Community HESI Study Guide
Geriatric Community Care
• Understand Polypharmacy and how to teach safe medication administration.
• Diabetic foot
... [Show More] care for Seniors
• What are complications that can arise for un-managed diabetic care
• What in senior living environments can create safety hazards
• Geriatric Grief of a spouse and how to manage it
• Geriatric grief counseling
• Geriatric nutrition
Mental Health (Psych) Community
• Legal\Ethical issues with mental health and communicating to others
• What social organizations are available to help
• How to deal with abuse and communicating ethically
Pediatrics
• Review childhood communicable diseases
• Know Menomune vaccine and how to educate on it
• School Nurse role and how they would deal with
• Child fainting
• Lack of immunizations
• Lead Poisoning
• Conjunctivitis (Safety and understand what it is!) Know how to assess for this condition.
• Adolescent Seatbelt safety
• Bicycle Safety
• Role of School Nurse dealing with Head Lice (Pediculosis)
• School Nurse’s role of how to handle and recognize an endemic in a daycare. (Read chapter 42)
• Use of Medical Homes for pediatrics
• What does Healthy People 2020 say about adolescents in regard to trauma and emergency
• Scroll to the bottom: https://www.healthypeople.gov/2020/topics-objectives/topic/Adolescent-Health/objectives
Vulnerable Populations (Review Table 32.1)!!
• Migrant Workers (Chapter 34) Suggest reading the whole chapter!!
o A migrant farmworker is a laborer whose principal employment involves moving from a home base to another location to plant or harvest agricultural products and lives in temporary housing. Migrant farmworkers may be single or travel with family members.
o An estimated one to three million migrant farmworkers are in the United States.
o Migrant farmworkers are considered a vulnerable population because of their lifestyle and lack of resources.
o Health problems of migrant farmworkers are linked to their work and housing environments, limited access to health services and education, and lack of economic opportunities.
o Migrant farmworkers are faced with uncertainty regarding work and housing, inadequate wages, unsafe working conditions and lack of enforcement regarding legislation for field sanitation and safety regulations.
o Farmworkers are exposed not only to immediate risk of pesticide exposure in the fields, but also to unknown long-term effects of chronic exposure to pesticides.
o When harvesting season is over, the migrant farmworker becomes simultaneously homeless and unemployed. Forced migration to find employment leaves little time or energy to seek out and improve living standards.
o Children of migrant workers may need to work for the family’s economic survival. They are most affected by the disruptive and challenging lifestyle.
• Make sure you read on Occupational and environmental risks (pp. 760-764)
o The migrant farmworker population is defined by their engagement in agricultural work, and an understanding of the occupational health risks and exposures of that work is therefore critical in understanding the health status and healthcare needs of this population.
o Agricultural work ranks as one of the most dangerous industries in the United States.
They often work in extreme heat resulting in heat illness fatalities.
Infectious diseases caused by unsanitary working conditions.
Working conditions, such as standing on ladders, exposed to chemicals, and using machinery without proper education or training produce occupational health risks.
Other injuries include falls; amputations; crush injuries from tractors, trucks or other machinery; injuries related to livestock; acute pesticide poisoning; electrical injuries; and drowning in irrigation ponds and trenches.
Organophosphate (OP) pesticides are known to be potential hazards. This includes not only immediate effects of working in fields that are foggy or wet with pesticides, but also the unknown long-term effects of chronic exposure to pesticides.
• Women’s Health – who is at risk for breast cancer and how risk is assessed (pp. 664-666)
o The Office on Women’s Health works through policy, education and model programs to improve the health of women and girls. This agency has guidelines that includes screening tests and disease specific information for women.
o Although the incidence of Breast cancer is higher in white women than in African American women, the death rate for African American women are higher due to low screening activity, social determinants such as low income and poor health access.
o The researchers also concluded higher rates of other diseases such as obesity contributed to the disparity between races with non-Hispanic whites and non-Hispanic African Americans having higher breast cancer incidences and death rates.
o Secondary prevention that includes screening activities such as mammography every two years after the age of 50, makes a difference in death rates. Family history of breast cancer stratifies a woman into screening between ages 40 and 49.
• Native Americans – Diabetes rates and effect on vision and Endocrine system? https://www.cdc.gov/vitalsigns/aian-diabetes/index.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6329453/
o American Indians have the highest prevalence rates of diabetes of any racial/ethnic group in the United States (US), with certain tribes having the highest rates in the world.
o The American Indian diabetes rate of 16.3% is more than double that of non-Hispanic Whites in the US.
o Multiple factors contribute to the extremely high prevalence of diabetes among American Indians.
Obesity prevalence among American Indians aged 20–74 is 54%, with an 81% prevalence of overweight or obesity.
Low socioeconomic status is also associated with prevalence of type 2 diabetes. American Indians have the highest poverty rate in U.S. at 27% compared to non-Hispanic Whites at 11.6%.
Elements of poverty, such as food insecurity and limited access to healthy food and shifts in consumer diets toward inexpensive, calorie-dense foods, also contribute to diabetes prevalence.
With so many American Indians impacted, and with evidence of type 2 diabetes prevalence increasing in younger populations, adherence to diabetes standards of care and self-management behaviors that impact quality of life and health outcomes is now more vital than ever.
o American Indians are less likely to maintain effective glucose control, more likely to be physically inactive, and least likely to inspect their feet daily compared to other racial/ethnic groups.
o Both the American Diabetes Association and the Indian Health Service (IHS) standards of care for people living with diabetes include:
o recommendations for semi-annual visits to a primary care provider focused on diabetes management
o daily blood glucose monitoring (at least 3 times daily)
o hemoglobin A1C monitoring (every 3 months for those not meeting glycemic goals)
o annual dilated eye exams
o annual comprehensive foot examinations along with daily self-examinations
o semi-annual or annual diabetes education with additional support as needed
o adherence to prescribed medication regimens
o What cultural competence do you need to care for them? Review on spiritual culture.
Spiritual care is unique to the individual’s purpose in life, the fulfilling of that purpose, and living wholeheartedly.
Holistic or whole person care relates to the relationship between body, mind and spirit in a constantly changing environment and involves caring for the soul in a special kind of engagement that goes beyond seeing the physical patient but includes observation of the entire patient.
• Rural Health Care – Chapter 32 pp. 725-732 Review rural resources available
o Barriers to healthcare in rural areas:
Lack of healthcare providers and services
Great distances to obtain services
Lack of personal transportation
Unavailable public transportation
Lack of telephone services
Unavailable outreach services
Inequitable reimbursement policies for healthcare providers
Unpredictable weather and or travel conditions
Inability to pay for care / lack of health insurance
Lack of “knowhow” to procure policy funded entitlements and services
Inadequate provider attitudes and understandings about rural populations
Language barriers (caregivers not linguistically competent)
Care and services not culturally and linguistically appropriate
o Resources available
o Partnership models such as case management and COPHC, have proven to be highly effective in areas with scarce resources and an insufficient number of healthcare providers.
o Partnership models enhance the ability of rural communities to do what they historically have done well (i.e. assume responsibility for the services and institutions that serve their residents).
• African Americans – CV risk and disease rates
o African Americans carry a significantly higher risk for cardiovascular disease than non-Hispanic whites in the United States today, and this is associated with higher rates of obesity, diabetes, hypertension, and ESRD.
Disease/Epidemiology/Conditions
• Tuberculosis transmission
o TB bacteria are spread through the air from one person to another. The TB bacteria are put into the air when a person with TB disease of the lungs or throat coughs, speaks, or sings. People nearby may breathe in these bacteria and become infected.
• Review immunities
o Passive Immunity- newborns via maternal antibodies
o Active immunity- acquired after exposure to a disease or via immunizations
o Cross-immunity- immunity to one pathogen confers immunity to another such as cowpox providing immunity to smallpox
o Herd-immunity- present in a population, the higher the immunity decreases risk of disease (use of immunizations); increasing immunizations reduces risk of exposure to disease of those not immunized
• Cardiovascular Disease p.660-661
o The leading cause of death for both men and women, African Americans, American Indians or Alaska natives, Hispanics and whites in the United States.
o Coronary heart disease is the most common type of Heart Disease.
• What are acceptable BP measures
o Normal BP is defined as <120/<80 mmHg.
• What does Health People address BP Screening and monitoring?
o About 23 of the Healthy People 2020 objectives focus on cardiovascular disease.
o Community health educational campaigns must emphasize the significance of CVD and behavioral changes to reduce risk factors.
• What would secondary prevention look like when dealing with hypertension
o Primary prevention- Collaborating with a variety of organizations such as the American Heart Association to design and implement interventions aimed at reducing women’s risk for cardiovascular disease.
o Secondary Prevention- Establishing screening clinics in community settings for cholesterol and hypertension.
o Tertiary prevention- Developing a community-based exercise program for a group of women who have cardiovascular disease.
• Review Heart failure lab results – What would be your interventions?
o Laboratory tests that may be ordered include: B-type natriuretic peptide (BNP) or N-terminal pro-BNP—measure the concentration of a hormone produced by the left ventricle (the main pumping chamber of the heart) to help diagnose and grade the severity of heart failure. Levels will be significantly higher in patients with Heart Failure.
o Monitor HR, BP, peripheral pulses, I/O, urine output
o Inspect skin for cyanosis and pallor
o Note changes in sensorium- lethargy, anxiety, confusion
o Assess for abnormal heart and lung sounds
o Encourage a low sodium diet and adherence to medication regimen
• Define community dermatitis
o Irritation of the skin from pathogens or contact agents within the community.
• Anthrax
• Agent: Bacterium B. anthracis
• Treatment- Doxycycline or Cipro
• Transmission by spores in animals and soil
– At risk; people working with dead animals
– Presents as a wound that has an irritated brown/black center. It then has a 5-20% mortality rate.
– ***Fatality rate increases to 95% in 48 hours if inhaled. Sent in powder form for Bioterrorism.
• Four routes of infection:
– Inhalation
– Cutaneous (most common)
– Eating uncooked or undercooked contaminated meat
– Injection
• Incubation: 2-6 days
• Skin irritation and itching with creation of eschar
Community Related Subjects
• Review OSHA Mandates
o The Occupational Safety and Health Act of 1970 created OSHA, which sets and enforces protective workplace safety and health standards.
o There are OSHA mandates for construction, agriculture, maritime and general industry. Employers also must comply with the General Duty Clause of the OSH Act, which requires them to keep their workplaces free of serious recognized hazards.
• Natural disaster preparedness
The Four Phases of Emergency Management
Mitigation
Preventing future emergencies or minimizing their effects
Includes any activities that prevent an emergency, reduce the chance of an emergency happening, or reduce the damaging effects of unavoidable emergencies.
Buying flood and fire insurance for your home is a mitigation activity.
Mitigation activities take place before and after emergencies.
Preparedness
Preparing to handle an emergency
Includes plans or preparations made to save lives and to help response and rescue operations.
Evacuation plans and stocking food and water are both examples of preparedness.
Preparedness activities take place before an emergency occurs.
Response
Responding safely to an emergency
Includes actions taken to save lives and prevent further property damage in an emergency situation. Response is putting your preparedness plans into action.
Seeking shelter from a tornado or turning off gas valves in an earthquake are both response activities.
Response activities take place during an emergency.
Recovery
Recovering from an emergency
Includes actions taken to return to a normal or an even safer situation following an emergency.
Recovery includes getting financial assistance to help pay for the repairs.
Recovery activities take place after an emergency.
• What are Gatekeepers
o Formal or informal community leaders who create opportunities for nurses to meet diverse members of the community.
o Gatekeepers can offer credibility to the nurse. For example, a church pastor may act as a gatekeeper by introducing a nurse to the congregation, thus increasing the likelihood that that the church members will trust the nurse enough to provide information or to serve as partners in the assessment and throughout any program planning, intervention and evaluation.
• Community risk findings
o CRA (Community Risk Assessment) is a participatory process for assessing hazards, vulnerabilities, risks, ability to cope, preparing coping strategies and finally preparing a risk reduction options implementation plan by the local community.
o Community Risk Reduction is community focused and employs the full spectrum of risk-reduction tools. It allows you to identify your high-risk neighborhoods, determine your hazards, build partnerships, improve safety, and form effective strategies with limited resources.
• Reliability and Validity
o Reliability- the degree to which the result of a measurement, calculation, or specification can be depended on to be accurate; its consistency or repeatability.
o Validity- refers to how accurately a method measures what it is intended to measure and how exact the measurement is.
• Assess Income for eligibility
o Modified Adjusted Gross Income (MAGI) is used to determine the programs and savings you qualify for. For most people, it’s identical or very close to Adjusted Gross Income (AGI). MAGI is not a line on your federal tax return.
o MAGI is used to determine financial eligibility for social safety net programs. By using one set of income counting rules and a single application across programs, the Affordable Care Act made it easier for people to apply and enroll in the appropriate program.
• Income Proxy? **This is not in your text, but it is a way to measure determine whether a household, or an individual, is
eligible for support from social safety net programs.
• Levels of Preventions
1. Primary (no pathology and + susceptibility)
• Susceptible to disease
• No pathology is present
• Pre-pathogenesis
o Example: Immunizations, nutrition education and counseling, prenatal vitamins
2. Secondary (disease acquired + no diagnosis)
• Person has acquired disease
• No diagnosis yet
• Health screenings are needed
o Example: Health screenings of people exposed to person known to have TB.
3. Tertiary (focus on limiting disability and rehabilitation)
• Interventions aimed at limiting disability and rehabilitation
• Example: Treatment for patient with active TB
• Calculate Incidence, Prevalence, Death Rate,
• Morbidity vs Mortality
o Morbidity- Frequency of illness in a defined population during a specific interval.
o Mortality- Frequency of death in a defined population during a specific interval.
• Pull or assess morbidity data from a chart.
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