesterol : Every 5 years • Visual acuity : Age 40 and under every 3 to 5 years. Ages 40 through 65 every 2 years. Every year after 65 years. • Skin assessment : Ages 20 to 40 every 3 years. 40 years and up every year. • Digital rectal exam : Annually • Colorectal screening : Every year between age 50 and 75 for high sensitivity fecal occult blood testing. Sigmoidoscopy every 5 years. Colonoscopy every 10 years. • Specific to women o Cervical cancer screening : Ages 21 to 29 pap smear every 3 years. Ages 30 to 65 Pap smear and HPV every 5 years o Breast cancer screening : Ages 20 to 39 every 3 years then annually. Mammograms for ages 40 and up every year. • Specific to men o Clinical testicular examination : each routine visit starting at age 20 o Prostate-specific antigen test, digital rectal examination : Every year starting at age 50 ▪ Newborns and Infants • Screenings o Phenylketonuria o Galactosemia • Immunizations • Nutrition o Breastfeeding first 12 months o Iron fortified formula is alternative to breast milk o Cow’s milk should not be given before 1 year of age o Solid food around 4 to 6 months ▪ Iron fortified rice cereal first ▪ Foods one at a time over a 5 to 7 day starting with veggies then fruits then meats o Delay milk, eggs, wheat, citrus fruits, peanuts and peanut butter because it can trigger allergies o Do not give honey to infants until after 12 months of age because it can cause infant botulism • Injury prevention o Aspiration o Bodily harm o Burns o Drowning o Falls o Poisoning o MVA o Suffocation ▪ Toddlers ( 1 to 3 Years ) • Immunizations • Nutrition o Picky eaters o Should consume 2 to 3 cups ( 16 to 24 oz ) per day o Limit juice to 4 to 6 oz per day o Food serving size is 1 tbsp for each year of age o Prefer finger food o Regular mealtimes and nutritious snacks o Avoid foods that pose choking hazards : nuts, grapes, hot dogs, peanut butter, raw carrots, tough meats, popcorn o Do not use food as reward or punishment • Injury prevention o Aspiration o Bodily harm o Burns o Drowning o Falls o MVA o Poisoning o Suffocation ▪ Preschoolers ( 3 to 6 years ) • Immunizations • Health screenings o Vision screening • Nutrition o 1,800 calories o Need 3 to 5 oz complete protein in addition to adequate calcium, iron, folate and vitamins A and C • Injury Prevention o Bodily harm o Burns o Drowning o MVA o Poisoning ▪ School Age Children ( 6 to 12 Years ) • Immunizations • Health Screenings o Scoliosis • Injury Prevention o Bodily harm o Burns o Drowning o MVA o Substance abuse/poisoning ▪ Adolescents ( 12 to 20 years ) • Immunizations • Health screenings o Education on illness prevention o Scoliosis • Nutrition o Rapid growth and high metabolism tend to cause deficit in iron, calcium and vitamin A and C o Eating disorders may develop • Injury prevention o Bodily harm o Burns o Drowning o MVA o Substance use o STIs o Pregnancy prevention ▪ Young Adults ( 20 to 25 years ) • Immunizations • At risk for : Substance abuse, Periodontal disease due to poor oral hygiene, unplanned pregnancies, STIs, infertility, work-related injuries or exposures, violent death and injury • Health education about contraception and regular physical activity • Routine health care visits • Nutrition o Monitor calcium intake in women • Injury prevention o Substance use o MVA o Firearms ▪ Middle Adults ( 35 to 65 years ) • At risk : obesity, type 2 diabetes mellitus, cardiovascular disease, cancer, substance use, psychosocial stressors • Immunizations : Annual influenza immunization, Tap, Zoster, Pneumococcal and pertussis • Screenings o DXA o Eye exam every 2 to 3 years o Mental health screening for anxiety and depression • Nutrition o Increase whole grains and fresh fruit and veggies o Increase vitamin D and calcium • Injury prevention o Substance use o MVA o Firearms ▪ Older Adults ( 65 and older ) • Health risks o Cardiovascular : Coronary artery disease, HTN o Factors affecting mobility : Arthritis, osteoporosis, falls o Mental health disorders : Depression, dementia, suicide, alcohol and tobacco use disorder o Other disorders : Stroke, Diabetes, cancer, incontinence, abuse and neglect, cataracts, chronic pain, issues related to poor dental hygiene • Immunizations o Tap, pertussis, varicella, flu, zoster and pneumococcal • Health screenings o Annual : Hearing, fecal occult blood test, digital rectal and prostate specific antigen (men), DXA, eye exam o Periodic Screening : Mental health screening, cholesterol and diabetes screening every 3 years • Nutrition o Total caloric intake should decrease to maintain a healthy weight since metabolism decreases o Increase intake of vitamin D, B12, E, folate, fiver and calcium o Fluid intake increase o Low-dose multivitamins o Limit sodium, fat, refined sugar and alcohol intake o Grief, Loss, Palliative care ▪ Advanced directives : legal documents that direct end of life issues ▪ Living will : directive documents for medical treatment per the clients wishes ▪ Health care proxy : a document that appoints someone to make medical decisions when the client is no longer able to do so on his own behalf ▪ Palliative care interventions focus on the relief of physical manifestations as well as addressing spiritual, emotional and psychosocial aspects of the client's life . o Culture ▪ Culturally sensitive • Knowledgeable about the cultures ▪ Culturally appropriate • Apply their knowledge of a client’s culture to their care delivery ▪ Culturally competent • Understand and address the entire cultural context ▪ Culturally responsive ▪ Cultural imposition • Understanding and awareness of their own culture and any culture biases ▪ The goal is to provide culturally competent care o Mobility ▪ Cane instructions • Maintain two points of support on ground at all times • Cane on stronger side • Support body weight on both legs • Move cane 6 to 10 inches forward then the weaker leg toward the cane and finally advance the stronger leg past the cane ▪ Crutch instructions • Do not alter crutches after fitting • Support body weight at the hand grips with elbows flexed at 20 to 30 degrees • Hold crutches on one hand and grasp the arm of the chair with the other hand for balance while sitting and rising from a chair o Home Oxygen Use ▪ Use and store oxygen equipment according to the manufacturer's recommendations ▪ Place a no smoking sign in a conspicuous space near the front door at the home ▪ Ensure the electrical equipment is in good repair and well grounded ▪ Replace bedding that can generate static electricity with items made from cotton ▪ Keep flammable materials such as heating oil and nail Polish remover away from the client when oxygen is in use ▪ Follow general measures of fire safety in the home such as having a fire extinguisher readily available and an established exit route if a fire occurs ▪ Wear cotton and do not smoke o Auditory Screening Tests ▪ Whisper Test • Occlude one ear and test the other to see if the client can hear whispered sounds without seeing your mouth move • The client should hear you whisper softly from 30 to 60 centimeters away ▪ Rinne Test • Place a vibrating tuning fork firmly against the mastoid bone. Have the client state when he can no longer hear the sound. Note the length of time that the client heard the sound, and this will determine the bone conduction . Then move the tuning fork in front of the ear canal and when the client can no longer hear the tuning fork sound note the length of time the sound was heard, and this is the air conduction. The expected findings are that the air conduction sound is longer than the bone conduction. ▪ Weber Test • Place a vibrating tuning fork on top of the client’s head and ask whether the client can hear the sound best in the right ear, the left ear or both ears equally. The expected findings are that the client hears the sound equally in both ears which will be a negative Weber test o Visual acuity ▪ Have the client stand 20 feet from the Snellen chart ▪ Evaluate both eyes and then each eye separately with and without correction ▪ Ask the client to read the smallest line of print visible ▪ Note the smallest line the client can read correctly ▪ The first number is the distance in feet the client stands from the chart and the second number is a distance at which a visually unimpaired eye can see same line clearly • A 20/30 vision means a client can read a line from 20 feet away that a person who has an unpaired vision can read from 30 feet away - Med surg o Pain assessment ▪ Pain scales is useful for clients over the age of 7 years ▪ Pain is categorized by duration (acute or chronic ) or by origin ( nociceptive or neuropathic ) • Nociceptive Pain o Arises from damage to or inflammation of tissue other than that of the peripheral and central nervous systems. Is the activation of normal processing of painful stimuli and it is usually throbbing aching and localized. • Neuropathic Pain o Arises from abnormal or damaged pain nerves and it is usually intense, shooting, burning or described as pins and needles o Alzheimer’s ▪ Nonreversible type of dementia ▪ Characterized by memory loss, problems with judgement and changes in personality ▪ Nursing care • Provide frequent walks to reduce wandering • Maintain a sleeping schedule • Use a calendar to assist with orientation • Be consistent and repetitive • Provide memory training • Keep noise and clutter to a minimum and avoid crowds ▪ Medications • Donepezil : prevents the breakdown of acetylcholine resulting in increased nerve impulses at the nerve sites ▪ Home Safety Measures • Removing scattered rugs • Installing door locks that cannot be easily opened and placing alarms on doors • Keeping a lock on the water heater and thermostat and keeping the water temperature at a safe level • Providing good lighting especially on stairs • Installing handrails on stairs and marking step edges with colored tape • Placing a mattress on the floor • Removing clutter and clearing hallway for walking • Securing electrical cords to base boards • Keeping cleaning supplies and locked cut boards • Installing handrails in the bathroom, at bedside and in the tub and placing a shower chair in the tub • Having the client where a medical identification bracelet if living at home with a caregiver • An exercise program to maintain mobility • Care for seizures that can happen late in the disease • Strategies to reduce caregiver stress o COPD ▪ Irreversible ▪ Emphysema is characterized by the loss of lung elasticity and hyperinflation of lung tissues ▪ Chronic bronchitis is an inflammation of the bronchi and bronchioles due to chronic exposure to irritants ▪ Expected findings • Chronic dyspnea • Productive cough that is most severe upon rising in the morning • Hypoxemia • Crackles and wheezing • Rapid and shallow respirations • Use of accessory muscles • Barrel chest • Hyperresonance on percussion due to trapped air • Irregular breathing pattern • Thin extremities and enlarged neck muscles • Dependent edema secondary to right sided heart failure • Clubbing of fingers and toes • Pallor and cyanosis of nail beds and mucous membranes • Decreased oxygen saturation levels ▪ Diagnostic procedures • As COPD advances the FEV/FVC ratio decreased on the pulmonary function test ▪ Nursing care • Increase work of breathing increases caloric demands • Dyspnea decreases energy available for eating so, soft high calorie foods should be encouraged ▪ incentive spirometer • Inhale and hold breath for three to five seconds to promote long expansion o TB ▪ Ghon tubercle on a chest x-ray ▪ Health promotion and disease prevention • High risk patients screened on a yearly basis ▪ Expected Findings • Persistent cough lasting longer than 3 weeks • Purulent sputum, possibly blood-streaked • Fatigue and lethargy • Weight loss and anorexia • Night sweats and low-grade fever in the afternoon ▪ Mantoux test • 10 mm or greater is positive but if they are immunocompromised then a 5 mm or greater is positive ▪ Acid-fast smear and culture • A positive acid-fast test suggests an active infection • Obtain three early-morning sputum samples • Obtained in a negative airflow room ▪ Client education • Follow-up care for 1 full year • Sputum samples are needed every 2 to 4 weeks to monitor therapy effectiveness o Pulmonary Embolism ▪ Expected findings • Anxiety • Feeling of impending doom • Pressure in chest • Pain upon inspiration and chest wall tenderness • Dyspnea and air hunger • Cough • Hemoptysis • Pleurisy • Pleural friction rub • Tachycardia • Hypotension • Tachypnea • Crackles and cough • Heart murmur in S3 and S4 • Diaphoresis • Low grade fever • Decreased oxygen saturation levels, low SaO2, cyanosis • Petechiae over chest and axillae • Pleural effusion • Distended neck veins • Syncope • Cyanosis ▪ Laboratory tests • ABG o PaCO2 are low due to initial hyperventilation (respiratory alkalosis) and as hypoxemia progresses, respiratory acidosis occurs ▪ Diagnostic procedures • Pulmonary angiography o Catheter inserted into the vena cava to see PE o HTN ▪ Nursing care • Assess respiratory status at least every 30 minutes • Assess cardiac status ▪ Greater than 140/90 ▪ For clients older than 60 years, BP should be less than 150/90 ▪ Assessment • What regulates BP? o Arterial baroreceptors : located in the carotid sinus, aorta and left ventricle o Regulation of body-fluid volume: kidneys retain fluid when a client is hypotensive and excrete fluid when a client is hypertensive o Renin-angiotensin-aldosterone system: renin is converted into angiotensin II, which causes vasoconstriction and controls aldosterone release, causing the kidneys to reabsorb sodium and inhibit fluid loss o Vascular autoregulation ▪ Essential HTN (Primary ) • No known cause ▪ Secondary HTN • Disease state ▪ Expected findings • Headaches, particularly in the morning • Facial flushing • Dizziness • Fainting • Retinal changes, visual disturbances • Nocturia ▪ Prehypertension : 120-139/80-89 ▪ Stage I Hypertension : 140-159/90-99 ▪ Stage II Hypertension: greater than or = to 160/100 ▪ Nutrition • Less than 2.3 g/day of sodium o Osteoporosis • Diet low in fat, saturated fat and cholesterol • Diet high in fruits, veggies and low-fat dairy foods • Avoid foods high in sodium and fat • Consume foods rich in calcium and magnesium ▪ When the rate of bone resorption (osteoclast cells) exceeds the rate of bone formation (osteoblast cells) resulting in fragile bone tissue and can lead to fractures ▪ Health promotion and disease prevention • Diet includes adequate amounts of calcium and vitamin D o Vitamin D: fish, egg yolks, fortified milk and cereal o Calcium: milk products, green veggies, fortified orange juice and cereals, red and white beans and figs • Expose areas of skin to sun 5 to 30 min twice a week ▪ Expected Findings • Reduced height • Acute back pain after lifting or bending • Restriction in movement and spinal deformity • Thoracic (kyphosis) of the dorsal spine • Pain upon palpation over affected area o Diabetes ▪ Foot care • Inspect feet daily • Pat feet dry • Avoid lotions • Use mild food powder • Best time to perform nail care is after a bath/shower • Separate overlapping toes with cotton ball • Avoid open toe or heel shoes • Avoid prolonged sitting, standing and crossing of legs • Trimming toenails straight across ▪ Illness • Monitor blood glucose every 3 to 4 hours • Consume 4 oz of sugar-free, noncaffeinated liquid every 30 minutes to prevent dehydration • Test urine for ketones • Call the provider : Blood glucose greater than 240, fever greater than 101.5 that does not get better with acetaminophen or lasts more than 24 hours, feeling disoriented or confused, experiencing rapid breathing, vomiting that occur more than once, diarrhea that occurs more than five times or for longer than 24 hour, inability to tolerate liquids, illness that lasts longer than 2 days ▪ Complications • Cardiovascular and cerebrovascular disease : HTN, MI, Stroke • Diabetic retinopathy : impaired vision and blindness • Diabetic neuropathy: damage to sensory nerve fibers resulting in numbness and pain • Diabetic nephropathy: damage to the kidneys from prolonged elevated blood glucose levels and dehydration o HIV/AIDS ▪ Expected findings sore throat so you don’t eat anything and get weak/fatigue, lose weight/anorexia, and are nauseous and have a headache/chills, and get rashes from night sweats • Chills, rash, anorexia, nausea, weight loss, weakness and fatigue, headache and sore throat, night sweats ▪ Laboratory Tests • CBC: anemia low rbc , thrombocytopenia low plt, leukopenia low wbc • Platelet count: decreased less than 150K ▪ Diagnostic procedures • Positive result from an HIV antibody screening test [ELISA] confirmed by a positive result from a supplemental HIV antibody test [IFA] • Home test kits are also available using a drop of blood • Non-invasive tests are available using either mucosal fluid or urine • HIV RNA quantification (HIV viral load test): Determines viral load before beginning treatment • HIV genotype or HIV tropism: Guides changes in medication therapy when resistance occurs ▪ Interprofessional care • Refer the client to local AIDs support groups as appropriate ▪ Client Education • Avoid raw foods, such as fruits or veggies and undercooked foods such as meats, fish or eggs • Instruct the client to avoid cleaning pet litter boxes to reduce risk of toxoplasmosis o Speech therapy and dysphagia ▪ Refer to speech language therapist for dysarthria and dysphagia o MRSA/ communicable disease in home environment ▪ Contact ▪ Do not share personal items ▪ Hand hygiene - Nutrition ▪ Home hygiene ▪ Wipe down shared items o Barriers to adequate nutrition ▪ Poor dentition ▪ Low socioeconomic status and lack of access ▪ Cognitive Disorders ▪ Altered sensory perception ( vision, smell or taste ) ▪ Impaired swallowing ▪ Mechanical fixation of the jaw ▪ Lack of knowledge and misinformation about nutrition ▪ Medical conditions o Dysphagia and Nausea Complications ▪ Nausea and Vomiting • Promote good oral hygiene with tooth brushing, mouth swabs, mouthwash and ice chips • Elevate head of bed • Serve foods at room temperature or chilled • Avoid hot and spicy foods • Avoid liquids with meals, as they promote feeling of fullness • Avoid high-fat foods if they contribute to nausea because they are difficult to digest ▪ Dysphagia • Clients who have dysphasia or at an increased risk of aspiration. Place a client in an upright or high fowlers position to facilitate swallowing • Provide oral care prior to eating to enhance the client's sense of taste • Allow adequate time for eating , use adaptive eating devices an encourage small bites and thorough chewing • Pills should be taken with at least 8 ounces of fluid (can be thickened) to prevent medication from remaining in the esophagus • Avoid thin liquids or sticky foods o Nutrition for Diabetes ▪ Clients who have hypoglycemia should take 15 to 20 grams of a readily absorbable carbohydrate • two or three glucose tablets 5 grams each • 6 to 10 hard candies • half a Cup or 4 ounces of juice or regular soda • 1 tablespoon of honey or 4 teaspoons of sugar • retest the blood glucose in 15 minutes and if the glucose is less than 70 repeat the above instructions ▪ clients who have hyperglycemia should do the following • notify the provider or go to the emergency Department for difficulty concentrating, altered consciousness or seizure activity • take medication if forgotten - Pharmacology o Herbal medications ▪ Aloe Vera • Topical anti-inflammatory, analgesic an cathartic • Soothes pain • Heals burns • Soft and skin • Laxative • Adverse effects and precautions o skin preparation : possible hypersensitivity o laxative : possible fluid and electrolyte imbalance o increases menstrual flow when taking during menses o avoid in clients who have kidney disorders • Interactions : interacts with digoxin, diuretics , corticosteroids an anti-dysrhythmics • Client education : recognize manifestations of fluid and electrolyte imbalance of using ▪ Black cohosh • acts as an estrogen substitute • mechanism of action is unknown • treat manifestations of menopause • adverse effects and precautions o GI distress, Lightheadedness , headache, rash, weight gain o avoid taking during pregnancy especially the first 2 trimesters o limit used to six months due to lack of information regarding long term effects • interactions LOW BP, LOW BS o increases effects of anti-hypertensive medications o can increase effect of estrogen medications o increases hypoglycemia in clients taking insulin or other medications for diabetes • nursing actions ▪ Echinacea o question clients who take anti hypertensives, insulin or hypoglycemic agents or clients who might be pregnant about possible use of black cohosh • Stimulate the immune system • decreases inflammation • topically heal skin disorder, wounds and burns • possibly treat viruses • used to increase T lymphocyte, tumor necrosis factors and interferon production • available in many forms • adverse effects o bitter taste o mild GI distress or fever can occur o allergic reactions, especially in clients who are allergic to plants such as ragweed or others in a Daisy family • interactions o with long term use it can decrease positive effects of medications for tuberculosis, HIV or cancer • nursing actions o question clients who have tuberculosis, cancer, HIV, lupus erythematosus is an rheumatoid arthritis about concurrent use an advises clients to talk to the provider ▪ Feverfew • can blood platelet aggregation • can block a factor that causes migraines • can decrease the number and severity of migraine headaches • adverse effects and precautions o mild GI distress o post feverfew syndrome can occur causing agitation, tiredness, inability to sleep, headache and joint discomfort o can cause allergic reactions and clients allergic to ragweed or echinacea • interactions o can cause increase risk of bleeding in clients taking nsaids, heparin, warfarin o discontinue two weeks before elective surgery • nursing actions o question clients about concurrent use of nsaids, heparin, warfarin ▪ Garlic • when crushed it forms the enzyme allicin • blocks LDL and raises HDL and lowers triglycerides • suppresses platelet aggregation and disrupts coagulation • acts as a vasodilator • interactions o due to antiplatelet qualities it can increase risk of bleeding in clients taking nsaids, heparin, warfarin o decrease levels of saquinavir and cyclosporine • adverse effects : GI distress • nursing actions o question clients about concurrent use of nsaids, heparin, warfarin o caution clients who are taking antiplatelet or anticoagulant medication to contact their provider ▪ ginger root • relieve Vertigo and nausea • increases intestinal motility • increases gastric mucus production • decreases GI spasms • produces an anti inflammatory effect • suppresses platelet aggregation • used to treat morning sickness, motion sickness and nausea from surgery • can decrease pain and stiffness of rheumatoid arthritis • adverse effects and precautions o used cautiously in clients who are priming because high doses can cause uterine contractions o adverse effects are unknown with potential CNS depression and cardiac dysrhythmias with very large overdose • interactions o interacts with medications that interfere with coagulations which are nsaids, heparin, warfarin o can increase hypoglycemic effects of diabetes medications ▪ Ginkgo biloba • promotes vasodilation: decreases leg pain caused from occlusive arterial disorders • decreases platelet aggregation : can decrease risk of thrombosis • decreases bronchospasm • increases blood flow to the brain • adverse effects and precautions o mild GI upset, headache and Lightheadedness which can be decreased by reducing the dose o use with caution and clients at risk for seizures • interactions o can interact with medications that lower the seizure threshold which are anti histamines, anti depressants, anti psychotics • nursing actions o question client about concurrent use of nsaids, heparin, warfarin ▪ Glucosamine • stimulate cells to make cartilage and synovial fluid • suppresses inflammation of the joints and cartilage degradation • treats osteoarthritis of the knee, hip and wrist • adverse effects and precautions o mild GI upset o use with caution with shellfish allergy • interactions o use caution if taking antiplatelet or anticoagulant medication ▪ Kava • *** causes LIVER injury • possibly acts on gamma aminobutyric acid receptors in the CNS • promote sleep • decreases anxiety • promotes muscle relaxation without affecting concentration • adverse effects and precautions o chronic use causes dry, flaky skin and jaundice o chronic use and large doses can cause liver damage including severe liver failure • interactions o can cause sedation when taking concurrently with CNS depressant ▪ Ma huang • *** Can cause hypertension, tachycardia, stroke , MI • stimulates the CNS • suppresses the appetite • used for weight loss • constricts arterioles increases heart rate and blood pressure • bronchodilator : treat colds, influenza and allergies • products that include more than 10 milligrams per dose are forbidden to be sold in the United States • adverse effects and precautions o because it contains ephedrine, it can stimulate the cardiovascular system and at high doses aching cause death from hypertension and dysrhythmias o stimulation of CNS can cause euphoria and in higher doses it could cause psychosis • interactions o interacts with CNS stimulants to potentiate their effect o can cause severe hypertension when taken with monoamine oxidase inhibitor antidepressants o interacts with anti-hypertensive medications, decreasing effects ▪ St. Johns wort • Affect serotonin, producing antidepressant effects : used for mild depression • used orally as an analgesic to relieve pain and inflammation • applied topically for infection • interactions o can call serotonin syndrome when combined with other anti-depressants, amphetamine and cocaine o decreases effectiveness of oral contraceptives, cyclosporin, warfarin , digoxin, calcium channel blockers, steroids, HIV protease inhibitors and some anti-cancer medications • Nursing actions o encourage clients to avoid prolonged sun exposure and use sunscreen ▪ saw Palmetto • can decrease prostate manifestations of hyperplasia • adverse effects and precautions o few adverse effects; can cause mild GI effects • interactions o possible additive affects with finasteride o can interact with antiplatelet and anticoagulant medications o pregnancy risk category X • nursing actions o question clients about use before prostate specific antigen test ▪ Valerian • Increases GABA to prevent insomnia • reduces anxiety related restlessness • drowsiness effect increases overtime • adverse effects and precautions o can cause drowsiness, Lightheadedness and depression o risk of physical dependence • precaution o clients who have mental health disorders should use with caution o should be avoided by women who are pregnant or lactating • interactions o it is unknown whether valerian potentiates effects of CNS depressant • nursing actions o warn clients taking valerian about the possibility of drowsiness when operating motor vehicles and other equipment o Adverse reactions vs side effects to medications ▪ Adverse effects: unintended pharmacological effects that occur when a medication is administered correctly ▪ Side effect: a secondary unwanted effect that occurs due to drug therapy - Mental health o Effective communication ▪ Intrapersonal: Self talk ▪ Interpersonal: one on one with another individual ▪ Small group: two or more people in a small group ▪ Public: large groups of people ▪ Transpersonal: when the nurse assists the client with meditation as a means of relaxation; addresses individual’s spiritual needs ▪ Verbal communication • Pacing: rate of speech • Intonation: Tone of voice ▪ Clarifying Techniques • Restating: client’s exact words • Reflecting: directs the focus back to the client in order for the client to examine his feelings • Paraphrasing: restates the client’s feelings and thoughts • Exploring: allows to gather more information o Group and family therapy ▪ Group therapy • Group process: verbal and nonverbal communication • Group Norm: way the group behaves • Homogeneous group: all members share a certain chosen characteristic ▪ Phases of group development • Orientation phase: define the purpose and goals of the group • Working phase: Promote problem-solving skills to facilitate behavioral changes • Termination phase: this marks the end of the group sessions ▪ Communication in dysfunctional families • Blaming • Manipulating: use dishonesty • Placating: member takes responsibility for problems to keep peace at all costs • Distracting: member inserts irrelevant information • Generalizing: member uses overall descriptions such as always and never ▪ Dysfunctional family • Scapegoating: member of the family with little power is blamed for problems within the family • Triangulation: a third party is drawn into the relationship with two members whose relationship is unstable • Multigenerational issues: emotional issues or themes within a family that continue for at least three generations ▪ Types of discipline • Reasoning: healthy; parent explains why a particular behavior is unacceptable • Scolding: unhealthy; the parent sends the message that the child is bad, rather than the behavior being bad • Behavior modification: based on positive and negative reinforcement; good behavior is rewarded, bad behavior leads to ignorance and punishment • Consequences: outcomes for misbehavior • Corporal or physical punishment: hitting child o Stress management ▪ Nursing care • Cognitive techniques: look at irrational cognitions (thoughts) in a more realistic light and to restructure those thoughts in a more positive way • Behavioral techniques o Meditation o Guided imagery: guided through a serious of images to promote relaxation o Breathing exercises o Progressive muscle relaxation o Physical exercise: yoga, walking, biking • Journaling • Priority restricting learns to prioritize differently to reduce the number of stressors affecting her • Biofeedback: gain voluntary control of such autonomic functions like heart rate and blood pressure • Mindfulness: use of all senses • Assertiveness training: learns to communicate in a more assertive manner in order to decrease psychological stressors o Substance use and addictive disorders ▪ Alcohol • 0.08% is legally intoxicated • Intended effects: relaxation, decreased social anxiety, stress reduction • Effects of intoxication o Effects of excess: Slurred speech , nystagmus , memory impairment, altered judgment, decreased motor skills , decreased level of consciousness , respiratory arrest, peripheral collapse and death o Chronic use: Direct cardiovascular damage, liver damage, erosive gastritis and gastrointestinal bleeding, acute pancreatitis, sexual dysfunction • Withdrawal effects o Abdominal cramping, vomiting, tremors , restlessness and ability to sleep , increased heart rate , transient hallucinations or illusions , anxiety , increase blood pressure respiratory rate and temperature and tonic clonic seizures o Alcohol withdrawal delirium can occur two to three days after cessation of alcohol and it is a medical emergency. Manifestations include severe disorientation, hallucinations , severe hypertension , cardiac dysrhythmias and delirium and this can progress to death • Medications o Withdrawal: diazepam, carbamazepine, clonidine, chlordiazepoxide, phenobarbital, naltrexone o Abstinence: disulfiram, naltrexone, acamprosate ▪ Opioids • Heroin, morphine and hydromorphone • Intended effects: rush of euphoria, relief of pain • Effects of intoxication: slurred speech, impaired memory, pupillary changes, decreased respirations and level of consciousness, which can cause death; maladaptive behavioral or psychological changes, including impaired judgment or social functioning. . . Antidote: Naloxone IV • Withdrawal manifestations: abstinence syndrome begins with sweating and rhinorrhea progressing to piloerection, tremors and irritability followed by severe weakness, diarrhea, fever, insomnia, pupil dilation, N/V, pain in the muscles and bones and muscle spasms. • Medications for withdrawal: methadone substitution, clonidine, buprenorphine, naltrexone, levo-alpha- acetylmethadol o Suicide ▪ Overt comment: open statement ▪ Covert comment: does not say it but implies it ▪ Assess the client for suicide plan ▪ Asses if any suicide in the family ▪ Nursing care • Primary intervention: Focus on suicide prevention through the use of community education and screening to identify individuals at risk • Secondary intervention : focus on suicide prevention for an individual client who is having an acute suicidal crisis . Suicide precautions are included in this level of intervention • Tertiary interventions : focus on providing support and assistance to survivors of a client who completed suicide ▪ Suicide precautions • One-on-one • Use only plastic utensils and count them when brought in and out of room • Clients hands should always be visible ▪ Suicidal contract • Agreement to not harm themselves but instead seek help o Antisocial personality disorder ▪ Characterized by disregard for others with exploitation, lack of empathy, repeated unlawful actions, deceit and failure to accept personality of responsibilities; sense of entitlement, manipulative, impulsive and seductive; nonadherence to traditional morals and values; verbally charming and engaging; they're always telling lies ▪ Cluster B o Copying mechanisms ( PTSD ) ▪ Provide emotional support ▪ Offer protection during panic levels of anxiety by providing for needs ▪ Providing assistance with working through traumatic events or losses to reach acceptance ▪ Encourage group therapy o Levels of prevention (PTSD) ▪ During the incident be aware of need for breaks, rest , adequate water and nutrition ▪ Provide emotional support for those involved in the incident - OB o STI ▪ Encourage staff to support each other ▪ Debrief with others following the incident ▪ Encourage expression of feelings by all involved ▪ Use offered counseling resources ▪ Chlamydia • Bacterial infections • Often asymptomatic , if left untreated can lead to pelvic inflammatory disease • Yearly screening of all sexually active women younger than 25 years and older women with risk factors ( new or multiple partners) and pregnant women at first prenatal visit • Expected findings o Men: urethral discharge, dysuria, mucoid or watery urethral discharge o Women: dysuria, urinary frequency, spotting or postcoital bleeding, mucopurulent endocervical discharge, easily induces endocervical bleeding • Nursing care o Clients who are pregnant should be retested 3 weeks after completing the prescribed regimen • Medication o Antibiotic ▪ Gonorrhea • Bacterial infection • Spread by genital to genital contact or oral to genital contact and can also be transmitted to a newborn during delivery • Can lead to PID • Expected findings o Men: dysuria, urethral discharge o Women: dysuria, vaginal bleeding between periods and dysmenorrhea, yellowish-green vaginal discharge, easily induced endocervical bleeding • Medication: Ceftriaxone IM ▪ Syphilis • Three stages o Primary: presence of chancre o Secondary: skin rashes o Tertiary: damage to internal organs • Medications o Penicillin G in a single dose IM o Menopause ▪ Cessation of menses ▪ Considered complete when no menses have occurred for 12 months ▪ Risk for DVT - Pediatrics o Communicable diseases ▪ Measles • Spread: Direct Contact, Droplet • Expected Findings: o 3 – 4 days prior to rash: Mild to moderate fever, conjunctivitis, fatigue, cough, runny nose, red eyes, sore throat o Rash: Koplik spots (tiny white spots) I mouth 2 days before rash, red or reddish-brown rash beginning on face spreading downward, spike in fever with rash ▪ Varicella • Spread: Direct contact, Droplet (airborne), contaminated objects • Expected findings: o 1 to 2 days prior to rash: Fever, fatigue, loss of appetite, headache o Rash: macules start in center of trunk, spreading to the face and proximal extremities, progresses from macules to papules to vesicles and crust formation follows, scabs appear in approximately 1 week ▪ Pertussis (Whooping cough) • Spread: Direct contact, droplet, indirect contact with freshly contaminated articles • Expected findings: runny nose, congestion, sneezing mild fever, mild cough, severe coughing starts in 1 to 2 weeks ( coughing fits, violent and rapid coughing, loud “whooping” sound upon inspiration) ▪ MRSA • Contact precaution ▪ Hep A • Fecal- oral • Hand hygiene and food handling education Practice Questions Information - The most important predictor of overall mortality is age. The mortality curve by age drops sharply during and after the first year of life to a low point in childhood then begins to increase through adolescence and young adulthood and then increases sharply through middle and old age is. - Epidemiologic roles: Collection, reporting analysis, and interpretation of data; Environmental risk communication - Demand management seeks to control use by providing clients with correct information and education strategies to make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make fewer demands on the health care system. Care management is an enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population. Case management is defining as a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to facilitate an individual's and family's comprehensive health needs through communication and available resources to promote quality cost effective outcomes. Disease management constitutes systematic activities to coordinate health care interventions and communications for populations with disease conditions in which client self-care efforts are significant. - Alcohol: psychoactive drug; Marijuana: illicit drug - The Intervention Wheel has been incorporated into the public/community health coursework of numerous undergraduate and graduate curricula. The Wheel was derived from the practice of PHNs and intended to support their work. It gives PHNs a means to describe the full scope and breadth of their practice. It serves as a model for practice in many state and local health departments. It has been presented internationally, but is not used widely at the international level - Population management involves assessing the needs of the client population through health histories, claims, use-of-service patterns, and risk factors. - Health indicators are numerical measures of health outcomes, such as morbidity and mortality, as well as determinants of health and population characteristics. Generally, these data are from secondary sources such as websites or printed materials. - After the National Mental Health Act was passed in 1946, the NIMH administered its programs. Objectives included development of education and research programs for community mental health treatments approaches. - A very high body temperature can lead to death when taking ecstasy. GHB, Rohypnol, and Ecstasy are known as "club drugs." - It is true that side stream smoke contains greater concentrations to toxic and carcinogenic compounds than mainstream smoke. Pipes are less hazardous than cigarettes because the harsher smoke discourages deep inhalation. The body quickly develops tolerance to nicotine. - A faith community nurse who holds discussions for targeted groups is functioning as a health educator. As a counselor, the faith community nurse discusses health problems and recommends interventions as necessary. As an integrator of faith and health, the faith community nurse assists others to improve spiritual and physical health. As the developer of support groups, the faith community nurse establishes and facilitates support groups. - Forensic nurses can demonstrate the role of advocate by promoting programs that prevent injuries. Partnering with public health professionals to implement programming demonstrates collaboration. Investigating injuries in the community demonstrates the role of epidemiologist. Providing holistic care to victims of violence demonstrates the role of caregiver. - Public Health nurses must customize the nursing process to consider the community, systems and individual/family levels of practice. - Memory loss is a symptom that is displayed following an acute exposure to pesticide. Musculoskeletal problems, cancer, and infertility are from chronic exposure. - The factors/determinant that influence implementation in the community are the nurse's chosen roles, the type of health problem selected as the focus for intervention, the community's readiness to take part in problem solving, and characteristics of the social change process. - Ecchymoses are not the result of aging and should be investigated to determine whether the client is sustaining injury or taking anticoagulant therapy. Cherry hemangiomas do not require further investigation as to cause. Tenting of the skin is a normal age-related change in an older adult. Nevi on the neck and forehead are not significant age-related findings. - Social determinants of health are such as economic status, education, environmental factors, nutrition, stress and prejudice that lead to resource constraints, poor health and health risk. - Confidentiality is of the utmost importance in faith community nursing practice. The faith community nurse values client confidentiality , but at the same time delicately assists the client and client's family at the appropriate time to share concerns with pastoral staff or fellow congregants. Personal faith, health care needs, and fellowship are addressed as the nurse maintains client confidentiality. - Aggregates are a defined population made up of individuals in communities of a specific geographical region. Population-focused practice is implemented with defined populations or sub populations. This is larger than the scope of individual care but may not address the larger needs of the entire community or geographical. - Examples of Medicare fraud and abuse in home health and hospice include inappropriate use of services, excessive payments to administrative staff or owners, "kickbacks" for referrals, and billing for visits and/or medical supplies that are not authorized or provided. The home care nurse must abide by established federal regulations when delivering care to clients. - Mosquitoes, the vector that transport encephalitis, are found in large numbers in swampy areas. The risk of acquiring meningitis increases when clients live in overcrowded livings conditions. - Tuberculosis is the second leading infectious disease killer of adults worldwide, with the largest numbers of the cases occurring in the South-East Region of the WHO. People are often co-infected with TB and HIV/AIDS; TB case rates and deaths have increased since 1995 in African countries with the highest rates of HIV infection. Drug-resistant strains have complicated the treatment regimen of TB, and so the standard treatment have become DOTS. No social stigma is associated with this treatment plan. Many cases are occurring in developing countries, no industrialized countries (such as US) - Having a disadvantaged background is a risk factor for a second teen pregnancy. Other risk factors include lower educational and cognitive ability, mental health issues, physical trauma, losses ( such as death of a loved one), and substance use. - Surveillance gathers the "who, when, where, and what"; these elements are then used to answer "why". Nurses are frequently involved in surveillance by collecting data, making diagnoses, investigating and reporting cases, and providing information to the general public. Client education, program evaluation, and advocating for changes are not part of the surveillance process. - The levels of practice encompassed by the intervention wheel are Communities, individuals and families, and systems are the three levels of public health nursing practice - The client is awake and alert. She does not have overt signs of cardiac or respiratory distress. This client can wait for treatment for 1-2 hours, indicating priority 2 (yellow tag). The nurse should check on her status every 30-60 minutes. A client with priority 1 (red tag) status requires treatment immediately. A client with priority 3 (green tag) most likely has minor injuries and can wait for a number of hours as long as reassessment is done every 1-2 hours. Clients who have a black tag do not have a priority rating; they are deceased and should be transported to a temporary morgue. - the majority of occupational health nurses work as nurse clinicians/practitioners. - Inhalants are among the firsts drugs that young children use. The primary abusers of most inhalants are adolescents who are 12-17 years of age. Most recent studies have found that the DARE program is less effective that other interactive prevention programs and may even result in increased drug use. Underage drinking is seen as the most serious drug problem for youth in the US. The younger a person is when beginning intensive experimentation with drugs, the more likely dependence will develop. - The priority role of the nurse should be role model, as nurses must be role models because many HIV-positive patients are stigmatized. - Client contracting provides adolescents with the ability to be involved in their care. Adolescents should be involved in planning and decision making regarding their need for information about their own health issues. A lecture format does not allow opportunity for feedback or involvement. Viewing a video may be visually interesting but is not designed for interactivity or feedback. Role play may be a useful strategy in selected instances if the client is learning new ways of interacting with others, but it is not a strategy that would be widely applicable. - Many clients with mental disorders were institutionalized because of a continued fear of people with mental disorders. These clients were essentially separated from the community and isolated from their families. The institutionalization combined with minimal information about cause, care, and cure, resulted in overcrowded conditions and exploitation of clients. - Tracking children known to be at risk for under immunization is a function of PHNs who work in health departments where immunization are given and tracked. - The wide variations in health services and health status between certain population groups are called health disparities. Vulnerable population are typically considered to be those who are at greater risk for poor health status and who have poor access to health care. Disadvantaged populations have fewer resources for promoting health and treating illness than does the average person in the United States. Risk describes that some people have a higher probability of illness than others. - Race refers to biologic features, whereas ethnicity refers to a shared culture. - The Social Security Act provides funds to insure currently uninsured children. The Balanced Budget Act shifted payment in home health care. The HIPAA was intended to help people keep their health insurance when moving from one place to another. The ACA of 2010 provides the opportunity for all to purchase health insurance. - An aggregate is a collection of individuals who have one or more personal or environmental characteristics in common. A community is a group of people that share something in common, such as geographic location, interests, or values. A group is people who are located close together. A family is considered parents and children living together in a household. - The main characteristics of partnership are awareness, flexibility, and negotiated distribution of power. - Forensic environment includes courtrooms, jails, prisons, and psychiatric facilities for the criminally insane. - Unemployment is associated with violence within and outside the home. - Transitional care ensures the coordination and continuity of health care as clients transfer between different locations and different levels of care in the same location. High intensity transitional care programs are designed for populations who have complex or high health problems. - Nurses behaviors in situations are influenced by their relationship with clients. It is important to evaluate clients and populations in the context of the environment to develop nursing interventions. - Community based nursing practice is a setting specific practice whereby care is provided for clients and families where they live, work, and attend school. Community oriented nursing emphasizes the prevention of disease and disability. Public health nursing focuses on the care within the community as a whole. Community health nursing focuses on the health status of individuals and the effect of their health status on the community as a whole. - Typical programs in a state health department include; communicable disease service, HIV/AIDS service, and budget and finance. Senior health, dental health, and mental health are typically found in a local health department. - The factors for successful inter-professional functioning include the categories of knowledge, skill and attitudes with subheadings including the understanding of the roles of each professional. - The Millennium Development Goals address reduction of child mortality and promotion of gender equality and empower women. Other goals include eradicating extreme poverty and hunger; achieving universal education; improving maternal health; combating HIV/AIDS, malaria, and other diseases; ensuring environmental sustainability; and developing a global partnership for development. - The Intervention Wheel provides a graphic illustration that give public health nurses a means to describe the full scope and breadth of their practice .The Wheel was derived from the practice of PHNs and intended to support their work. It gives PHNs a means to describe the full scope and breadth of their practice. It serves as a model for practice in many state and local health departments, but not all. - Family caregivers and older adults are at risk for health disruptions. Involvement in a community support group can help reduce stress of caregiving and provide networking opportunities for the older adult. - Drug abuse and addiction is associated with many problems, including neonates with low birth weights and congenital anomalies; accidents, homicides, and suicides; chronic diseases such as cardiovascular disease, cancer lung disease, hepatitis, and human immunodeficiency (HIV) acquired immune deficiency syndrome (AIDS; and mental illness. - Developing a list of exposures associated with urban, rural, or suburban settings, assessing the risk by medium such as air, water, soil, or food and dividing the environment into functional locations: home, school, workplace, and community are ways a nurse can assess the environment. - Public health consultants with the Minnesota Department of Health carried out grounded theory process in response to uncertainty about the contributions of public health nursing to population health level improvement, resulting in the identification of the Intervention Wheel components. - Two major movements have influenced the treatment of mental illness: (1) consumer advocacy and (2) a better understanding of neurobiology. - The structure of the community is defined in terms of services and resources. The subsystems of community structure consist of physical environment, health and social services, economy, transportation and safety, politics and government, communication, education and recreation. - Risk factors for child abuse include unemployed parents, no support network, parents not knowledgeable about child development, and a mother who is scared of her partner. -