Community ATI

Informant Interviews Participant Observation Windshield Surveys

Use of existing data (statistics) --> Prevalence of disease Medical Records Health Surveys Morbidity/Mortality statistics

Teach skills to counteract peer pressure increases self-responsibility = awareness of various strategies to resist drug use

(1) Don't adjust the flow rate = could eliminate the client's hypoxic drive to breathe (2) Use when starting strenous exercise (3) Use non-petroleum based lip moisturizer on lips/nares (oxygen dries out pores) (4) contact provider when feeling SOB

(1) May exhibit more aggressive behavior (2) Many have imaginary friends + are highly imaginative (3) Set limits on behavior

(1) Identify needs of community (2) Develop objective to be achieved with education (3) Select educational strategies that are appropriate for audience (4) Implement education

To prevent transmission wipe changing tables with a dilute bleach solution between children

Tendency of people to view the world from the perspective of their own cultural background + viewpoint

Process of forcing one group's cultural beliefs on others

Pattern of relationships among a cultural group + how that group structures itself to carry out role functions

*Use tap water to clean inner cannula (clean technique) *Leave the old soiled ties in place until the new ones are secured to prevent accidental dislodging of the trach tube * Never place the thumb over the suction port while inserting the catheter (don't suction while inserting) * Insert the catheter 5 inches into the trach tube

*Have a 2 week supply of food + water at home (may need to stay at home for several weeks to prevent spread) - Flu vaccine does not protect against Avian Influenza - Receive 2 injections of H5N1 vaccine 28 days apart when an outbreak occurs - Antivirals can minimize symptoms but do not prevent transmission

(1) Can give acetaminophen for fever after immunizations (2) A cold or other minor illnesses are not contraindications for receiving immunizations (3) Child needs MMR vaccine at 12 months (1 year) (4) Don't give influenza vaccine if have egg allergy

* Religious Preference * Food Patterns * Health Practices (immunizations)

(1) Use metered-dose inhaler attached to a spacer when taking corticosteroids (2) Pace activities depending on effort required for breathing (3) Avoid environmental triggers (4) Report the highest of 3 peak expiratory flow rates instead of average (5) Take prednisone until prescription is complete

(1) Make referral in accordance with client's decision (respect autonomy) (2) Does not include verification of insurance coverage (3) Never provide advice (non-therapeutic + does not respect autonomy) (4) Do not assess families decisions (goes against confidentiality + autonomy)

(1) store at room temperature in a dark place (2) Remove gray tip to activate device --> Leave black tip on (covers spring-loaded needle) (3) First dose of epinephrine controls allergic symptoms for about 20 mins = after dose is administered transport to hospital immediately (4) Inject medication in outer thigh = can be injected through clothing

Interviewing community members (Informant Interviews = provide specific information about community)

Organizing community-wide disaster drills * Planning + practicing drills will help people know what procedures to follow during a disaster

Place a tuning fork behind ear, tell when no longer hear the sound (compares air conduction + bone conduction of sound)

Place tuning fork on scalp, tell if hear sound better in one ear or the other

Initial screening to determine need for further testing of client's hearing (Use fingers to close one ear while whisper some numbers into other ear)

Precise measurement of hearing ability = wear headphones + press button when hear sound (hearing tones of various intensities)

(1) No link between race + abuse (2) No link between economic status + abuse (3) Child abuse is more common in homes where intimate partner abuse is present (4) Children who are abused are more likely to become abusers

(1) Household members should take Isoniazid (INH) for 6-12 months (2) Respiratory isolation is not necessary (3) Client with active TB should receive a chest x-ray for future screenings

(1) Provide referral info Facilitates movement of client through health care system (2) Negotiation (3) Collaboration

(1) Content should be organized to make it easier to comprehend + retain material (2) Majority of adults comprehend info at 8th grade level (3) Powerpoints are good sources of teaching = addresses both visual + auditory learners (4) More likely to benefit from a voluntary program since they have the choice to attend

Vomiting, febrile, petechial rash (unstable)

Diarrhea, abdominal pain, fever of 99.4F

Used to restore client's metabolic rate * Toxic effects = heat intolerance, Tachycardia, Weight loss, Hypertension

Office of Emergency Management (develops + coordinates emergency response plans within the defined area)

Works with other agencies to provide a relief service after a disaster (not responsible for developing local disaster plan)

Focuses on protecting the US from threats + hazards

Provide emergency preparedness training to public health employees

*Encourage women to participate in weight-bearing activities * Sun exposure --> absorption of Vitamin D --> Absorption of Calcium (prevents osteoporosis)

*Methylphenidate (1) Use a reward + consequence system throughout the day (have difficulty recognizing inappropriate behavior = provide positive feedback to minimize negative behaviors (2) Limit distractions to promote focus (no music) (3) Have a consistent routine daily (4) Better ability at focusing in the morning when on methylphenidate

(1) Put antiembolic stockings on BEFORE getting out of bed (2) Use incentive spirometer every 2 hours (3) Do NOT place pillow under knee (increases risk for deep vein thrombosis) (4) Use an assistive device to retrieve items on floor (decreases risk for hip dislocation)

Mitoxantrone IV every 3 months (chemo drug) * Report Sore Throat (greatest risk for client is severe infection due to myelosuppression from mitoxantrone) * Vomiting = causes dehydration * Hair Loss = emotional distress * Amenorrhea = emotional distress

Determine the incidence rate (determine # of new cases in community)

Considers ONLY the OUTCOMES or CONSEQUENCES in determining which choice to make (ex: A public health nurse examining potential negative consequences of proposed public policy)

Serving on a community task force for suicide prevention (Supporting a course of action relative to a community health issue)

*Conducting cholesterol screening at senior center * Administer immunizations to a group of migrant workers

(1) Decreased Sensitivity to Pain* = loss of neurons + nerve fibers = places older adults at increased risk for injury (2) Decreased peristalsis = delayed gastric emptying (3) Vision changes (presbyopia = hold near objects further away in order to be seen) + distance vision decreases (narrows client's visual field) (4) Decreased intellectual capacity is NOT an age-related health change

(1) Take a hot shower or bath daily = improves joint mobility + pain (2) Get 8-10 hours of sleep + additional 1-2 hrs during the day (3) Consume well-balanced diet + weight loss can reduce severity of disease (4) Exercise Daily

(1) Limit liquid intake at meal times (2) Consume foods w/ protein (like eggs) (3) Maintain an upright position (High Fowler's position) to promote ventilation (4) Use milk instead of water when making soup

*Report the case to the state health department (reportable disease) * Refer student to provider (not appropriate to report the case to student's provider = breach of confidentiality + privacy) * DON'T notify parents * DON'T notify principal

Client exhibits increased anxiety + may project anger toward self + others "I don't deserve to die, this isn't fair"

Client acknowledges the impending loss while remaining hopeful "If I could just make it through this, I'd never smoke again"

Client establishes coping strategies + accepts the impending loss "I'm going to plan my memorial service next week"

"What has changed to make you decide this?" = Seek clarification from client to establish mutual understanding while staying therapeutic * Never ask "why" questions * Never make value judgements or give advice * Don't generalize client's statement = minimizes feelings

Facilitating substance abuse support groups

Provide pharmacologic pain management for clients with terminal illness

Plan safety services for employees at local workplace

Maximize recovery AFTER injury/illness (REHAB) *Nutrition Counseling * Exercise REHAB * Case Management of chronic illnesses * Physical Therapy * Support Groups *Exercise of hypertensive clients * Teaching a client with rheumatoid arthritis measure to prevent joint deformities * Teaching foot care to adults who have Diabetes

Early detection + treatment of disease (goal = limit severity + adverse effects) * Community Assessments * Home safety checks * Disease Surveillance (communicable diseases) * SCREENINGS * Control outbreaks of communicable diseases (Implementing program to notify individuals exposed to a communicable disease)

Direct Contact ONLY (1) Oral Contact (2) Sexual Contact

(1) ABC's = always airway first if compromised (2) Acute, new onset of symptoms

Angiotensin-converting enzyme = converts Angiotensin 1--> 2 (treats HTN + Heart Failure) * Report Angioedema (fatal reaction) * SE's = Tachycardia, Wt. Loss * Dry Cough = from accumulation of bradykinin

FACE

(1) Keep bathroom doors closed to prevent accidental drowning (2) Crib slats need to be less than 2.375 inches apart to prevent accidental strangulation (3) Water heater should be no higher than 120F (49C) to prevent accidental burns (4) Clip pacifier onto clothing during naps (not around neck) to prevent strangulation

(1) examine oral mucous membranes (candidiasis) (2) Watch for wasting syndrome (encourage client to consume 1.2 - 2.0 g/kg of protein daily) + Increase calorie intake by 25%

Low income + no insurance

Focus more on the group members who have a positive outlook (Speak to group member privately to uncover source of anger)

Remind the group that everyone should have a chance to participate

Divide the group into pairs + give each pair a topic for discussion + Give member extra time to compose thoughts before expressing them

(1) Advanced HIV or AIDS = immunocompromised patients who are unable to produce an immune response (2) Time between exposure + screening = 9 weeks following exposure (3) Age of client = older adults due to changes in immune system

(1) BCG Vaccination = up to 10 years following vaccination

FIRST assess the NEED (collects data on client/community = program planning) *Needs of community determines all other steps of planning process*

# of EXISTING cases in population at specific time/Total population

Population exposed to specific agent who develop the disease/ Total people exposed

# of NEW cases in population at specific time/ Total population (Newly diagnosed)

(1) Increase amount of red meat + milk in child's diet (Increase IRON + CALCIUM to prevent lead absorption from environment) (2) Use Wet sanding technique to prevent aerosolizing lead particles (3) Wet mop wood floors (don't vacuum) to prevent aerosolizing lead particles (4) Use cold tap water when preparing infant formula since hot water dissolves lead more quickly from pipe

"At NA meetings, your willingness to change will be crucial for sobriety" (1) must be willing to make amends (2) People who have addictions are powerless over them (3) Disease theory = not responsible for their symptoms but are responsible for getting treatment for their diseases (4) Must be able to admit defeat + surrender to a higher power

(1) Stay indoors during cold weather = triggers asthma (2) Still able to play sports (3) Rescue medication is used when experiencing an exacerbation (NOT DAILY) (4) Receive a flu shot to decrease risk of flu-related respiratory complications

(1) Consult with dietician to determine appropriate school lunch for child (2) Eat a snack within 2 hrs of physical activity (3) DON'T provide info to insurance company (4) Test ketone levels when client is sick or blood glucose levels are elevated (not daily)

Prevention of the initial occurrence of disease/injury (DOES NOT have it) *Nutrition Education *Family planning/Sex education *Smoking education *Communicable disease education *Education about health + hygiene *Safety education *Prenatal education *Advocating for access to health care, healthy environments * Immunizations (prevents disease)

Warfarin due to hindering coagulation properties

Based on Individual State Law

Demonstration on breast model

*Case Manager = schedule speech therapy + physical therapy appointments that do not interfere with academic schedule

(1) Instruct parent to keep child home until coughing stage has passed (when disease is most communicable) (2) Encourage family members to obtain prophylactic treatment (erythromycin, clarithromycin, azithromycin) (3) Check immunizations status of child's classmates (4) pneumococcal vaccine is not effective against pertussis

(1) Central Cath can stay in place for a year or more (peripheral catheters must be replaced every 72 - 96 hrs) (2) Both can have clots but an anti-thrombolytic agent can dissolve a clot in PICC (peripheral IV = clot must be removed + replaced by nurse) (3) Both causes infections (4) PICC requires daily flushing to maintain patency

Primary = Chancre (painless, ulcer) Secondary = Malaise, Maculopapular rash on palms + soles of feet, Lymphadenopathy

(1) Attempting to END relationship with partner (2) Physical problems + cognitive decline = elder abuse (abusers thrive on dependence + codependence with victim (3) Substance use disorder (alcohol + drugs)

Disease affects the liver (usually asymptomatic) --> Cirrhosis * Transmitted through Blood + Bodily Fluids (sex) * Consume diet high in carbs + calories

(1) Exposed person may develop dry cough, mild chest pain, fever, fatigue (2) Not transmitted from person to person (3) Tx = COMBO of ATB's (4) Fatality rate = 95 - 100%

(1) Children drink more water for their body weight (take in more toxins from water) (2) Kidneys filter at smaller rate in children (less able to filter out toxins that enter body) (3) Children breathe more rapidly (increases exposure to air pollutants) (4) Both indoor + outdoor pollutants increase frequency + severity of asthma attacks

(1) Test bath water w/ thermometer (prevent burns) (2) Wear shoes that extend 2.54 cm (1 inch) past longest toe (3) Don't use heating pads or ice packs (4) Inspect feet for areas of redness + skin breakdown daily (5) Monitor temperature of feet + lower extremities for changes

Reviews morbidity + mortality data for the community

(1) Cares for mothers + newborns (health of individuals, families, groups in community) (2) Review meds (individual + family illnesses) (3) Provide allergy shots (illness care)

A fan in the client's room (moves air which stimualtes trigeminal nerve + minimizes sensation of dyspnea)

When they experience noisy breathing

Contraindicated = Herpes Zoster + Varicella + MMR (measles, mumps, rubella) Should give = TDaP (Tetanus, Diphtheria, Pertussis)

(1) Use a hand-held mirror to improve ability to see objects around you (altered visual perception + decreased visual fields) (2) Encourage self-care (3) Nurse manager should coordinate outpatient therapy BEFORE discharge (4) Dress + Care for affected side of body first to prevent unilateral body neglect

Hepatitis A + HPV

HIV + Hep B + Hep C

(1) Difficulty Learning New things (2) Short term memory loss (3) Subtle changes in personality

(1) Withdrawal from social activities (2) Loss of language skills + moderate cognitive decline (3) Neglecting personal hygiene (lose ability + willingness to perform ADL's = bathing, grooming, dressing)

Gastric Ulcerations, perforations, hemorrhage, hypertension

Change at individual level Take an action to avoid disease

Based on health belief model Change at COMMUNITY level Relationships between health deficits + resources Behavior changes w/ large number of people = social change

Individuals + Families Illness Care = manage acute/chronic conditions (1) Home health nurse performing wound care for client who is immobile (management of acute condition) (2) A school nurse teaching a student who has asthma about medications (management of chronic condition)

At-risk Individuals, Families, Groups + community Health Care: Determine HEALTH NEEDS of community, Intervene to improve collective health of community (1) Occupational Health nurse providing classes on body mechanics at a local industrial plant (2) A parish nurse teaching a class on low-sodium cooking techniques (3) A mental health nurse discussing stress management techniques with support group

Maintain health of population by delivering health services to individuals, families, groups to impact "community health" PREVENT + MAINTAIN Disease

Maintain health of population through disease + disability prevention + health protection of community as a whole - Assessment of health of populations - Development of policies to support health of populations - Ensuring essential health services are available to all persons

Fair distribution of benefits + burdens in society based on needs + contributions of members = eligibility for health care services based on income + fiscal resources

Health-related trends in populations * Based on statistical evidence to determine rate of spread of disease + proportion of people affected * Spread, transmission, incidence of disease + injury * Relationships among agent, host, + environment

Keeping commitments + following through with promises

Concept of telling the truth

* Ethnicity * Altered Immunity

Adapting to a new culture = changes in daily living practices * Merging w/ or adopting traits of a different culture *Change in language, education, work, recreation, social experiences, health care system

"I PREPARE" I = Investigate potential exposures P= Present work R = Residence E = Environmental concerns (air, water, soil) P = Past work A = Activities (hobbies, activities) R = Referrals + Resources E = Educate (risk reduction, prevention, follow-up)

World Health Organization (WHO) * Provides daily info regarding occurrence of diseases * World standards for ATB's + Vaccines * Focuses on health care workforce + education, environment, sanitation, infectious diseases, maternal/child health, primary care

Must be older than 65 + receiving Social Security or disability for 2 years A = Hospital + Home care B = Medical care + Diagnostic services C = Private insurance company (A + B) D = Prescription drug coverage

Provides health care coverage for individuals of low socioeconomic status + children *Eligibility based on household size + income *Inpatient + Outpatient hospital care, vaccines for children, family planning, screening, diagnosis, treatment of children younger than 21

State Departments of Health * WIC (Women, Infants, Children) programs *Medicaid program administration * Notifiable communicable diseases within state to the CDC

Gather data about the client's cultural beliefs *Nutritional practices, family structure, health care interactions, views about illness

Provide EDUCATION to achieve community health goals Coordinate directives from state personnel (1) Identify + intervene to meet health needs of local community (2) Work closely w/ local officials, businesses (3) Report notifiable communicable diseases to state departments of health

Community ASSESSMENT + DIAGNOSIS

(1) Gathering collected data into database (2) Assess completeness of data (3) Identify + generate missing data (4) Synthesize data + identify themes (5) Identify community needs + problems (6) Identify community strengths + resources

Direct conversations with individual community members for the purpose of obtaining ideas + opinions

Receive services from community health nurses *Individuals (infancy - death) * Families * Groups in community

CONTROLLING SYMPTOMS

Health + Safety of Workers *Improvement + maintenence of health *OSHA *NACOSH = collects data on incidence + prevalence of occupational illness + injury

C = Caring I = Intuition R = Respect for religious beliefs C = Caution L = Listening E = Emotional Support

(1) Missionary Nurse = promote health + prevent disease by meeting spiritual, physical, and emotional needs of people across the globe (2) Parish Nurse = Promote health + wellness of populations of faith communities (church members) (Holistic approach to healing = body, mind, spirit) - Liason between faith communities + local resources - Spiritual support (strengths for coping)

(1) Case manager = coordinates services for children with complex health needs (2) Community outreach = meet needs of all school-age children (3) Consultant = assists student, families, in info gathering + decision-making about health needs + resources (4) Counselor = Supports students (5) Direct Caregiver = nursing care to ill or injured (6) Health Educator = prepare people/community to make well-informed health decisions (7) Researcher = contributes to knowledge for school health + educational needs

NOISE + LIGHTING

Virus

Work practices of employees as a WHOLE

*History of being abused * Low self-esteem * Poor self-control * Fear + Distrust of others * Inadequate social skills * Minimal social support * Weak coping skills

(1) Develop a plan for safety (2) Make referrals for community services

Body burns 0.5 oz of alcohol per hour * Withdrawal appears within 4-12 hours * Irritability + Tremors + Anxiety * Nausea + Vomiting + HA * Diaphoresis * Sleep Disturbances * TACHYCARDIA + HTN Use Benzodiazepines = tx

*Upper Respiratory Disorders * TB * Infestations (scabies, lice) * Dental Carries * Hypothermia + Heat-related illness * Malnutrition

(1) Higher infant + maternal morbidity rates (2) Higher rates of DM (3) Higher rates of SUICIDE (4) Less likely to receive preventative care

25 million veterans *2 million women * 9 million > 65 years old

* Underweight = malnourished * Poor Hygiene

* Healing spiral fracture * Burns on palms of hands

(1) Tolerance to nicotine develops quickly (2) Smoking is the FIRST preventable cause of death in the US (3) Nicotine is a CNS STIMULANT (4) Withdrawal effects from smoking are substantial = increase physical dependence

Families with Children

Inhaled by susceptible host *Measles *Chickenpox *TB *Pertussis (whooping cough) *Influenza

Bacterial, Viral, Parasitic infection of food *Salmonellosis *Hepatitis A = Oral/Fecal stool * Trichinosis * E.Coli

Fecal contamination of water *Cholera * Typhoid Fever * Gardia lamblia

Via a carrier such as a mosquito or tick *Lyme Disease *Malaria *Rocky Mountain spotted fever

Mandated by STATE + LOCAL regulations - State notification to CDC is VOLUNTARY

Highest priority: national security = easily transmitted + high mortality rates * Smallpox (variola) * Botulism toxin * Anthrax * Tularemia * Hemorrhagic viral fevers * Plague

Second-highest priority: Moderately easy to transfer + high morbidity/mortality rates * Typhus * Cholera

Third-highest priority: emerging pathogens that can be engineered for mass dissemination (easy to produce) + high morbidity/mortality rates * Hantavirus

HA + Fever + Muscle Aches Chest discomfort + Severe Dyspnea Shock *IV ciprofloxacin (Cipro) prophylactically for exposure or high-risk of exposure * ATB's DO NOT stop the disease progression

Difficulty Swallowing + Breathing Progressive Weakness Nausea/Vomiting/Abdominal Cramps *Airway management *Antitoxin *Supportive Care

High FEVER + Fatigue Severe HA + Vomiting RASH (beginning on FACE + TONGUE --> rest of body) = pus-filled lesions NO CURE Prevention = vaccine (10 years of immunity)

ORGANS (1) Respiratory passages (2) GI Tract (3) Mucous Membranes (4) Skin (5) GU Tract (6) Eyes (7) Blood Vessels

LIQUIDS (1) Respiratory SECRETIONS (2) Feces (3) Blood (4) Semen + Vaginal Secretions (5) Saliva (6) Skin lesion exudates

Identifying community vulnerabilities

Providing stress counseling

Outlining specific ROLES of community agencies

Prioritizing care of individuals

Partnerships within the community --> desired health outcomes *Groups partnering to elicit needed change

Specialized knowledge who provide expert advice, services, + information * Notify provider of client's needs * Seek expertise from health care professionals * Request expert opinions

Educating clients about community resources + self-care measures (1) Engage working relationship w/ client (2) Establish criteria for referral (3) Explore resources (4) Accept client decision to use given resource (5) Make the referral (6) Facilitate referral (7) Evaluate outcome

At Admission

*Decreasing cost by improving client outcomes * Providing education to optimize health participation * Advocating for services + client's rights

Combination of nursing science w/ information + communication technologies in delivery of nursing care *Electronic records, database, billing

Delivery of quality health care through the use of technology *Transfers information easily between providers improving access to health care * Allows nurses to provide care to clients at home * Transmission of physical data * Transmission of Audio data * Transmission of Visual Data

Persuade or Influence legislators

Facilitation of goal achievement through collaboration of two or more groups

Serving Society + Advocating for change by influencing policy development through public service

Updating state officials about health needs of local community *Concerned w/ healthcare NEEDS of individuals, families, + groups within community

Advocating for federal funding of local health screening programs

Review available resources w/ the client

Performing health screenings for high blood pressure at local health fair

Identify referrals that the client NEEDS

(1) Costs associated w/ services (2) Attitudes of health care personnel (3) Physical accessibility of resources

(1) Decreased motivation (2) Inadequate knowledge of resources (3) Lack of transportation (4) Finances + Cultural Factors