Community HESI Review
Community HESI Review
Environmental
Dermatitis
- Inflammation of the skin
- Nuts and dairy can trigger symptoms
- Triggered by
... [Show More] smoke and pollen
Flooding
Triage Color Code System
RED YELLOW GREEN BLACK
Urgency Most urgent, first priority Urgent, second priority Third priority Dying or dead
Injury type Life-threatening injuries Injuries with systemic effects and complications Minimal injuries with no systemic complications Catastrophic injuries
May delay treatment? NO For 30-60 minutes Several hours No hope for survival, no treatment
Home safety
Ebola
- hemorrhagic fever, transmitted from wild animals-->people through human to human transmission via direct contact (body fluids, broken skin, mucous membranes)
- survivors should abstain from all types of sex… well that sucks
- Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days.
- Fever, severe headache, muscle pain, diarrhea, vomiting, and bleeding (only contagious if displaying these symptoms)
and Zika Virus - Mentioned heavily in the Hesi Book. P.21 ( for anyone who thinks it could pop up on the exam)
Vector borne diseases
- Infx transmitted by bite from infected arthropod
- Malaria: infected mosquito- fever, chills/ full-like illness. Mosquitoes are infected by previous blood meal taken from an infected person
- Lyme Dx: caused by tick- rash (bull’s eye), flu-like sx, joint pain and weakness, stiff neck, lymphadenopathy, (Borrelia burgdorferi)
TX: tetracycline, PCN
- Rocky Mountain fever: caused by tick- sudden severe fever, deep muscle pain, malaise
TX: tetracycline
Rabies: No treatment once S&S develop, need prompt attention after exposure
TX: Four 1 mL immunoglobulins in Deltoid
Anthrax
- Bioterrorism, spore-forming bacterium B. anthracis
- Spread through infected animals and undercooked meat from those animals
- Cutaneous, GI, respiratory
- Range from a skin ulcer with dark scab (necrosis), difficulty breathing, bloody diarrhea, nausea, fever, pain, loss of appetite, chest discomfort
- Adventitious attack by terrorists
- Treat with Ciproflaxacin (Cipro), penicillin, doxycylcine (60-day course treatment)
Anthrax
Agent ● Bacillus anthracis
● Bacterium that forms sports
● Three types: cutaneous, inhalation, digestive
Transmission ● Inhalation of powder form
● Inhalation of spores from infected animal products (wool)
● Handling of infected animals
● Eating undercooked meat from infected animals
● Not spreadable from person to person
Incubation period ●
Within 7 days (all types)
● Inhalation incubation: period extends to 42 days
Signs and symptoms ● Cutaneous sores that develop into painless blisters, then ulcers with black centers
● Gastrointestinal: nausea, anorexia, bloody diarrhea, fever, severe stomach pain
● Inhalation: cold and flu symptoms, including sore throat, mild fever, muscle aches, cough, chest discomfort, SOB, tiredness, muscle aches
Treatment ● Prevention after exposure consists of the use of antibiotics, such as ciprofloxacin, doxycycline, or penicillin, and vaccination
● Treatment after infection is usually a 60-day course of antibiotics
● Success of treatment after infection depends on the type of anthrax and how soon the treatment begins
Miscellaneous ● Vaccine available, but not to the general public
● Given to those who may be exposed, such as certain members of the U.S. Armed Forces, lab workers, and workers who enter or re-enter contaminated areas
Smoking
- Nicotine act as both depressant and stimulant
- Constricts blood vessels including coronary arteries
- Mortality: cancer, cardiovascular disease (heart disease and stroke), respiratory disease (PNA, COPD, influenza, bronchitis, emphysema)
- Mainstream: inhaled directly by the smoker
- Secondhand/ side stream: smoke entering atmosphere from the lighted end of cig that is inhaled by others
- Second-hand contains more toxic and carcinogenic compounds
Home Care
Diabetes home care (pt care; medications; labs; risk reduction/complications; diet)
Diabetes home care (Hispanics and blacks)
- Pt care: trx complications, foot care, managing A1C
- Medications
- Insulin
- Metformin- biguanide decreases how much sugar liver makes
- Labs: A1C- less than 7 (BS for past 2-3 months); ALT; FSBS
- Risk reduction: exercise, proper nutrition, weight reduction
- Complications: cardiovascular dx, neuropathy, retinopathy, foot damage, hearing impairments
- Diet: 3 meals a day; healthy carbs, fish, fiber-rich; consistent CHO diet: try and equally distribute carbs throughout the day
Cardiac patients (pt care; medications; labs; risk reduction/complications; diet)
- African American HTN - annual urinalysis
- Pt care
- Medications: BP meds, cholesterol pills
- ACE: Watch Renal function
- Beta Blockers: Contraindicated with Asthma
- Calcium Channel: No grapefruit juice; take before meals
- Statins: Liver labs
- Diuretics: F&E imbalance, take in the morning
- Labs: LDL, HDL, CBC, LP
- Risk reduction: quit smoking, active, healthy diet, control BP
- Complications: heart attack, stroke, HTN,
- Diet: fruits and veggies, whole grains, low-fat dairy, fish, nuts, veg oil, LOW sodium diet (2g Na)
- Nutrition counseling = primary care
Heart Failure (pt care; medications; labs; risk reduction/complications; diet)
- Heart doesn’t pump blood as well as it should
- Sx- shortness of breath, fatigue, swollen legs, rapid heartbeat (watch for S3/S4)
- Eat less salt, limit fluid, meds
- Labs: EKG, ABGs, I & Os, K+, digoxin (safe range: 0.5-2, apical pulse, digibind-antidote)
HTN (pt care; medications; labs; risk reduction/complications; diet)
- Affects Black, Hispanic
- See cardiac meds above
Referrals
Antepartum (genetic counseling)
- Teen pregnancy = higher risk for premature birth
-increase intake by 300 calories
-increase protein 30g/day
-increase iron and folic acid intake through diet and supplements
-increase vitamin A, C, and Calcium
-drink 8-10 glasses of fluid per day
-record weight each visit (1lb/week in second and third trimesters)
- Analyzing small samples of blood or body tissues
- Determine if you, partner, or baby carry genes for inherited disorders
Antepartum ( genetic counseling )
- Screening for neural tube defects by testing maternal serum alpha fetoprotein levels or amniotic fluid levels is mandated by state law. This screening test is associated with false positives and negatives ( Hesi Hint).
- Amniocentesis- determines genetic diagnosis , lung maturity , and fetal well being. Takes place between 12 and 13 weeks.
- Hesi HInt -bladder must be full to help support the uterus and push up the uterus in early pregnancy. Bladder must be empty in late pregnancy so it will not puncture.
Postpartum (breast feeding)
- Breasts become engorged first 2-3 days, cabbage leaves treat breast engorgement.
- Colostrum first and then milk
- Stimulated by Pitocin
- For dry nipples:
- Rub colostrum
- Air dry 15 min (2-3x day)
- Alternate sides
- Have baby latch on to a large part of nipple
Hospice
- Less than 6 months to live (end of life care)
- Comfort measures, patient and their families
Elderly (safety; polypharmacy; grief and loss)
- Increased blood pressure, decreased hormone production
- Safety: throw rugs, side rails, seat in shower, able to use stove and appliances
- Polypharmacy: the use of multiple drugs or more than necessary.
-At greater risk of adverse drug reactions because of metabolic changes and reduced drug clearance because of ageing. Solution= cutting out drugs that do not have therapeutic effect
- Grief and loss: vulnerable to emotional, mental stress, depression, substance abuse, integrity vs. despair (reminisce)
School Nurse
Prioritization patient care
- ABCs, asthma, diabetes (polydipsia, polyphagia, polyuria, irritability, fatigue, weight loss, abd. Cramps, N/V)
Infections
Screenings
- Scoliosis-occurs during growth spurt just prior to onset of puberty, most prevalent among females
- height/weight (obesity/diabetes), hearing, vision
- Child gains 4-6lbs each year and 2 inches in height
Health Promotion
-substance abuse, sports related injuries, seat belt safety
Report signs of abuse
Infection/Control
Reportable Diseases
- Anthrax, chickenpox, chlamydia, cholera, diphtheria, gonorrhea, all Hepatitis, Lyme, malaria, measles, mumps, pertussis, plague, polio, rabies, rubella, rocky mountain spotted fever, salmonella, SARS, syphilis, tetanus, TSS, TB, VRSA
Conjunctivitis
- V contagious
TB
- Negative pressure room, N95 mask, reportable disease
- cough, weight loss, night sweats, fever
- Migrant workers
- Hesi Hint- Quantiferon TB Gold test , a blood test, is more reliable than skin testing. Nucleic Acid amplification testing may be recommended when a client has s/sx of TB.
-
less than 5 mm negative for TB
at least 5 mm positive if:
• you’ve had recent contact with someone with TB
• you are HIV-positive
• you have had an organ transplant
• you are taking immunosuppressants
• you have previously had TB
at least 10 mm positive if:
• you recently immigrated from a country with a high incidence of TB
• you live in a high-risk environment
• you work in a hospital, medical laboratory, or other high-risk setting
• you’re a child under the age of 4
• you’ve used injected drugs
15 mm or more positive
-
Medications
Safety
Immunizations (contraindications) Health Promotion
- leads to more harm for others around them
- Live vaccines not given to kids living with family on chemo, prednisone, or fever
- DTAP: 1st dose at 2nd mo., 2nd dose at 4mo.
- Ask about hxt. of reaction to vaccine, neurologic symptoms, seizures allergic reactions
- Hep B: 1st at birth, 2nd dose 1-2mo., 3rd dose at 6-15mo.
- MMR/Varicella: after 12 mo., again when entering college
- Ask about reaction to eggs or neomycin
- Influenza: after 6mo.
- Toxoid immunization = longer lasting active immunity
Cardiac
- (low Na) healthy diet, exercise, regular check up
Breast cancer
- mammograms, regular check ups, meds
Migrant workers
- immunizations, TB tests, HIV testing
Adolescents
- exercise, sex ed, healthy diet, smoking cessation programs
Primary; secondary; tertiary
Program Planning/Design
Finances
- Funding from state
- Prospective payment system
- Need to use what you ask for
- Based on Nurses first OASIS
Goals/objectives
- Educate community
Main focus of community nursing: improve quality of health in a population
- Health screenings, physical assessments, and disease management offered by preventative and primary care services
Public health nursing: population
Health Promotion
Breast Cancer- Hesi Hint - The importance of teaching female clients how to conduct a breast self exam cannot be overemphasized and the early detection = better outcomes.
Precontemplation
- Not intending to make changes within 6 months
- Patient not interested in information and may be defensive
Contemplation
- Considering change within next 6 months
- Patient more likely to accept information
Preparation
- Making small changes in preparation for big change in the next month
- Patient believes advantages outweigh disadvantages
- Need assistance in planning
Action
- Actively engaging in strategies to change
- Lasts up to 6 months
- Nurse identifies barriers
Maintenance Stage
- Sustained change over time
- Lasts after 6 months after change has been made, continues indefinitely
- Changes need to be integrated into patient lifestyle
◦Endemic
Constant presence of a disease within a geographic area or population
◦Epidemic
Occurrence of disease in a community or region in excess of normal expectancy
◦Pandemic
Epidemic that occurs worldwide and effects large populations [Show Less]