Community HESI Study Guide
Community HESI Study Guide
Population Groups across the Lifespan: Health Risks
Infants
# 1 cause of injury
... [Show More] or death is suffocation, followed by MVA then homicide
Infection is the most significant cause of illness in infants and children
• Sudden Infant Death Syndrome
Children
Healthy People objectives have addressed youth fitness and obesity (defined by BMI)
• Risks for childhood obesity were related to obesity in the parents
• ↑ in Native American, Hispanic, and African American populations and individuals of lower socioeconomic status
Children: Injuries and Accidents (#1 cause of death in ages 1 – 24 yrs)
Motor vehicles accidents are the leading cause of death among children and teenagers
Toddlers- experience a large number of falls, poisonings, and motor vehicle accidents
School age children- have the lowest injury death rate but experience difficulty judging speed and distance, placing them at risk for pedestrian and bicycle accidents
Adolescents -injury accounts for 75% of all deaths; high risk-taking behavior (SAFETY IS TOP CONCERN)
• Suicide is the 2nd leading cause of death among youths between the ages of 15 and 24 and the 3rd leading cause of death among youth between the ages of 10 and 24 years
Children: Chronic Health Problems
Improved medical technology has ↑the # of children surviving with chronic health problems
• Ex: Down Syndrome, spina bifida, cerebral palsy, asthma, diabetes, cancer, congenital heart disease, hemophilia, broncopulmonary dysplasia, and AIDS
Good nutrition is essential for healthy G&D and influences disease prevention in later life
Women
More likely to have acute/chronic conditions that require the use of more services than men
• Have a longer life expectancy than men
• Heart disease is the leading cause of death
• Lung Cancer is the leading cause of cancer and 2nd leading cause of death
Women of color are more likely to have poor health outcomes because of lack of access to health care, poor understanding of health and lifestyle practices
Men
Physiologically the more vulnerable gender, shorter life span and ↑infant mortality rate
• Life expectancy of men in the US is one of the lowest in the developed countries
Tend to avoid diagnosis/treatment of illnesses that may result in serious health problems
Elderly
Steadily growing population; more older adults live in the community
• ↑ chronic conditions, demand for services, and strained health care budgets
Address the chronic health concerns of elders with a focus on maintaining or improving self-care and preventing complications to maintain the highest possible quality of life
U.S. Healthcare Problems
More than 43 million people in the US are uninsured; many more simply lack access to adequate health care
Health care reform measures seek to make changes in the cost, quality, and access of the present system
Integration of primary care and public health is necessary for the future health of the nation
To achieve the specific health goals of programs such as Healthy People 2010, primary care and public health must work within the community for community-based care
The most sustainable individual and system changes come when people who live in the community have actively participated
Home Visits
Provide opportunities to identify barriers and facilitators for ↓health risks and reaching family health goals
Gain a more accurate assessment of the family structure and behavior in the natural environment
Parish Nursing
Parish nurses- respond to health and wellness needs within the context of faith and are partners with the church in fulfilling the mission of health ministry; usually focused on primary prevention
Services respond to health, healing and wholeness within the context of the church
• To sustain oneself as a parish nurse healer, the nurse takes heed to heal and nurture self while supporting individuals, families, and congregation communities in their healing process
To promote a caring faith community, usual functions of the parish nurse include:
personal health counseling, health teaching, facilitating linkages and referrals to congregation and community resources, advocating and encouraging support resources, and providing pastoral care
Hospice Care
Palliative system of health care for terminally ill people with <6 months to live with the normal course of disease
In the home with family involvement under the direction and supervision of health professionals
• In the hospital whenever complications of terminal illness occur or when family becomes exhausted or does not fulfill commitments
Disaster Preparedness
1st level- Personal Preparedness
Plan for keeping oneself ready for disaster, both mentally and physically (checklists are helpful)
2nd level- Professional Preparedness
Requires personnel to understand their workplace and community disaster plans (participate in mock drills)
3rd level- Community Preparedness
Adequately prepared nurses will function in leadership capacity and assist towards smoother recovery phase
The Role of Community Health Nurse in Disaster Preparedness
Depends on past experience, role in community disaster preparedness, specialized training, special interest
• Initiate or update disaster plans at workplace and community and ensure education, drill participation
• Possess knowledge of vulnerable populations, available community resources
• Assessing /reporting of environmental hazards, unsafe equipment, faulty structures, disease outbreaks
Plans for triage must begin as soon as rescue workers arrive!
• Highest priority given to life-threatening injuries with high probability of survival
• Accurate assessment info will help match available resources to population’s emergency needs
Before anything happens
1. Find out what could happen to you
• Identify common disasters in your area, learn about community warning signals, ask about care for pets
2. Create a disaster plan
• Pick 2 types of places to meet, choose an out-of-state friend to contact, review evacuation plans
3. Complete this checklist
• Post emergency numbers next to phone, teach how to call 911
• Identify all escape routes
• Determine when and how to turn of water, gas, and electricity
• Locate and review use of fire extinguishers
• Install and maintain smoke detectors
4. Practice and maintain your plan
• Conduct drills and review q 6m, replace stored water q3m and stored food q6m, test smoke detectors and fire extinguishers (recharge if necessary)
American Red Cross and Federal Emergency Management Agency (FEMA) are two well known authorities on disaster preparedness, response, and recovery
Most states and counties have an Office of Emergency Management (OEM) that is responsible for developing and coordinating emergency response plans within their defined area
• During an actual emergency or disaster, the state OEM coordinates the response and recovery program
• County OEMs are in charge of creating a comprehensive, all-hazard plan that should address realistic dangers to the community and list available resources
Stages: Preparedness, Response, and Recovery
Preparedness: knowing who is at risk
• Personal Preparedness
• Plan for keeping oneself ready for disaster, both mentally and physically (checklists are helpful)
• Individuals not personally prepared will have less to give/help other disaster victims
Nurses can be disaster victims too- personal preparation needed to attend to patients
• Professional Preparedness
• The Red Cross provides training for health professionals to adapt existing skills to disaster setting
• Requires personnel to understand their workplace and community disaster plans (mock drills)
• Community Preparedness
• Well-prepared communities have written disaster plans, an adequate warning system and backup evacuation plan, conduct drills on a regular basis
Understanding past disasters can influence planning for future, liabilities in resources
Response: the primary objective of disaster response is to minimize morbidity and mortality
• Levels are not determined by the number of casualties but by the amount of resources needed
• FEMA Levels of Disaster Response
• Level 3- a minor disaster, involves a minimal level of damage but could result in the president declaring an emergency; a minimal request for federal help
• Level 2- moderate disaster- likely to result in major disaster being declared; regional federal resources engaged, other outside area may be called on
• Level 1- massive disaster, severe damage or multistate scope; full engagement of federal regional and national resources
• American Red Cross Levels of Disaster Response (3 ways to classify)
• 1) Type- agent that caused the event; such as hurricane, hazmat, transportation
• 2) Level- anticipated or actual Red Cross response and relief costs
Level 1 costs < $10,000 to Level 5 costs $2.5 million or more
• 3) Scope- magnitude of the event and units affected
Single family- can also affect an individual within the jurisdiction of a single chapter
Local Disaster- affects multiple families within the jurisdiction of a single chapter
State Disaster- affects multiple families within the jurisdiction of several chapters in a single state
Major Disaster- has one or more of the following characteristics:
coordinated response of multiple Red Cross units- affects more than a single state
creates national news- will result in emergency or disaster declaration by the President
Presidentially Declared Disaster- full/partial implementation of the National Response Plan
• The National Response Plan
• A concerted effort to prevent terrorist attacks within the US; reduce American’s vulnerability to terrorism, major disasters, and other emergencies; and recover from crisis situations that may occur
May take effect once a federal emergency has been declared
Recovery: occurs as all agencies pull together to restore the economic and civic life of the community
• The government takes the lead in rebuilding efforts whereas the business community tries to provide economic support
• Nurse’s Role in Recovery
• Teaching health promotion and disease prevention
• Assessment of physical, psychological problems incurred in cleanup efforts
• Determine the threat of any communicable diseases
• Case finding (referral for mental distress)
• Assessment and reporting of environmental health hazards resulting from event
• Get community back to normal, deal with emotional matters and after effects
• Assess what might be going on in community using primary, secondary and tertiary care
Terrorism
Role of the Nurse
Help people cope with the aftermath of terrorism and relieve public concerns and fears of bioterrorism
Identify the feelings that you and others may be experiencing (need to be positive and move to the future)
Nurses are concerned with anthrax and small pox and should have awareness of these diseases
• Need to have vaccine for small pox!
Populations at Greatest Risk for Disruption After a Disaster
Persons living on a low income: including the homeless Non-English speaking persons and refugees
Persons with disabilities; active substance abuse; living alone; new to the area
Institutionalized persons or those with chronic mental illness
Public Health Response to Outbreaks of Illness
The 5 components to a comprehensive public health response to outbreaks of illness are:
Detecting the outbreak
Determining the cause
Identifying factors that place people at risk
Implementing measures to control the outbreak
Educate the public about treatments, health consequences and preventative measures
Triage
The process of separating casualties and allocating treatment on the basis of the victims’ potentials for survival
Highest priority is always given to victims who have life threatening injuries but who have a high probability of survival once stabilized
Second priority is given to victims with injuries that have systemic complications that are not yet life threatening and could wait 45- 60 minutes for treatment
Last priority is given to those victims with local injuries without immediate complications and who can wait several hours for medical attention
Rationale from Saunders
Classifying clients according to their need for care and includes establishing priorities of care; the kind of illness, the severity of the problem, and the resources available govern the process
• Number 1 priority “emergent”: trauma, chest pain, severe respiratory distress or cardiac arrest, limb amputation, acute neurological deficits, and have sustained chemical splashes to the eyes
• Number 2 priority “have urgent needs”: a simple fracture, asthma without respiratory distress, fever, hypertension, abdominal pain, or kidney stones
• Number 3 priority “non urgent”: a minor laceration, sprain, or cold symptoms
Older Adult Health Risks
Top considerations: nutrition, safety, social isolation and depression
Program outcomes: smoking cessation, weight management, diabetic management
Research studies using the tracer or sentinel method to identify clients’ outcomes and client satisfaction surveys can be used to measure outcome standards
• The most common measurement methods are direct physical observations and interviews
Levels of Prevention
Primary- prevention of the initial occurrence of disease or injury; very cost effective (immunizations)
Infant and child safety seat restraint laws have been one of the most effective worldwide
• Opportunities are limited with home health care
Secondary- early identification of disease or disability (physical assessments, school health screenings)
Breast CA screenings can only detect a cancerous growth not inhibit its formation
• Often directed to high-risk populations to be cost-effective
Tertiary- assistance after disease or disability has occurred to prevent further damage (rehabilitation)
Other examples: shelters for battered women, counseling for abused children, etc.
• Children with disabilities that attend public schools
Federal Agencies
U.S. Department of Health and Human Services (USDHHS)
The largest health program in the world, its mission is to enhance the health and well-being of the American people through the following:
• Substance abuse and mental health programs; disease tracking and identification; national safety net programs; identification and correction of health hazards; medical assistance after disasters; promotion of exercise and healthy habits; protection of the nation’s food and drug supply
The National Institute for Nursing Research (NINR) and Healthcare Research and Quality (AHRQ)
This institution is the focal point of the nation’s nursing research activities
Others: Dept. of Labor (includes OSHA), Dept. of Agriculture (includes WIC), Food and Drug Administration, Bureau of Health Professions (divisions for nursing, medicine, dentistry, public health & allied health professions)
Voluntary and private agencies are grouped together as nonprofit home health agencies
• Supported by charities such as United Way, Medicare, Medicaid, other third-party payers
Vulnerable Populations
Have an increased risk to develop adverse health outcomes; and often experience multiple cumulative risks
Vulnerable populations often are more likely than the general populations to suffer from health disparities
• Health disparities across populations groups are: infant mortality, childhood immunization rates and disease-specific mortality rates
Vulnerable Population Groups of Special Concern to Nurses
Poor and homeless people; pregnant adolescents; severely mentally ill individuals
Substance abusers; abused individuals and victims of violence
Persons with communicable disease and those at risk
Persons who are human immunodeficiency virus (HIV positive) or have Hep B or sexually transmitted disease
Behavioral (Lifestyle) Health Risk Assessment
Families are the major source of factors that can promote or inhibit positive lifestyles. It is important to look at risks for the family as a unit
Critical dimensions of lifestyle risks include:
• Value placed on behavior
• Knowledge of the behavior and its consequences
• Effect of the behavior on the family and effect of the behavior on the individual
• Barriers to performing the behavior
It is important to assess the frequency, intensity, and regularity of specific behaviors
It also is important to evaluate the resources available to the family for implementing the behaviors
Modifiable and Unmodifiable Risk Factors
Risk factors that are "unmodifiable," are things that neither you nor your patients can do anything about
Nurses need to know these because they help to define high-risk individuals and groups for whom treating or
Unmodifiable examples include age, gender, race/ethnicity, family or personal history
Evaluating Outcomes
Outcomes can be measured by looking at changes from before and after the intervention to solve the problems
Changes in the following can be used to see the outcomes of the interventions:
• Demographics, Socioeconomic factors, Environmental factors, Individual and community health status
Incidence VS Prevalence
Incidence rate-the frequency or rate of new cases of an outcome in a populations
Provides an estimate of the risk of disease in that population over the period of observation
Prevalence: the number of existing cases in a population at a given time
Community Assessment
Assessing the community health requires the following three steps:
Gathering relevant existing data and generating missing data
Developing a composite database
Interpreting the composite database to identify community problems and strengths
In order to describe the demography of a community the following are used
Age and gender distribution of residents, socioeconomic characteristics and racial distributions
Windshield Survey
The motorized equivalent of simple observation that “will help define the community, the trends, stability, and changes that will affect the health of the community”
The Role of the School Nurse
Primary- monitors students for all of their state-mandated immunizations for school entry
Secondary- screens students for illnesses and providing direct nursing care
Tertiary- cares for children with long-term health needs (asthma, diabetes and disabling conditions)
Occupational Health Nursing
Maintaining employee health; providing assistance to those who are returning to work following illness or injury
Medicare
Provides hospital insurance and medical insurance to persons ages 65+ years, permanently disabled persons and persons with end-stage renal failure
Part A covers: hospital care and home care (home care or hospice- can’t have both), skilled nursing care
Part B covers (non-institutional care insurance): medical care, diagnostic services and physiotherapy
Medicaid
Financial assistance to states and counties to pay for medical services for poor older adults, the blind or disabled and families with dependent children
Women, Infants and Children (WIC)
A supplemental food program administered by the Dept. of Agriculture through the state health departments
Provides nutritious food that add to the diets of pregnant and nursing women, infants, and children < 5 y/o
• Eligibility is based on income and nutritional risk as determined by a health professional
Outreach worker
Makes a special, focused effort to find people with specific health problems for the purpose of ↑their access to health services; evaluate effectiveness find out if successful and use ways to measure success
Epidemiologic triangle
Changes in one of the elements of the triangle can influence the occurrence of disease
Agent- an animate or inanimate factor that must be present or lacking for a disease or condition to develop
• Causive- infectious agents (bacteria, viruses, fungi, parasites)
• Chemical (heavy metal, toxic chemicals, pesticides) or physical agents (radiation, heat, cold, machinery)
Host- a living species (human or animal) capable of being infected or affected by an agent
• Anything capable of being infected- genetic susceptibility
• Immutable (age, sex) and acquired characteristics (immunologic status)
Environment- all that is internal or external and that is influenced and influences the host and/or agent
• Human population distribution (crowding, social support)
• Socioeconomic factors (education, resources, access to care)
Family assessment
Ecomap- represents the family’s interactions with other groups using a series of circles and lines
It is represented by a circle in the middle of the page; other groups are then indicated by circles
• Lines representing the flow of energy are drawn between the circles
An arrowhead at the end of each line indicates the direction of the flow of energy (into or out of the family)
Genogram- a pictorial display of a person's family relationships and medical history
Allows the user to visualize hereditary patterns and psychological factors; to identify repetitive patterns
Prevention Strategies for Violence
Individual and Family levels
Primary: educate on needs of children; teach parenting and stress-reduction techniques
Secondary: assess during routine examination; counsel for at-risk parents; assist with controlling anger
Tertiary: treat for substance abuse
Community Level
Develop resources such as transition housing and shelters [Show Less]