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Community-Based Nursing
Focus: Health of individuals, families, and groups within a
community.
Client: Individuals, family, or group of individuals
Activity: Provision of direct primary care in the settings
where individuals and families live, work, and "attend"
(schools, camps, parishes)
Social determinants
Impact whether someone is able to attain/maintain health;
(Income, social status, education, literacy, environment,
support networks, gender, culture, available health care)
Disparities
Gaps in care experienced by one population compared to
another
Florence Nightingale
Studied nursing in Germany then established nursing
schools in England
District Nursing
A mode of service delivery in which a community health
nurse is responsible for addressing all the health needs of a
given population
Lemuel Shattuck
First use of demographic data to look at population health
birth and death records
Dorthea Dix
Established first hospital for the mentally ill in the US
Clara Barton
Civil war nurse: Established the American Red Cross
(providing aid for natural disasters)
Lillian Wald
Mary Breckenridge
Pioneer in nurse-midwifery; established the Frontier Nursing
Service - nurses traveled on horseback to reach mothers in
the hills of Kentucky
Nongovernment Agencies
Agencies that acquire resources from private sources to
assist others
Philanthropic Agencies
Organization that uses endowments or private funding to
address the needs of individuals, families, and populations
Health
A quality, an ability to adapt to change or a resource to
help cope with challenges and processes of daily living
Well Being
A subjective perception of full functional ability as a human
being
Learning Theory
Goal established and reinforced by nurse; Rewards given
for partial accomplishment
Epidemiology
The study of the distribution and determinants of health
and illness
Rate
Primary measurement used to describe either the
occurrance or the existence of a specific state of health or
illness
Outbreaks
Epidemic usually limited to a localized increase in the
incidence of the illness
John Graunt
Father of demographics. recognized importance of
recording birth and death rates and age structure of human
population
William Farr
John Snow
Used mapping and rates as an objective measure to
compare populations
Epidemiological Triad
Model based on the belief that health status is determined
by the interaction of the characteristics of the host, agent,
and environment
Wheel of Causation
Epidemiologic model that deemphasizes the agent as the
sole cause of disease while emphasizing the interplay of
physical, biological, and social environments
Web of Causation
Epidemioligcal model that strongly emphasizes the concept
of multiple causation while deemphasizing the role of
agents in explaining illness
Rate
Primary measure used to describe either the occurrence or
existence of a specific state of health or illness within a
group during a specific time frame
Ratio
Fraction that represents the relationship between two
numbers; Divide one quantity by another quantity
Ex: # boys in class/# girls in class
Proportion
Type of ration
Ex: # boys/ total students
Crude Rate
Adjusted Rate
Controls for differences between populations-used for
comparison
Incidence
Measures probability that people without a condition will
develop the condition over time; measures pace of new
illness
Prevalence
Existence of a condition during a period/interval at a
specific point; Studies number of people diagnosed in the
past and length of illness; Longer length=greater the
prevalence-indicates burned of community
Mortality Rates
Crude mortality: probability of dying from any cause; #
deaths in a year/total population
Incidence Density
Used when unequal periods of observation for study
subjects; Accounts for people who die, drop out of a study,
or acquire an illness
Attributable Risk
The risk of a condition occurring in an exposed group that
is attributable to an exposure, not other factors
Sensitivity
Ability of the test to correctly identify people who have the
health problem
Specificity
Specific incidence and prevalence rates calculated based
on specific characteristics (demographic data), variations
based on location and variations in time (short-outbreak,
periodic- seasonal, long-years)
Incidence Rate
#new cases during time period/population at risk in the
same time period
Causality
Strengths of Association
Consistency
Temporality
Plausibility
Biological Gradient
Case Studies
In-depth analysis of individual or group, often first clue to a
problem
Cohort Studies
(Longitudinal Studies) Monitor over time to find
associations between risk factors and health;
Minimize selection bias;
Relative risk is the ratio of disease incidence in an exposed
population;
Indicates strength of exposure to illness causality
Case Control
Compare group with health problems (cases) to group
without (control)
Key Informants
Persons knowledgeable about specific aspects of a problem
and the communities current and past attempts to address
it
Stakeholders
An individual, organizational, or group that has interest
(stake) in a specific community health issue or the outcome
of a community level intervention
Gantt Chart
Visual of the sequence of steps to achieve objectives;
Developed in planning stages to identify steps, a tool for
scheduling tasks, monitor progress
Community of Interest
People and groups/aggregate that will be affected by
change; Those that will help bring about change
Sustainability
How to maintain change, support system in place
Social Justice
Health care is a risk; Address root cause of illness
Health Equities
Requires elimination of health disparities in living and
working conditions
SMART objectives
S- Specific
M- Measurable
A- Achievable
R- Relevant
T- Time
Coalition Building
Community members participate in planning and
implementing changes at the community level; Need clear
mission, goals, objectives, expectations, leadership,
accountability, and should be heterogenous
Community Readiness
Web of Causation
Identify multiple factors that contribute to chronic disease
Levers of Change
Increase driving/reinforcing forces
Decrease restraining/resisting forces
Geopolitical Population
Has identified designated boundaries with the same
governing structure
Phenomenological Population
Group with common interests or beliefs who have
interpersonal and intrapersonal connection
Community of Solution
Formed by aggregate to address a health problem
In 1988 the Institute of Medicine (IOM) published a report
on the future of public health and its mission that defined
public health:
What society does collectively to ensure the conditons in
which people can be healthy.
Community-oriented care.
T/F
Primary health care is the chief means of delivery of
health care in the United States.
False
External evidence:
Includes research and other evidence
Internal evidence:
Includes the nurse's clinical experiences and client's
preferences.
care workforce.
- Use EBP to evaluate effectiveness, accessibility and
quality of personal and population-based services.
POEM
"Patient oriented evidence that matters." Proposed by
Shaughnessy, Slawson and Bennett (1994), criteria for
evaluating the usefulness of evidence. In general, the
reader should ask "What are the results? Are they
important? Are the results valid? How can the results be
applied to client care?"
Systematic review:
A method of indentifying, apparaising and synthesizing
research evidence. The aim is to evaluate and interpret all
available research that is relevant to a particular research
question. Is usually done by more than one person and
describes the methods used to search for and evaluate the
evidence.
Meta-analysis:
"A specific method of statistical synthesis used in some
systematic reviews, where the results from several studies
are quantitatively combined and summarized.
Integrative review:
A form of a systematic review that does not have the
summary statistic found in the meta-analysis because of
the limitations of the studies that are reviewed (e.g small
sample size of the population)
Narrative review:
A review is done on published papers that support the
reviewer's particular point of view or opinion and is used to
provide a general discussion of the topic reviewed. This
review does not often include an explicit or systematic
review process.
A "paradigm shift"
A change from old ways of knowing to new ways of
knowing and practicing.
4 Ways of Knowing
Empirical knowledge, personal knowledge, aesthetic
knowledge, and ethical knowledge.
Empirical knowledge
The science of nursing
Aesthetic knowledge
The art of nursing
Personal knowledge
interpersonal relationships and caring
Ethical knowledge
Moral and ethical codes of conduct usually established by
professional organizations.
Nightingale's vision
Trained nurses and a model of nursing education
influencing the development of professional nursing, and
indirectly, public health nursing in the United States.
Inspired by the poorly educated, untrained and often
unreliable healthcare workers of the time.
District nursing
The Kaiserwerth Lutheran deaconesses incorporated care
of the sick in the hospital with client care in their homes.
William Rathbone
Nightingale's contemporary and friend, British
philanthropist. Founded the first district nursing
association.
Visiting Nurses:
Became the key to communicating the prevention
campaign, through home visits and well-baby clinics.
Visitng nurses emphasized education of family members in
the care of the sick and in personal and environmental
prevention measures such as hygiene and nutrition.
Settlement Houses
Neighborhood centers that became hubs for health care,
education and social welfare programs.
Lillian Wald
Established leader of public health nursing during it's early
decades. Known as the First Public Health Nurse in the US.
She persuaded the American Red Cross to sponsor rural
health nursing services across the country. Beginning in
1909, Walkd worked with Dr. Lee Frankel of MetLife to
implement the first insurance payment for nursing services.
She convinced business owners that keeping working
people and their families health increased productivity.
Lina Rogers
A Henry Street Settlement resident that became the first
school nurse, worked with children in New York City schools
Frances Root
The first trained nurse in the United States, who was
salaried as a visiting nurse.
Typologies
List of types, which involve classifying communities by
category rather than single definitions.
"Communities of place"
In this type of community, interactions occur within a
specific geographic area. Neighborhood and face-to-face
communities are two examples of this type of community.
Aggregate:
A collection of individuals who have in common one or
more personal or environmental characteristics.
Population-centered practice:
seeks healthful change for the whole community's
benefit.Although the nurse may work with individuals,
families or other interacting groups, aggregates, or
institutions or within a population, the resulting changes
are intended to affect the whole community.
9. Social support
10. Leadership development
Data gathering:
the process of obtaining existing, readily available data.
Data Generation
Informant interviews
i.e focus groups, directed talks with selected members of a
community about community members or groups and
events
Participant observation
The deliberate sharing in the life of a community
Four methods of generating direct data:
Informant Interview, focus groups, participant observation
and windshield studies
Informant interviews
i.e focus groups, directed talks with selected members of a
community about community members or groups and
events
Participant observation
The deliberate sharing in the life of a community
Community
A collection of people who interact with one another and
common interest forms a unity
Geographic community
A group of people usually defined by geographic
boundaries
community of solution
a group of people who come together to solve one problem
- shape and size may vary depending on problem
aggregate
a mass of individuals who are considered as a whole but
are loosely connected
population
all people occupying an area or may also refer to people
who share one or more characteristics
health
a holistic state of well-being including a soundness of mind,
body, spirit
levels of Prevention
Primary example immunization
Secondary example breast screening with mammography
Tertiary example diabetes education after diagnosis
Florence Nightingale
Author of modern day nursing
Lillian Wald
Margaret Sanger
a nurse who openly opposed the Cromstock act, arrested;
her defiance lead to International Planned Parenthood
Federation
cultural sensitivity
recognizing that culturally based values, beliefs, and
practices influence people health's and lifestyles and
should be considered in plans for service
epidemiological triad
host
agent
environment
chain of causation
begins by identifying the reservoir, then portal of exit, then
the agent, then the portal of entry - all set by the
environment
immunity
ability to resist particular infectious disease causing agent active, passive, cross-immunity
herd immunity
risk
the probability that a disease or health problem will occur
census data
data taken from the population - in the US every 10 years
reportable diseases
requirements to report certain diseases to local health
authority
descriptive epidemiology
observe or describe a pattern of disease in a population
rates
statistical measures expressing proportion of people with a
given health problem among a population at risk
prevalence
at a given point of time all the people with a particular
health condition
prevalence rate
number of people with characteristic/total population
incidence
all new cases of disease or health condition within a period
of time
incidence rate
number of new cases of disease or health condition/total
number at risk for developing disease. Note: once a person
has the disease/condition and there is not the possibility of
getting the disease/condition again then the risk is not
there and that number is subjected from the total
population.
mortality rate
sum of deaths in given population at a given time
analytic epidemiology
beyond simple description, seeks to determine associations
DOT
direct observed therapy - client takes the medication in the
presence of health care worker
quarantine
period of forced isolation of a person exposed to
communicable disease during the incubation period to
prevent the spread of the disease
ecological perspective
total relationship or patterns of relationship among people
and environment
built environment
structures built by humans within the environment - can be
used positively or negatively - urban vs rural
epidemic
disease occurring that exceeds the normal or expected
frequency in a community
pandemic
worldwide distribution of disease
endemic
naturally occurring in population
communication
transferring meaning and enhancing understanding
health literacy
the ability to read, write, understand, and act upon health
information
collaboration
purposeful exchange between nurses, clients, health
professionals with shared values, mutual participation, and
joint effort
contracting
negotiating a working agreement between two or more
parties with shared understanding and mutual consent over
a period of time.
health promotion
behavior motivated by a desire to increase well-being and
actualize human potential (Pender, Murdough, & Parsons,
2006)
social marketing
influencing behavior in targeted audiences
social justice
advocacy
pleading a case for another or championing a cause
Community
Group of people sharing something, interacting with one
another. May exhibit commitment with one another and
may share geographic boundary. E.g., a NORC, a school,
NYU students.
Population
Group of people having at least one thing in common and
who may or may not interact with one another. E.g., nightshift workers, children with CF.
Community-focused nursing
Delivery of nursing care to improve health of an entire
community - bigger picture, deals with prevention and
population at systems level.
Population-focused care
Interventions for a defined "at risk" population (e.g. people
with hypertension, weight problems)
Acute Care
Provider control
Predictable routine
Hospital policy
Resources available
Collaboration and consultation
Controlled PT compliance
Standardized care
Health
"extent to which an individual or group is able on the one
hand, to realize aspirations and satisfy needs; and on the
other hand, to change or cope with the environment." WHO
Levels of Care
Individual - downstream
Family
Community
Population - upstream
Levels of Prevention
Primary
Secondary
Tertiary
Primary Prevention
PREVENTION
Stay well and avoid problem
Reduction of risk factors before occurrence of disease
condition/injury
E.g., exercise, brushing teeth, condoms, immunizations,
nutrition.
Secondary Prevention
PREVENTION/MAINTENANCE
SCREENINGS/EARLY DX
Early detection of potential for disease/condition or
existence of such while asymptomatic.
E.g., screening programs - Pap smears, mammograms,
colonoscopy.
Tertiary Prevention
RESTORATIVE
Treatment of existing or symptomatic disease to
prevent/delay progress.
Treatment after Dx, e.g, cardiac/stroke rehab.
Assurance
Ensuring healthy populations
Appropriate and accessible services for all
Healthful physical environment
Stable ecosystem
Strong, supportive, non exploitive membership
Extensive participation in decision making
Members' basic needs provided for.
Access to resources and opportunities for interaction
Sustainable vital economy
Maintain connectedness with cultural and biological
heritages
Provide governance structures that promote health.
ADPIE:
Assessment
Diagnosis (written in different format for the community)
Planning
Implementation
Evaluation
Community Assessment
Population assessment
Primary informants
Gaining entry (Kauffman's 5 phases)
Collecting data
IOSFCW
7 methods
Informant interviews
Observation
Secondary analysis of existing data
Focus groups
Community forums
Windshield surveys
Community Diagnosis
Risk of X
Among X group/population
Implementation Phase
Action phase
Role of community health nurse
Social change, community action
Evaluation
formative - changes made during process
summative - at end, related to outcomes
Health education
"The pedagogy of the oppressed"
Community empowerment (WHO)
Community as partner model (Betty Neuman)
Community as Partner
Community core
8 interacting community subsystems
Community stressors/boundaries
Normal line of defense LOD = status quo
Flexible line of defense - protection vs stressors
Lines of resistance LOR - strengths, resources, coping
mechanisms
Health Education
Planned learning experiences based on sound theories to
provide individuals, groups, communities opportunity to
learn info and skills to make quality health decisions
Marine Hospital
Established by Congress
Facility became the Public Health Service
Florence Nightingale
Established a training school for nurses, Established
sanitary nursing care units. Founder of modern nursing.
began professional education of nursing.
Clara Barton
Established The Red Cross, Launched the American Red
Cross in 1881. An "angel" in the Civil War, she treated the
wounded in the field.
Lillian Wald
Mary Breckinridge
Founder of the Frontier Nursing Service, in Leslie County,
KY; 1st midwifery program in U.S.
Sheppard-Towner Act
U.S. Act of Congress providing federal funding for maternity
and child care, a response to the lack of adequate medical
care for women and children
Community-Oriented Nursing
Client: Community
Focus: Health of community as a "whole"
Community-Based Nursing
Client: Individual, family, or groups
Focus: Individuals, families, and groups within the
community
Epidemiological Triangle
Host - Agent - Environment and (Vector)
Infant Mortality
# infants (< 1 yr.) specific year / # live births in the same
year
Attack Rate
# people developing a certain disease / # people at risk
Better nutrition, water, antibiotics, immunizations. PUBLIC
HEALTH.
Life Expectancy - U.S.
What factors/events resulted in the 21+ additional years of
life from 1900-1950???
What factors/events resulted in the 7 additional years of
life from 1950-1990?
1. Upstream
2. Downstream
There are two views of the health care picture
We need to question the way we have thought of health
and health care...
Should we focus on treatment of illness or prevention of
disease in the first place?
How should we act?
______ or ______
1. Microscopic
2. Medical Model
3. Downstream
_______ approach to solving community health problems
(the _____ or _____):
- Individual (family) response to health and illness
- Emphasizes behavioral responses to illness or lifestyle
patterns
- Nursing interventions aimed at the individual
------Changing lifestyles
------Changing perceptions or belief system
- The individual is the locus of change
- Focuses on the "cure"
1. Macroscopic
2. Public Health
3. Upstream
______ approach to solving community health problems
(______ or _______)
- Interfamily and intercommunity themes
- Emphasizes social, economic, and environmental
precursors of illness
- Nursing interventions may include modifying social or
environmental variables
- May involve social or political action
- society (social system) is the locus of change
- focuses on "prevention"
1.
2.
3.
4.
5.
6. Cues to action
7. Self-efficacy
_________:
- focuses on a person's perceptions of a threat or a health
problems and related appraisal of a recommended
behavior to elicit change
- developed in the 1950s and was one of the first models
using concepts and assumptions from behavioral sciences
to examine health behaviors
------- Addresses attitudes and beliefs of individuals
------- Focus was on increasing the use of preventive health
services
- Primary assumptions of the model are that people fear
disease and that health actions are motivated based on the
extent of the fear and belief in benefits obtained by
preventative action
- Five (Six?) Primary Constructs:
1.
2.
3.
4.
5.
6.
1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
Transtheoretical Model (Stages of Change):
1. _______: No intention to change behavior in the next 6
months
------May be lack of information about consequences or
previous failure.
2. _______: Individual intends to change behavior in the next
6 months.
------Weighs pros and cons
3. _______: Individual intends to act within the next month
and has taken steps toward change
------Has a plan of action
4. _______: Individual has changed behavior for less than 6
months
------Change is sufficient to reduce disease risk.
5. _______: Individual has changed behavior for more than 6
months.
------Tries to prevent relapse
------Phase may last months to years
1. Smoking cessation
2. Injury prevention
3. RNs assisting families obtain health insurance
Examples for applying Transtheoretical Model in nursing:
1.
2.
3.
1. Health Disparities
2. Health and social justice
Examples of applying critical social theory:
1.
2.
1. Purposeful actions
2. Processes
3. Responses
4. Behaviors
Definitions of Health:
Health consists of:
_____, ______, _____, or _____ that leads to: "soundness,"
"wholeness," or "well-being"
1. Physical Environment
2. Social Environment
3. Individual Behavior
4. Biology & Genetics
5. Health Services
6. Policy making
Determinants of Health:
Health Outcomes due to:
1.
2.
3.
4.
5.
6.
Physical Environment
Determinants of Health - Examples of ______ factors:
- Natural environment (ie plants, weather, climate change)
- Worksites, schools and recreational settings
- Housing, homes, neighborhoods
- Exposure to toxic substances
- Physical barriers
- Aesthetic elements (ie good lighting, trees, parks)
Social Factors
Determinants of Health - Examples of ______ factors:
- Availability of resources (ie educational and job
opportunities, living wages, healthful foods)
- Social norms and attitudes
- Exposure to crime and violence
- Social interactions
- Exposure to emerging technology (ie the Internet)
- Transportation options
Individual Behaviors
Determinants of Health - Examples of ______ factors:
- Diet
- Physical activity
- Alcohol, tobacco and other drug use
- Sexual behavior
- Hand washing
Health Service
Determinants of Health - Examples of ______ factors:
- Barriers (lack of availability, high cost, lack of insurance,
language issues)
------- Unmet health needs
------- Delays in receiving care
------- Inability to get preventive services
------- Preventable hospitalizations
Policy Making
1. Life expectancy
2. Health life expectancy
3. Years of potential life lost
4. Physically and mentally unhealthy days
5. Self-assessed health status
6. Limitation of activity
7. Chronic Disease Prevalence
Indicators of General Health Status:
1.
2.
3.
4.
5.
6.
7.
Community
___________:
- It can be a physical place or a geopolitical community.
- Has boundaries
- It can be a relational, interactive group. - A community
with no physical boundaries. A phenomenological
community is abstract. Churches, universities, online
groups are examples
Community
__________:
"A collection of people who interact with one another and
whose common interests or characteristics form the basis
for a sense of unity or belonging." (Nies and McEwen,
2011)
Community
__________:
"A group of people who share something in common and
interact with one another, who may exhibit a commitment
to one another and may share a geographic boundary."
1. People
2. They must interact with each other in some way
3. Something in common: an interest, a geographical
location, a commitment
A community has to have:
1.
2.
3.
1. Primary Prevention
2. Secondary Prevention
3. Tertiary Prevention
Levels of Prevention:
1.
2.
3.
Primary Prevention
_______ level of prevention
- activities preventing a problem before it occurs
- Health promotion
- Specific protection
- Immunizations
Secondary Prevention
________ level of prevention
- Early detection and prompt intervention
- Screening
- Early referral for treatment
- Screening for STDs
Tertiary Prevention
_______ level of prevention
- Focus on limitation of disability and rehabilitation
- Prevention progression of disease
- Reduce the effects of the disease
- Teaching insulin administration
Community-based nursing
___________:
o Nursing of individuals and families to improve their
health
o Goals: Help them manage illness while they move among
health care settings
o Promote self-care and rehabilitation; prevent disease
o Processes: NP; diagnosis and treatment
2.
3.
4.
5.
6.
Clinical Nursing
_________:
o Goal: improve the health of patients
o Clients: Patients of the health care system
o Processes used: nursing process, treatment and patient
care procedures
o Settings: inpatient
1.
2.
3.
4.
5.
6.
Surveillance
Disease and other health event investigation
Outreach
Screening
Case finding
Referral and Follow-up
7. Case management
8. Delegated functions
9. Health Teaching
10. Counseling
11. Consultation
12. Collaboration
13. Coalition Building
14. Community Organizing
15. Advocacy
16. Social Marketing
17. Policy and enforcement
Public Health Interventions:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
12.
13.
14.
15.
16.
17
Surveillance
Describes and monitors health events through ongoing and
systematic collection, analysis and interpretation of health
data for the purpose of planning, implementing and
evaluating public health interventions
Outreach
Locates populations of interest or populations at risk and
provides information about the nature of the concern, what
can be done about it, and how services can be obtained
Screening
Identifies individuals with unrecognized health risk factors
or asymptomatic disease conditions in populations
Case finding
Locates individuals and families with identified risk factors
and connects them with resources
Case Management
Optimizes self-care capabilities of individuals and families
and the capacity of systems and communities to coordinate
and provide services
Delegated Functions
Direct care tasks a registered professional nurse carriers
out under the authority of a health care practitioner as
allowed by law
Health Teaching
Communicates facts, ideas, and skills that change
knowledge, attitudes, values, beliefs, behaviors, and
practices of individuals, families, systems, and/or
communities
Counseling
Establishes an interpersonal relationship intended to
increase or enhance capacity for self-care and coping with
a community, system, and family or individual
Consultation
Seeks information and generates optional solutions to
perceived problems or issues through interactive problem
solving with a community, system, and family or individual
Collaboration
Commits two or more persons or organization to achieve a
common goal through enhancing the capacity of one or
more of the members to promote and protect health
Coalition Building
Promotes and develops alliances among organizations or
constituencies for a common purpose
Community Organizing
Helps community groups to identify common problems or
goals, mobilize resources, and develop and implement
strategies for reaching the goals they collectively have set
Advocacy
Plead someone's cause or act on someone's behalf, with a
focus on developing the community, system, and individual
or family's capacity to plead their own cause or act on their
own behalf
Social Marketing
Utilizes commercial marketing principles and technologies
for programs designed to influence the knowledge,
attitudes, values, beliefs, behaviors, and practices of the
population of interest
John Snow
_______: Father of epidemiology
1. Pasteur
2. Lister
3. Koch
____, _____, _____: On "germs" and disease causation (late
1800s)
1. Edward Jenner
2. Edwick Chadwick
History of Public Health Nursing:
Pre 1850: Home visiting to sick as an act of charity.
- ______ observed people who worked around cattle were
less likely to have smallpox.
1. John Snow
2. Florence Nightingale
3. Pasteur, Lister, Koch
4. Lilian Wald
5. Mary Brewster
History of Public Health Nursing:
1850-1900: Home visiting to sick
- _______ demonstrated that cholera was transmissible
through contaminated water.
-________ - credited with establishing "modern nursing."
- ________: On "germs" and disease causation (late 1800s)
- In 1893, nurses _______ ("mother of community nursing")
and _______ established a district nursing service on the
lower east side of New York City called The House on Henry
Street.
1. 1900-1960s
History of Public Health Nursing:
________:
- Nursing in community centers for the poor
- Communicable disease control
- Communicable disease control/immunization
- Rise in PHN, home visits, school and OH nursing
1. 1960-1980
History of Public Health Nursing:
________: Care provided in public health clinics
1. 1980s-present
History of Public Health Nursing:
_________:
- Health promotion and education
- Health care access improvement
1. Poverty
2. Violence
3. HIV/AIDS
4. TB
5. Bioterrorism
Public/Community Health Nursing Today in U.S.
- Concerned with contemporary problems such as _____,
______, ______, _______, and _______.
- Practice is everywhere in public health agencies, schools,
occupational settings, community-based agencies, etc.
Healthy People
__________:
- provides science-based, 10-year national objectives for
improving the health of all Americans. For 3 decades, this
has established benchmarks and monitored progress over
time in order to:
o Encourage collaborations across communities and
sectors.
o Empower individuals toward making informed health
decisions.
o Measure the impact of prevention activities.
- Vision: A society in which all people live long, healthy lives
Community
Group of people and institutions that share geographic,
civic, and/or social parameters
Community-Based Nursing
Focus of Care (FOC):
Individuals, families
Nursing Activities (NA):
Illness care: Management of acute and chronic conditions
in settings where individuals, families, and groups live,
work, and "attend" (schools, camps, prisons)
Community-Oriented Nursing
FOC:
At-risk individuals, families, and groups
Community
NA:
Health care: Determining health needs of a community,
and intervening at the individual, family, and group level to
improve the collective health of the community
Ethical Considerations
The Public Health Code of Ethics identifies the ethical
practice of public health.
Preventing harm
doing no harm
promoting good,
respecting both the individual and community rights
respecting autonomy and diversity
providing confidentiality
competency
trustworthiness
advocacy
Advocacy
Epidemiology
Study of health-related trends in populations for the
purpose of disease prevention, health maintenance, and
health protection
Relies on statistical evidence to determine the rate of
spread of disease and the proportion of people affected.
Used to evaluate the effectiveness of disease prevention
and health promotion activities and to determine the
extent to which goals have been met.
Provides broad understanding of the spread, transmission,
and incidence of disease and injury. This information is an
important component of community assessment and
program planning.
Involves the study of the relationships among an agent, a
host, and an environment (referred to as the
epidemiological traingle).
Epidemiological triangle
The Agent is the animate or inanimate object that causes
the disease.
Chemical Agents: Drugs, Toxins
Physical Agents: Noise, Temperature
Infectious Agents: Viruses, Bacteria
The host is the living being that is affected by the agent.
Susceptible Host: Age, Gender, Genetics, Ethnicity,
Immunological status, Physiological state, Occupation
The environment is the setting or surrounding that sustains
the host.
Physical Environment: Geography, Water/food supply,
Presence of reservoirs/vectors
Social Environment: Access to health care, High-risk
working conditions, Poverty
Epidemiological Calculations
Incidence: number of new cases in the population at a
specific time/population total X 1,000 = per 1,000
Prevalence: number of existing cases in the population at a
specific time/ population total X 1,000 = per 1,000
Crude Mortality Rate: Number of deaths/population total X
1,000 = per 1,000
Infant Mortality Rate: Number of infant deaths before 1
year of age in a year/numbers of live births in the same
year X 1,000 = per 1,000
Attack Rate: Number of people exposed to a specific agent
who develops the disease/total number of people exposed
Epidemic
When the rate of disease exceeds the usual level of the
condition in a defined population.
Disease Prevention
Levels Of Prevention Focus
Primary Prevention: Prevention of the initial occurrence of
disease injury
Nutrition education
Family planning and sex education
Smoking cessation education
Communicable disease education
Education about health and hygiene issues to specific
groups (day care workers, restaurant workers)
Safety education (seat belt use, helmet use)
Prenatal classes
Providing immunizations
Advocating for access to health care, healthy environments
Disease Prevention
Levels Of Prevention Focus
Secondary Prevention: Early detection and treatment of
disease with the goal of limiting severity and adverse
effects
Community assessments
Disease surveillance (communicable diseases)
Screenings
*Cancer (breast, cervical, testicular, prostate, colorectal)
*Diabetes mellitus
*Hypertension
*Hypercholesterolemia
*Sensory impairments
*Tuberculosis
*Lead exposure
*Genetic disorders/metabolic deficiencies in newborns
Control of outbreaks of communicable diseases
Disease Prevention
Levels Of Prevention Focus
Tertiary Prevention: Maximization of recovery after an
injury or illness (rehabilitation)
Nutrition counseling
Exercise rehabilitation
Case management (chronic illness, mental illness)
Physical and occupational therapy
Support groups
Exercise for hypertensive clients (individual)
Community
Group of people sharing something, interacting with one
another. May exhibit commitment with one another and
may share geographic boundary. E.g., a NORC, a school,
NYU students.
Population
Group of people having at least one thing in common and
who may or may not interact with one another. E.g., nightshift workers, children with CF.
Community-focused nursing
Delivery of nursing care to improve health of an entire
community - bigger picture, deals with prevention and
population at systems level.
Community-based nursing
Nursing care provided outside of acute care setting. Care
for families, individuals within a community. At individual,
"hands on" level. Does not require public health
background.
Population-focused care
Interventions for health promotion, disease prevention to
shape a community's overall health status.
Acute Care
Provider control
Predictable routine
Hospital policy
Resources available
Collaboration and consultation
Controlled PT compliance
Standardized care
Health
"extent to which an individual or group is able on the one
hand, to realize aspirations and satisfy needs; and on the
other hand, to change or cope with the environment." WHO
Eudaimonistic Model
HOLISTIC
UPSTREAM
Greek origins. R/t Maslow's hierarchy of needs.
MOST HOLISTIC
Health = actualization/realization of complete fulfillment
and development. Illness impedes/prevents selfactualization.
Aim to redirect thinking away from mechanistic view
toward holistic view.
HOLISM, UNITY, INDIVIDUALITY
Adaptive Model
ABLE TO ADAPT
Medicine beyond treatment of disease: from writings of
Dubos.
Health means ability to adapt to a changing environment.
Disease is failure to adapt.
How flexible is someone in a changing environment?
Role-performance Model
ABLE TO DO JOB
Medical sociology, work of Parsons.
Person is healthy if they can perform their job.
Shapes health policies of military, industry.
Limited since one person may have many roles.
Clinical Model
MOST LIMITING
DOWNSTREAM
Health extreme = absence of S/S of disease/disability as
IDed by medical science
This model = downstream pattern of thinking rather than
upstream which is holistic.
Levels of Care
Individual - downstream
Family
Community
Population - upstream
Levels of Prevention
Primary
Secondary
Tertiary
Primary Prevention
PREVENTION
Stay well and avoid problem
Reduction of risk factors before occurrence of disease
condition/injury
E.g., exercise, brushing teeth, condoms, immunizations,
nutrition.
Secondary Prevention
PREVENTION/MAINTENANCE
SCREENINGS/EARLY DX
Early detection of potential for disease/condition or
existence of such while asymptomatic.
E.g., screening programs - Pap smears, mammograms,
colonoscopy.
Tertiary Prevention
RESTORATIVE
Treatment of existing or symptomatic disease to
prevent/delay progress.
Treatment after Dx, e.g, cardiac/stroke rehab.
Assurance
Ensuring healthy populations
Appropriate and accessible services for all
Healthful physical environment
Stable ecosystem
Strong, supportive, non exploitive membership
Extensive participation in decision making
Members' basic needs provided for.
Access to resources and opportunities for interaction
Sustainable vital economy
Maintain connectedness with cultural and biological
heritages
Provide governance structures that promote health.
Community Assessment
Population assessment
Primary informants
Gaining entry (Kauffman's 5 phases)
Collecting data
IOSFCW
7 methods
Informant interviews
Observation
Secondary analysis of existing data
Focus groups
Community forums
Windshield surveys
Community Diagnosis
Risk of X
Among X group/population
Implementation Phase
Action phase
Role of community health nurse
Social change, community action
Evaluation
formative - changes made during process
summative - at end, related to outcomes
Health education
"The pedagogy of the oppressed"
Community empowerment (WHO)
Community as partner model (Betty Neuman)
Community as Partner
Community core
8 interacting community subsystems
Community stressors/boundaries
Normal line of defense LOD = status quo
Flexible line of defense - protection vs stressors
Lines of resistance LOR - strengths, resources, coping
mechanisms
Health Education
Planned learning experiences based on sound theories to
provide individuals, groups, communities opportunity to
learn info and skills to make quality health decisions
Facilitate learning
Stimulate senses
Active learning
Comfortable
Learner's readiness?
Relevant information
Repetition
Learning should be positive
Start simple, go to complex
Generalize and pace appropriately
Transtheoretical Model
Most common learning theory
Stages of Change
Precontemplation - resistance; don't see problem
Contemplation - know there's a problem and thinking about
it
Preparation - decision making; prepared for action, e.g.,
cutting down on cigarettes.
Action - modifies behavior/environment to overcome
problem. Takes lots of time and energy. W/D S/S now.
Maintenance - constant work to avoid relapse.
Nature of learning
CAP = B F D
Cognitive Domain
Affective Domain
Psychomotor Domain
Cognitive Domain
BRAIN
memory, recognition, understanding, application, problem
solving.
Affective Domain
FEELINGS
attitudes, values:appreciates, chooses, accepts - role play,
talk to s.o., feelings.
Psychomotor Domain
DEMONSTRATE
Hands on manipulation, "teach back"
performance of skills requiring coordination and motor
skills.
Educational objectives
Cognitive
Affective
Psychomotor
Community Health Nursing:
-Is it broad or specific?
-Wide variety of settings or limited?
-Do they promote health and welfare of pts?
-Specific age groups?
-Diverse populations or specific cultures?
-Nurses working in the community should have an
understanding of what 3 things?
Community Health Nursing:
-broad
-wide variety of settings
-allows nurses to practice in wide variety of settings
-Promote health and welfare of clients
-across the lifespan
-Nurses working in the community should understand the
foundations of CHN, the principles of CHN, and health
promo and disease prevention
-What is a community?
-Do communities vary in their characteristics and health
needs?
-What is a community's health determined by?
-Community- group of people and institutions that share
geographic, civic, and/or social parameters.
-Communities vary in the characteristics and health needs.
Community-oriented nursing:
-Who is the focus of care?
-What are the nursing activities?
-Focus of care: at risk individuals, family, groups as well as
community.
-Nursing activities are r/t health care: determining health
needs of a community, and intervening at the individual,
family, and group level to improve the collective health of
the community.
Autonomy:
-Definition
-Situation
Nonmaleficence:
-Definition
-Situation
-No harm is done with applying standards of care.
-Developing plans of care that include a system for
monitoring and evaluation outcomes.
Beneficence:
-Definition
-Situation
-Maximize possible benefits and minimize possible harms.
-Assessing risks and benefits when planning interventions.
Distributive justice:
-Definition
-Situation
-Fair distribution of the benefits and burden in society is
based on the needs and contributions of its members.
-Determining eligibility for health care services based on
income and fiscal resources.
What is epidemiology?
The study of health-related trends in populations for the
purpose of disease prevention, health maintenance, and
health protection.
Epidemiological triangle:
What are the 3 components?
Agent, host, environment
What is an epidemic?
The rate of disease exceeds the usual level of the condition
in a defined population
learning need.
3) Select aspects of learning theories to use in the
educational program based on the identified learning
need.
4) Identify barriers to learning, and learning styles.
5) Design the education program.
6) Implement the education program. Ensure an
environment that is conducive to learning
7) Evaluate the achievement of learning objectives and the
effectiveness of instruction.
B. Fidelity
C. Respect for autonomy
D. Veracity
Answer: A
A: Correct- distributive justice is fair distribution of benefits
and burden in society
B: Incorrect. Fidelity involves keeping commitments and
following through with promises.
C: Incorrect. Autonomy is supporting the rights of
individuals to determine and pursue personal HC goals.
D: Incorrect. Veracity is the concept of telling the truth.
Boston Dispensary
1796
1st home care program in US
1886
1st visiting nurse service in US
Philadelphia
1893
visiting nurse service
for the poor
NYC
Nurses Settlement House on Henry Street
Licensure by state
gives legal permission to operate w/i state only
Certification by state
Certificate of need
some states grant according to rules and formulas that
state regulator devise
Restorative
return to previous level of function as appropriate/ realistic
Improvement
achieving better health and highter level of function than at
admission
maintenance
preserving functional capacities and independence by
maintaining current level of health
Promotion
teaching healthy lifestyles that keep the effect of illness or
disaibility to a minimum and prevent the recurrence of
illness
1.
2.
3.
4.
5.
technically proficiency
self motivated
independent decision maker
respond prompltly to problems
able to adapt to family/patient/ home enviroment
physical therapy
licensed / qualified physical therapist is required, PT
assistant
goals: restorative and maintanance
rehab plan taught to patient/ family to promote self care
Occupational therapist
Referral
Admission
RN makes the initial eval and admission vist within 24-48
hours of the referreal
1. evaluation
2. enviromental assess.
3. i.d. of impairments
4. i.d. of impact of disease/ disability
5. assess support system
6. determine knowledge/adherence of treatment/ meds
7. involvment of patient/ fam in care plan
8. determin desire for care/ services
9. notify patient of rights
10. explain rights of self determination
11. initial nursing interventions (every 60 days)
Care Plan
from physician
-describes current physical status, meds, treatments,
disciplines, duration, goals, outcomes, time frame
Visits
to serve / meet patients- centered goals
Documentation
concise and complete doc. to provide accurate info of type
and quality of care
linked to legal implications
Discharge planning
done by case manager
begins with admission and ends when
patient goals or other specific criteria are met
Structural Criteria
agencies overall practices
Process criteria
eval of care delivery
Outcome criteria
Measurement of change
Medicare
agency required to be certified
meet federal conditions of :
organization
staffing
training
services covered
agency eval
65 OR OLDER, DISABLED, END STAGE RENAL DISEASE
Medicaid
pays for home care services for LOW INCOME PPL OF ALL
AGES
state administers, federal subsidized
Third Party
pay for limited home care services
payment rates vary
posthospitalization recoveries tied to reimbursment
Private Pay
directly pay for home health services
charges range
HMOs
prefered provider organization
prepaid
based on prevention
PPOs
negotiated contracts with home health agencies
NURSING PROCESS
assessment
analysis/ nursing diagnosis
planning
implementing
evaluation
Take aways
- current trends support growth of home care as an
economic, humane, preferred health delivery system
-medical management and control rather than cure are the
standards of care for illness
-home care provides assessment and eval of chronic
illnesses and is helpful for preventation in future
-aide and homemakers can provide necessary support in
ADLs to enable patient to remain @ home
-skilled nursing and therapy offer rehab and prevention of
deterioration, and methods to cope with physical changes
Long-Term care
defined by ANA as provison of physical, psychological,
spiritual, social, economic services to help ppl attain,
maintain, regain their optimum level of functioning
-range of services:
health maintenance care, to ppl who have lost ability to
function independantly due to chronic illness or condition
Patient-centered approach
achieve/ maintain an individualized plan of carre to assist
patient in preserving meaningful quality of life
quality of life
measure of optimum energy/ force that endows a person
with the power to cope successfully with full range of
challenges he or she encounters in the real world
Hospice
services to patients/families as end of life approaches.
available to any age-group
-maintain comfort as death approaches
pallative care
broader pop. having ability to benefit from comfort care
earlier in their illness or disease process.
provides care for
-basic needs (ADLs)
-ADLs
-pain and symptoms management
-spiritual/ psychosocial support
Adult DayCare
community-based programs to meet needs of functionally
or cognitibely impaired through supervised health and
social/ recreational activities
provide:
-physical care
-mental stimulation
-socialization
-assistance w/ maintanance
-health referrals
(during any part of the day, but for less than 24 hours)
Assisted Living
residential care
rental of small apartment
serveral personal care services:
-bathing, dressing, medications
(choice, autonomy, independance w/ supervision)
-communal dining and various social activities
HOME
least restrictive
INSTITUTIONAL
most restrictive
Institutional settings
1. subacute unit
2. long-term care facility
subacute unit
not limited by reimbursment
less expensive alt. to acute care when patient has high
acuity medical and nursing intervention needs
-bridge between acute care and long-term care
-located in free standing skilled nursing facilities
Medicare
federally funded national health insurance program in US
for ppl older than age 65
Functional Nursing
each has a function adn reports back to head nurse
Team nursing
all work together toward common goal
Utilization Guidelines
wealth of clinical info to assist in assessment and care
planning
nonmaleficience
no harm is done when applying standards of care
beneficience
maximize possible benefits and minimize possible harms
distributive justice
fair distribution of the benefits and burden in society based
on the needs and contributions of its members
epidemiology
investigative study of disease trends in populations for the
purposes of disease prevention and health maintenance,
relies on statistics
agent
animate or inanimate object that causes the disease (virus,
trauma, fumes)
host
the living being that will be affected by the agent
environment
setting or surrounding that sustains the host
incidence
number of new cases
prevalence
existing disease in population at a particular time
attack rate
number of people at risk who develop certain disease
epidemic
the rate of disease exceeds the usual level of the condition
behavioral theory
focus on changing behavior through the use of
reinforcement menthods
cognitive theory
focus on changing thought patters through sensory input
and repetition
critical theory
focus on increasing depth of knowledge through discussion
and inquiry
developmental theory
focus on human developmental stage with methods that
are age-specific and age appropriate with importance given
to "readiness to learn"
humanistic theory
focus on feelings and relationships, principle that learners
will do what is in their best interest
primary prevention
prevent occurrence, immunizations, classes
secondary prevention
early detection and treatment, screenings, treat STD
tertiary prevention
recovery after occurrence, rehab, shelter
airborne illnesses
measles, chickenpox, strep, TB, pneumonia, flu
foodborne illnesses
salmonella, Hep A, trich, E coli
change agent
advocate for needed change at the local, state, or federal
level
lobbyists
persuade or influence legislators
coalitions
facilitation of goal achievement through the collaboration
of two or more groups
public office
serving society and advocating for change by influencing
policy development through public service
culture
beliefs, values, and assumptions about life that are widely
held among a group of people and are transmitted across
generations
environmental health
influence of environmental conditions on the development
of disease or injury
acculturation
process of learning a new culture
cultural awareness
self awareness of one's own cultural background, biases,
and differences
cultural competence
knowing, appreciating, and considering the culture of
someone else in resolving problems
WHO
World health organization, provides daily information
regarding the occurrence of internationally important
diseases, establishes world standards for antibiotics and
vaccines, focus on health care workforce and education,
environment, sanitation, infectious diseases, maternal and
child health, and primary care
informant interviews
direct discussion with community members for the purpose
of obtaining ideas and opinions from key informants
community forum
open public meeting
secondary data
windshield survey
descriptive approach that assesses several community
components by driving through a community
focus groups
directed talk with a representative sample
surveys
specific questions asked in a written format
participant observation
observation of formal or informal community activities
A nurse manager at a community agency is developing
an orientation program for newly hired nurses. When
discussing the differences between community-based and
community-oriented nursing, the nurse should include
which of the following as examples of community-based
nursing? (Select all that apply.)
a. A home health nurse performing wound care for a
client who is immobile
b. An occupational health nurse providing classes on body
mechanics at a local industrial plant
c. A school nurse teaching a student who has asthma
about medications
d. A parish nurse teaching a class on low-sodium cooking
techniques
e. A mental health nurse discussing stress management
techniques with a support group
a, c
d. Biological variations
e. Views about illness
a, b, c, e
c, d, e
a.Assessment
b.Prevention
c.Assurance
d.Policy development
a. Assessment
characteristic
d.Geographical location within a community
c. Collection of individuals who share at least one common
characteristic
a. The mindset that the only role for the nurse is at the
bedside.
b. The structures within which nurses work and the process
of role socialization within those structures.
c. Few nurses receive graduate-level preparation in the
concepts and strategies of the disciplines basic to public
health.
Community-Based Nursing
Focus: Health of individuals, families, and groups within a
community.
Client: Individuals, family, or group of individuals
Activity: Provision of direct primary care in the settings
where individuals and families live, work, and "attend"
(schools, camps, parishes)
Social determinants
Impact whether someone is able to attain/maintain health;
(Income, social status, education, literacy, environment,
support networks, gender, culture, available health care)
Disparities
Gaps in care experienced by one population compared to
another
Florence Nightingale
Studied nursing in Germany then established nursing
schools in England
District Nursing
A mode of service delivery in which a community health
nurse is responsible for addressing all the health needs of a
given population
Lemuel Shattuck
First use of demographic data to look at population health
birth and death records
Dorthea Dix
Established first hospital for the mentally ill in the US
Clara Barton
Civil war nurse: Established the American Red Cross
(providing aid for natural disasters)
Lillian Wald
Found of public health nursing in the US; Founded the
Henry Street Settlement and Visiting Nurse Service which
provided nursing and social services and organized
educational and cultural activities. She is considered the
founder of public health nursing
Mary Breckenridge
Pioneer in nurse-midwifery; established the Frontier Nursing
Service - nurses traveled on horseback to reach mothers in
the hills of Kentucky
Nongovernment Agencies
Agencies that acquire resources from private sources to
assist others
Philanthropic Agencies
Organization that uses endowments or private funding to
address the needs of individuals, families, and populations
Health
A quality, an ability to adapt to change or a resource to
help cope with challenges and processes of daily living
Well Being
A subjective perception of full functional ability as a human
being
Learning Theory
Goal established and reinforced by nurse; Rewards given
for partial accomplishment
Epidemiology
Rate
Primary measurement used to describe either the
occurrance or the existence of a specific state of health or
illness
Outbreaks
Epidemic usually limited to a localized increase in the
incidence of the illness
John Graunt
Father of demographics. recognized importance of
recording birth and death rates and age structure of human
population
William Farr
Set up a system of data collection for causes of death in
difference occupations, gender, and imprisonment.
Importance of definition of illness and population
comparison, groups, and factors such as age, health, and
environment can affect statistics
John Snow
Used mapping and rates as an objective measure to
compare populations
Epidemiological Triad
Model based on the belief that health status is determined
by the interaction of the characteristics of the host, agent,
and environment
Wheel of Causation
Epidemiologic model that deemphasizes the agent as the
sole cause of disease while emphasizing the interplay of
physical, biological, and social environments
Web of Causation
Epidemioligcal model that strongly emphasizes the concept
of multiple causation while deemphasizing the role of
agents in explaining illness
Rate
Primary measure used to describe either the occurrence or
existence of a specific state of health or illness within a
group during a specific time frame
Ratio
Fraction that represents the relationship between two
numbers; Divide one quantity by another quantity
Ex: # boys in class/# girls in class
Proportion
Type of ration
Ex: # boys/ total students
Crude Rate
Measures the occurrence of the condition in the whole
population; May obscure info because it does not consider
factors such as age, race, gender
Numerator: Number of events
Denominator: Total population (not just those at risk)
Adjusted Rate
Controls for differences between populations-used for
comparison
Incidence
Measures probability that people without a condition will
develop the condition over time; measures pace of new
illness
Prevalence
Existence of a condition during a period/interval at a
specific point; Studies number of people diagnosed in the
past and length of illness; Longer length=greater the
prevalence-indicates burned of community
Mortality Rates
Crude mortality: probability of dying from any cause; #
deaths in a year/total population
Incidence Density
Used when unequal periods of observation for study
subjects; Accounts for people who die, drop out of a study,
or acquire an illness
Attributable Risk
The risk of a condition occurring in an exposed group that
is attributable to an exposure, not other factors
Sensitivity
Ability of the test to correctly identify people who have the
health problem
Specificity
Specific incidence and prevalence rates calculated based
on specific characteristics (demographic data), variations
based on location and variations in time (short-outbreak,
periodic- seasonal, long-years)
Incidence Rate
#new cases during time period/population at risk in the
same time period
Causality
Strengths of Association
Consistency
Temporality
Plausibility
Biological Gradient
Case Studies
Cohort Studies
(Longitudinal Studies) Monitor over time to find
associations between risk factors and health;
Minimize selection bias;
Relative risk is the ratio of disease incidence in an exposed
population;
Indicates strength of exposure to illness causality
Case Control
Compare group with health problems (cases) to group
without (control)
Key Informants
Persons knowledgeable about specific aspects of a problem
and the communities current and past attempts to address
it
Stakeholders
An individual, organizational, or group that has interest
(stake) in a specific community health issue or the outcome
of a community level intervention
Gantt Chart
Visual of the sequence of steps to achieve objectives;
Developed in planning stages to identify steps, a tool for
scheduling tasks, monitor progress
Community of Interest
People and groups/aggregate that will be affected by
change; Those that will help bring about change
Sustainability
How to maintain change, support system in place
Social Justice
Health care is a risk; Address root cause of illness
Health Equities
Requires elimination of health disparities in living and
working conditions
SMART objectives
S- Specific
M- Measurable
A- Achievable
R- Relevant
T- Time
Coalition Building
Community members participate in planning and
implementing changes at the community level; Need clear
mission, goals, objectives, expectations, leadership,
accountability, and should be heterogenous
Community Readiness
Assess readiness to undertake change process-issue
specific
Web of Causation
Identify multiple factors that contribute to chronic disease
Levers of Change
Increase driving/reinforcing forces
Decrease restraining/resisting forces
Geopolitical Population
Has identified designated boundaries with the same
governing structure
Phenomenological Population
Group with common interests or beliefs who have
interpersonal and intrapersonal connection
Community of Solution
Formed by aggregate to address a health problem
The factors, exposures, characteristics, and behaviors
that determine patterns of disease are described using:
a. Descriptive epidemiology
b. Analytic epidemiology
c. Distribution
d. Determinants
d. Determinants
b. Risk
c. Epidemiology
d. Epidemic
b. Risk
b. Age
c. Gender
d. Income
b. Age
a. Sensitivity
b. Specificity
c. Positive predictive value
d. Negative predictive value
c. Positive predictive value
geopolitical community
a type of community that is formed by human or natural
boundaries.
a specific area possessing geographic boundaries and
sharing the same governing structure.
*could also include people who work within the community
phenomenological community
a type of community that is formed because its members
have a common interest, experience or a feeling of
belonging.
boundaries are less well defined, members decide what is
meaningful to them
communities of solution
this type of community is formed by an aggregate
specifically to address health concerns within a particular
area. It is composed of persons not only from the area of
need but also members of neighboring communities with a
vested interest.
Community health
is a synthesis of the status (what do they look like),
structure (are there services to deal with the issues),
process (how effective are they- do they require outside
help?)
coalition
a group of consumers, health professionals, policy makers,
and others working together to improve community health
status or to solve a specific community health problem
stakeholder
an individual, organization, or group that has an interest in
a specific community health issue or the outcome of a
community-level intervention
key informant
person knowledgeable about specific aspects of a problem
and the communities current and past attempts to address
it
quantitative
numbers, statistical data
qualitative
perception, beliefs, values, attitudes, health concerns
data sources
statistics, surveys, key informants, libraries, telephone
books, drive-through, churches, school systems,
government offices, public safety depts., maps,
professional, business, voluntary and social organizations
assessment issues
gaining entrance/acceptance
trust
confidentiality
Health planning
problems identified, priorities selected, objectives set for
the development of community health programs based on
findings of community health assessments and health
surveillance data
SMART objectives
Specific
measurable
achievable
relevant
time bound
community-based nursing
-minor acute and chronic care that is comprehensive and
coordinated where people live, work or attend school
-illness care provided outside of acute care setting
-focus on "illness care"
-interacts 1 to 1
-levels of prevention : 2, 3
community-oriented nursing
-focus on "health care"
-Preserve, Promote, Protect
-interacts with groups and 1 to 1
-levels of prevention :1, 2, 3
-uses systematic processes to deliver care
levels of prevention
Primary- prevents disease
Secondary-controls outbreak
Tertiary-limits disability
primary prevention
promotes health
prevents occurrence of disease
(education, vaccinations)
secondary prevention
early diagnosis and interventions
contains/controls outbreak
(mammograms, hearing and vision screening, flu shots)
tertiary prevention
rehabilitation and limiting disability
(cardiac rehab, management of chronic conditions)
Florence Nightingale
formed a team of nurses that assisted soldiers during the
Crimean War and statistically documented her successes
saving lives through prevention of infections and improving
environmental conditions
-also she opened the first school of nursing
Lillian Wald
She was the founder of public health nursing
Founded the Henry street settlement house
Mary Breckinridge
Frontier Nursing- developed a system of rural healthcare in
remote regions.
Traveled on horseback
opened school for frontier nursing and midwifery
Clara Barton
Red Cross
Definition of health
maximal development- physical, social, emotional
positive interaction with physical environment
effective role performance
absence of disease
Primary prevention
maximizing health and wellness through strategies that are
set in place before illness or injury is present
Secondary prevention
maximizing health and wellness through strategies that are
set in place at the early and active chronic stages of
pathogenesis of illness and injury
-interventions designed to diagnose and treat illness early
and restore to health; includes screenings
Tertiary Prevention
maximizing health and wellness through strategies that are
set in place at the palliation and end-stage of disease and
injury trajectories
-rehabilitative/restorative; limites disability
motivational interviewing
client-centered communication style for eliciting behavior
change by helping clients and groups explore and resolve
ambivalence to change
primary prevention
use of seat belts, hand washing, proper preparation of food,
exercise, balanced nutrition, vaccinations
secondary prevention
women diagnosed with HIV/AIDS
student with scoliosis
microsystem influences
relationship between women and the environment
-relationship stage, intimacy, communication patterns
exosystem influences
formal and informal social structures
-socioeconomic and employment status, degree of social
isolation, social networks and supports, poverty
macrocultural influences
values and beliefs of culture
-social norms, attitudes about gender roles, race
theories of learning
behavioral
cognitive
humanistic
developmental
social learning
Domains of learning
-Affective
-Psychomotor
-Cognitive
follower
seeks and follows others direction/authority
gatekeeper
controls/limits outsiders access
ensures all members get an equal voice
leader
guides and directs
peacemaker/conflict manager
facilitate harmony and compromise
task specialists
b. Analytic epidemiology
c. Testicular self-examination
d. Family counseling
a. Rehabilitative job training
b. 100 cases
c. 500 cases
d. Unable to determine
d. Unable to determine
c. Community trial
d. Screening
c. Community trial
C. poverty
D. all above
D
management
b. When demonstrating competencies required for
practicing case management
c. When attempting to achieve a measurable outcome for
a specific client
d. When effectively managing conflict resolution
c. When attempting to achieve a measurable outcome for a
specific client
Transcultural Nursing
comparison of differing cultures to understand their
similarities and their differences across human groups
Culture
set of values, beliefs and traditions that are held by a
specific group of people and that are handed down,
generation to generation
Leininger
1. cultural preservation or maintenance
2. cultural care accommodations or negotiation
3. cultural care re-patterning or restructuring
Nightingale's 10 Canons
1. ventilation and warming
2. light and noise
3. cleanliness of the pt area
4.health of houses
5. bed and bedding
6. personal cleanliness
7. variety
8. offering hope and advice
9. food
10. observation
Primary prevention
patient assessment and intervention to identify and reduce
possible risk factors
Secondary prevention
detection of symptoms that are a reaction to stressors,
appropriately prioritizing interventions, and treatments that
reduce the toxic effects of stressors
Health
seen as a dynamic, positive state and not just absence of
disease
Market justice
people are only entitled to what they can earn; the focus is
on individual responsibility "minimal collective action and
freedom from collective obligations except with respect to
others fundamental rights
Vulnerable populations
low income, less education, homelessness, military
veterans, immigrants, prisoners, migrant and seasonal
farm workers and their families, chronic illness, mental
illness
social determinants
are the circumstances in which people are born; grow up,
live, work, and age as well as the systems put in place to
deal with illness
Health disparities
difference in health outcomes between populations, social,
demographic and geographic
Health inequities
modifiable associate with social inequalities and are
considered unfair
Ethnocentric
tendency to believe others think the same was as "they
do," have the same world view, culture
Altruism
putting others interests before one's own, being present is
an example
Autonomy
PHN independent and responsible for actions - respects
community and individual right to self-determination;
maintain privacy, honesty, and fidelity
Beneficence
seek to do good, not harm
Ethics
standards of behavior that tell us how we ought to act in
various situations we encounter in life
Fairness Perspective
focuses on how fairly or unfairly actions affect a group how benefits and burdens are distributed; requires
consistency in the way people are treated
Non-maleficence
first do no harm - primum non nocere
Advance directive
legal document in which an individual conveys their
decisions about end-of-life care
Health literacy
includes the ability to understand instructions on
prescription drug bottles, appointment slips, medical
Pre-crisis
planning and test messages
Initial
audience wants information NOW
Maintenance
on-going assessment of the situation
Resolution
community will not be ready to conduct risk reduction
immediately after emergency
Evaluation
Crisis and emergency risk communication response
NICs
Nursing interventions classification
NOCs
nursing outcomes classification
Tele-Health
electronic technologies to support clinical health care,
patient and practitioner education, public health and health
administration by long distance
"Right-to-Know" Laws
give people and communities the right to know about
possible chemical exposures where they live and work
Infancy
Adolescence (12-16yrs)
Identity vs. inferiority diffusion
Sensory-motor stage
birth to two
Pre-operational stage
about two to seven
Epidemiology
distribution and determinants of health related
states/events in populations and the use of this study to
control health problems
Prevalence
measures the proportion of the population affected by a
specific condition in a specific time period
Incidence
Mortality rate
also called death rate=an estimation of the proportion of a
population that dies during a specified time period
Epidemic
rates exceed normal or expected frequency in a given
population/community/region
Pandemic
worldwide epidemic (influenza and plague)
Chain of causation
chain of events where every event caused by the previous
event; the sequence of stops that have been identified as
linked to the disease
Web of causation
describes events that have multiple causative factors
Passive Immunity
newborns via maternal antibodies
Active immunity
acquired after exposure to a disease or via immunizations
Cross-immunity
immunity to one pathogen confers immunity to another
such as cowpox providing immunity to smallpox
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
Primary prevention
used before the person gets the disease or condition to
reduce the incidence and prevalence of the disease;
includes health promotion (education) and protection
(immunization)
Secondary prevention
applied after the disease has occurred but before signs are
evident; focuses on early dx (screening) and prompt tx to
limit disability
Tertiary prevention
applied when person already has the disease, focuses on
preventing damage from the condition, slowing the process
of the disease, preventing complications, and returning the
person afflicted to their optimal level of health
(rehabilitation)
Cohort Studies
may be prospective or retrospective, used to establish
causation or evaluate the impact of treatment when
randomized control trials are not possible over time-longitudinal; not good for rare conditions, requires large
study group
meta-analysis
combines data from numerous studies and arrives at
pooled estimates of treatment effectiveness and statistical
significance
Descriptive studies
are observational studies that seek to describe phenomena
Qualitative studies
describe phenomena of interest; include participant
observation, in-depth interviews and focus groups
Quantitative studies
seeks to confirm hypotheses about phenomena; uses more
rigid style eliciting and categorizing responses
sulfur dioxide
product of industry produces acid rain and contributes to
respiratory illness
nitrous oxide
combustion product contributes to illness of lungs, immune
system and asthma
carbon monoxide
car exhaust reduces oxygen delivery at high concentrations
radon
naturally occurring radioactive gas that cannot be detected
by our senses, but is the leading cause of lung cancer in
non-smokers; it is the second cause of lung-cancer behind
smoking
consultation
involves seeking advice or an opinion of an expert; the
consultant does not solve the problems, but assists and
guides the group seeking consultation to solve their own
problems
collaboration
taking an active role in implementing the plan, this requires
understanding of each party's perspectives, on-going
communication and feedback
coalition-building
alliance or group of stakeholders with a common
interest/goal
Advocacy
Cognitive
thinking (comprehension, analysis, synthesis, application,
evaluation); evaluate the level of the learner
affective
feeling (receptive, active participation, valuation,
internalization), includes changes in attitude and values
psychomotor
acting - demonstrates performance skills
natural disasters
due to weather or other natural occurrences
man-made disasters
intentional power outages, chemical spills, acts of bio
terrorism
bacterial agents
anthrax, plague
viral agents
smallpox
Biological toxins-category A
considered high priority and pose national security threathigh morbidity and mortality
smallpox, anthrax, plague, Ebola, Lassa fever, Q fever,
botulism, tularemia, hemorrhagic fever
Biological toxins-category B
moderate to low morbidity and mortality, difficult to detect
Bucellosis, clostridia toxin, staph enterotoxin, salmonella,
shigella, e.coli, cholera
Biological toxins-category C
Health outcomes
health promotion interventions there must be outcomes to
measure analysis of proper structure and constructive
process, operationalizing, outcomes (improved health =
weight loss, lower blood sugars)
Disparities
exist due to poverty, lower educational levels, unequal
access to healthcare, language barriers, environmental
conditions, racism
Motivation
moved from contemplation to action
Self-efficacy
belief about capabilities to produce effects
Self-management
manage independently choices and consequences of life
Compliance
degree to which a plan is followed (passive)
Adherence
agreement to follow a plan of action (active)
pedagogy
literally means the "art and science of teaching children"
andrgogy
intentional and professionally guided activity the aims at a
change in adults
Nurse-managed centers
nurse-managed centers provide a safety net for the poor
and undeserved in rural and urban areas; run by advanced
practice nurses, and may be associated with universities or
may be independent
parish nursing
licensed, registered nurses practicing holistic care in faith
communities
OSHA
sets health and safety work standards, employers are
legally required to protect workers from hazards;
employees have right to know what hazards they are
exposed to
HIPPA
protects the privacy of identifiable, private health
information
EPA
reduce environmental risk and protect the public, maintain
safe air and water, establish pollution regulations, solid
waste and toxic substance disposal, regulate pesticides,
oversee radiation hazards, and noise abatement
CMS
Center for Medicare and Medicaid Services
CDC
monitors and tracts diseases, research injury, infectious
disease, environmental health, genomics, global health,
chronic disease prevention, birth defects and
developmental disorders; publishes the morbidity and
mortality weekly report
NIH
mission is to seek fundamental scientific truth about the
natures and behavior of the living systems and the
application of science to improve health, lengthen life and
reduce the heavy load of illness and disability
SAMHSA
Substance Abuse and Mental Health Administration;
coordinates and funds sustainable substance abuse and
mental health programs in communities or community
health agencies
stakeholders
documentation standards
an agency's standards for how care is
recorded/documented on an individual or program level;
provides a legal record, and should be performed in a
timely manner to ensure accuracy
performance standards
defined standards/expectations for how business is to be
conducted and how performance will be measured
mentoring
expert who establishes a long-term relationship with a
mentee to help them meet professional goals or learn the
role
preceptor
guidance and role modeling are ways to nurture colleagues
or students
professional credibility
clearly demonstrates expertise in an area
expert
perform as an expert maintain standards of behavior and
accountability
health promotion
assessing the health of our community, planning activities
to help our participants to gain some control over their
health to improve their health; emphasis on helping people
change their lifestyles and move toward a state of optimal
health
determinants of health
factors which influence an individual's or population's
health; influences include the availability and access to:
high quality education, nutritious food, decent and safe
housing, affordable, reliable public transportation, culturally
sensitive health care providers, health insurance, and clean
water and non-polluted air
MAPP
Mobilizaing for Action through Planning & Partnerships; this
tool helps communities improve health and quality of life
through community-wide strategic planning; communities
seek to achieve optimal health by identifying and using
their resources wisely, taking into account their unique
circumstances and needs, and forming effective
partnerships for strategic action
Principles of MAPP
systems thinking, dialogue, shared vision, data,
partnerships and collaboration, strategic thinking, and
celebration of successes
incidence
the number of people in a population who develop the
condition during a specified period of time (number of new
cases over a period of time; rate: (# of new cases of
disease/total population at risk)x100,000
prevalence
the total number of people in the population who have the
condition at a particular time; rate: (# of existing cases of
disease/# of in total population)x100,000
relative risk
compares the risk of developing the health condition for
the population exposed to the factor with the risk for the
population not exposed to the factor; indicates the benefit
that might accrue to the person if the risk factor is
removed; rate: incidence among those exposed/incidence
rate among those not exposed
epidemiologic triangle
agent-host-environment model that is a traditional view of
health and disease developed when epidemiology was
concerned chiefly with communicable disease; all 3 can
coexist-disease occurs with interaction of agent, host and
environment
agent
an organism capable of causing disease
host
the population at risk for developing the disease
environment
a combination of physical, biological, and social factors that
surround and influence both the agent and the host
web of causation
views a health condition as the result not of individual
factors but of complex interrelationships of numerous
factors interacting to increase or decrease the risk of
disease; a number of interrelated variables are almost
always involved in the cause of particular outcome
surveillance
passive surveillance
more common form of surveillance used by most local and
state health departments; health care providers report
notifiable conditions
active surveillance
purposeful, ongoing search for new cases of disease by
public health personnel
community analysis
multi-step process used to derive a community nursing
diagnosis; phases used are: categorization, summarization,
comparison, and inference elaboration
demographic characteristics
family size, age, sex, and ethnic and racial groupings
geographic characteristics
area boundaries, number and size of neighborhoods, public
spaces and roads
socioeconomic characteristics
occupation and income categories, educational attainment,
and rental or home ownership patterns
primary prevention
improves the health and well being of the community,
making it less vulnerable to stressors; health promotion
programs, programs that focus on protection from specific
disease; usually nonspecific and directed toward raising the
general healthy of the total community
secondary prevention
begins after a disease or condition is present, although
there may be no symptoms; emphasis on screening, early
diagnosis, and treatment of possible stressors that may
adversely affect the community's health
tertiary prevention
focuses on restoration and rehab; act to return the
community to an optimal level of functioning.
evaluation
must be planned before implementation; measures
progress toward goals and learning objectives; revises
assessment database and community nursing diagnosis
Phases of MAPP
Phase 1: organizing for success, partnership development
Phase 2: visioning
Phase 3: The MAPP assessments
Phase 4: Identifying strategic issues
Phase 5: developing goals and strategies
Phase 6: the action cycle
educational process
1. identify client needs-needs assessment
2. establish educational goals and objectives
3. select appropriate educational strategies
4. develop effective skills as an educator
5. develop effective health education programs
goals
long term group overall learning needs or expected
outcomes after instruction or program activities
objectives
specific, short term, measurable, action oriented behaviors
to be met as steps towards achieving the long term goal
genomics
the study of functions and interactions of all genetic
material in the genome, including interactions with
environmental factors
nursing informatics
specialty that integrates nursing science, computer
science, and information science to manage and
communicate data, information, and knowledge in nursing
practice
information literacy
the ability to recognize when information is needed as well
as the skills to find, evaluate, and use needed information
effectively
public policy
applies to all members of society; includes prescribed
sanctions for failure to comply; formulated by government
bodies; frequently restricts personal choice to improve
public welfare
institutional policy
governs work sites; based on the institution's mission and
goals, and they determine how the institution will function
and relate to employees
organizational policy
formed an applies to groups who have similar interests or
special interests, such as professional associations-state
nurses association or specialty nursing organization that
determines governing rules for membership
medicare
health insurance program; 65 years or older, disabled
people younger than 65, end stage renal disease or Lou
Gehrig disease
medicaid
healthcare, insurance assistance, nursing home coverage;
low-income residents and pregnant women, a parent or
relative caretaker of a dependent child under age 19, the
blind, people with a disability or with a family member in
their household with a disability, or people aged 65 years
or older
health economic
concerned with how scarce resources affect the health care
industry
macroeconomics
microeconomics
the branch of economics that studies the economy of
consumers or households or individual firms; the behavior
of individuals and organizations & how this effects prices,
costs and resources; behaviors that result from tradeoffs in
the use of service and budget limits
efficiency (economics)
refers to producing maximal output, such as a good or
service, using a given set of resources (or inputs), such as
labor, time, and available money; suggests that inputs
used in such a way that there is no better way to produce
the service, or output, and that no other improvements can
be made
effectiveness (economics)
refers to the extent to which a health care service meets a
stated goal or objective, or how well a program or service
achieves what is intended; immunization=herd immunity
environmental health
promotion of safe, healthful living conditions and protection
from environmental factors that may adversely affect
human health or the ecologic balances essential to longterm human health and environmental quality, whether in
the natural or man-made environment
radon (Rn)
a radioactive gas that is formed naturally from the
radioactive decay of uranium in rocks and soil; it can
remain in the soil, move to the soil surface and enter the
air, or enter groundwater; colorless, odorless, and
tasteless, but extremely toxic; when cooled below the
freezing point, it becomes phosphorescent, in yellow and
orange-red tones.
Fracking
common but controversial practice among companies that
drill underground for oil and natural gas; drillers inject
millions of gallons of water, sand, salts and chemicalsall
too often toxic chemicals and human carcinogens such as
benzeneinto shale deposits or other sub-surface rock
formations at extremely high pressure, to fracture the rock
and extract the raw fuel.
dangers of fracking
leaves behind a toxic sludge that companies and
communities must find some way to manage; toxic
chemicals used in the fracking process remain stranded
underground where they can, and often do, contaminate
drinking water, soil and other parts of the environment that
support plant, animal and human life; Methane from
fracture wells can leak into groundwater, creating a serious
risk of explosion and contaminating drinking water supplies
human capital
the knowledge and skills that workers acquire through
education, training, and experience
benefits of MAPP
creates a healthy community; increases visibility of public
health; manages change; stronger public health
infrastructure; builds stronger partnerships; builds public
health leadership; creates advocates
pandemic
steady occurrence of disease over a large geographic area
or worldwide, such as malaria
epidemic
refers to the unexpected increase of an infectious disease
in a geographic are over an extended period of time
endemic
diseases that occur at a consistent, expected level in a
geographic area
outbreak
refers to the unexpected occurrence of an infectious
disease in a limited geographic area during a limited period
of time
infectious agent
an organism (virus, Rickettsia, bacteria, fungus, protozoan,
helminth, or prion) capable of producing infection or
infectious disease
reservoirs
the environment in which a pathogen lives and multiplies
portal of exit
means by which an infectious agent is transported from the
host
mode of transmission
method whereby the infectious agent is transmitted from
one host (or reservoir) to another host
portal of entry
means by which an infectious agent enters a new host
host susceptibility
the presence or lack of sufficient resistance to an infectious
agent to avoid prevent contracting an infection or acquiring
infectious disease
direct transmission
implies the immediate transfer of an infectious agent form
an infected host or reservoir to a portal of entry in the
human host through physical contact such as touching,
biting, kissing, or sexual contact
indirect transmission
the spread of infection through a vehicle of transmission
outside the host
fomites
an inanimate object, material, or substance that acts as a
transport agent for a microbe
vectors
can be animals, insects or artropods, and they can transmit
infection through biologic and mechanical routes
susceptible
at risk for contracting an infection or developing infectious
disease; affected by general health status, personal
behaviors, presence of healthy lines of defense, immune
system and immunization status
natural immunity
an innate resistance to a specific antigen or toxin
acquired immunity
derived from actual exposure to the specific infectious
agent, toxin, or appropriate vaccine
active immunity
when the body produces its own antibodies against an
antigen, either as result of infection with the pathogen or
introduction of the pathogen in a vaccine
passive immunity
the temporary resistance that has been donated to the
host through transfusions of plasma proteins,
immunoglobulins, and antitoxins, or transplacentally from
mother to neonate
herd immunity
refers to a state in which those not immune to an infectious
agent will be safe if a certain proportion of the population
has been vaccinated or is otherwise immune
descriptive epidemiology
focuses on the distribution of frequencies and patterns of
health events with groups in a population; examine disease
analytic epidemiology
seeks to identify associations between a particular disease
or health problem and its etiology; directed toward finding
answers to the "how" and "why" of health disease to
determine casuality
synergism
concept central to the web of causation model, wherein the
whole is more than the sum of its separate parts
Epidemiology is...
the study of the distribution and determinants of health
and disease in human populations
Person-place-time model
Person: "Who" factors, such as demographic
characteristics, health, and disease status
Place: "Where" factors, such as geographic location,
climate and environmental conditions, political and social
environment
Time: "When" factors, such as times of day, week, or
month and secular trends over months and year
Descriptive epidemiology:
-Study of the amount and distribution of disease
-Used by public health professionals
-Identified patterns frequently indicate possible causes of
disease
Analytic Epidemiology
-Examine complex relationships among the many
determinants of disease
-Investigation of the causes of disease, or etiology
Epidemiological Triangle
Host, Agent, Environment
Web of Causation
illustrates the complexity of relationships among causal
variables for heart disease; page 73
Ecosocial approach
-Emphasizes the role of evolving macro-level
socioenvironmental factors along with microbiological
process in understanding health and illness
-challenges the more individually focused risk factor
approach to understanding disease origins
Morbidity rates
rates of illness (page 75)
Risk factor
-Refers to the specific exposure factor
-Often external to the individual
Attributable risk
Primary prevention:
-when interventions occur before disease development
-Includes health promotion and specific prevention
Secondary prevention:
occurs after pathogenesis; screening and physical
examinations that are aimed at early diagnosis
Tertiary prevention:
focuses on limitation of disability and the rehabilitation of
those with irreversible diseases such as diabetes and spinal
cord injury
What is surveillance?
a mechanism for the ongoing collection of community
health information
adolescent son
C) A new mother cuddles and sings to her newborn
D) A father arranges a play date for his 5-year old
daughter
C
Rationale: The affective family function is the family's
ability to meet the psychological needs of its members,
such as bonding with a newborn. The economic function of
the family involves the allocation of adequate resources for
the family members. The providing for health care and
physical necessities function is involved in scheduling
checkups. Arranging a play date is an example of the
socialization function.
and politics
B) Culture plays a minor role in the overall character of
the community
C) Community boundaries cannot limit the services
available to individuals
D) Social systems have little or no impact on a
community's health
A)
Rationale: Social determinants of health are defined as the
circumstances in which people are born, grow up, live,
work, and age, and the systems put in place to deal with
illness. These circumstances are shaped by economics,
social policies, and politics. Social systems have an impact
on a community, and consequently the health of that
community. Culture contributes to the overall character of a
community and, in turn, influences its health needs. A
community is defined by boundaries that often determine
what services are available to individuals.
Upon graduation, a nurse chooses to practice communitybased nursing instead of working in an acute care setting.
Which of the following statements best defines
community-based nursing?
A) It is a "flowing" kind of care that does not necessarily
occur in one setting
B) It does not have a defined philosophy but rather is
defined by the setting itself
C) It is defined by the level of academic preparation
The nurse is caring for a male client with HIV who is living
unmarried with another male and has two adopted
children. How would the nurse document this client's
family structure?
A) Nuclear Family
B) Nuclear Dyad
C) Single-Parent Family
D) Multigenerational Family
A
Rationale: A nuclear family consists of a married couple
with children, or unmarried, heterosexual, or same-sex
couples with children. A nuclear dyad is a couple, married
or unmarried; heterosexual or same sex. A single-parent
family is one adult with children, and a multigenerational
family is any combination of these family structures.
A nurse is designing a physical activity program for a 48year-old male client who has been diagnosed with mild
hypertension. Which of the following is an appropriate
long-term goal for this client?
A) Jog for 15 minutes and weight train for 15 minutes, 3
days a week
B) Walk briskly for 30 minutes most days of the week
C) Bicycle for 1 hour every day of the week
D) Walk briskly for 30 minutes every other day
B
Rationale: Moderate physical activity is recommended for
30 to 45 minutes, 3 to 5 days a week as an initial goal. An
appropriate long-term goal is 30 minutes of moderateintensity physical activity all or most days of the week.
B
Rationale: Older smokers are more likely to stay off
cigarettes once they quit than younger smokers since they
know more about the short-term and long-term benefits of
quitting. It is always good to quit smoking at any age, and
ex-smokers live longer and healthier lives. People who
smoke have a 70% greater heart disease death rate than
do nonsmokers. In some cases, ex-smokers who have had a
heart attack can cut their chance of having another one by
50%.
One of the components of community-based care is selfcare. Which of the following nursing interventions is the
best example of promoting self-care in the community
setting?
A) A nurse arranges for a client who smokes a pack of
A home health care nurse visits the home of an 82-yearold female client who is receiving nursing care and
physical therapy following discharge from the hospital.
The client has right-sided paralysis following a TIA. Upon
assessment, the nurse finds that the client has lost five
pounds since the last visit a week ago. The client is living
alone with daily visits from her two children. Which of the
following would be the most important assessment
question for this client?
A) Are your children still visiting you daily?
B) Who is preparing your meals for you?
C) Are you able to walk to the kitchen to get a snack?
D)How has your physical therapy affected your appetite?
B
Rationale: Assessment is a continuous process designed to
collect information used for an immediate intervention or
as a foundation for additional assessments at a later time.
After assessing this client for weight loss, the nurse would
make further assessments to determine if the client needs
help with grocery shopping, meal planning, and cooking
meals. Tracking the client's eating pattern and intervening
where appropriate are the most important assessments in
this situation.
B
Rationale: Primary prevention is used to prevent the initial
occurrence of a disease, such as preventing obesity or
heart disease through exercise. Screening for hypertension
and recommending a colonoscopy are secondary
preventive measures. Performing range-of-motion exercises
to improve the mobility of a client with arthritis is an
example of tertiary prevention.
helmet), self-esteem (parental praise), and selfactualization (attaining a GED) are higher-level needs that
can be met after physiological needs are met.
The nurse explains to the novice nurse how communitybased nursing differs from nursing care provided in
hospital settings. Which of the following statements
accurately describes one of these differences?
A) In the community setting, the nurse is in charge of all
aspects of client care whereas in the hospital setting the
client directs the care
B) In the community setting, the nurse is the primary
facilitator of self-care as opposed to being solely a care
provider
C) In the hospital setting, a holistic assessment is
facilitated by the collaboration of many professionals,
which is not available in the community setting
D) In the community setting, the client's environment
must be changed to facilitate care, which is not an issue
in the hospital setting
B
Rationale: Because the client and family are involved in
nearly all aspects of care the majority of the time, the
community-based nurse is primarily a facilitator of self-care
as opposed to being the sole care provider. In the
community setting, the delivery of care must be considered
within the family and environment. A holistic assessment
often occurs through the collaboration of many
professionals.
integrity. The nurse should meet the client in a quiet, welllit room with no background noise.
D
Rationale: The first step in providing culturally competent
care is to understand one's own cultural background,
influences, and biases. Only with cultural awareness can
nurses appreciate and be sensitive to values, beliefs, life
practices, and problem-solving methods of a client's
culture. Cultural blindness occurs when the nurse does not
recognize his or her own beliefs or practices, or those of
others. Ethnocentrism is the idea that one's own ideas or
beliefs are the best way to behave, which has a negative
effect on cultural awareness. Preventing stereotyping
(generalizing about others) is important, but is not the first
step in this process.
C
Rationale: The health-illness continuum considers health
rather than illness as the essence of care, which requires a
shift in thinking. Improvement in health is not seen as an
outcome of the amount and type of medical services or the
size of the hospital. Treatment efficacy rather than
technology drives care in this model. Care provided in
acute care facilities is directed at resolving immediate
health problems, whereas in this model the focus is on
maximizing individual potential for self-care.
C
Rationale: An affective learning objective relates to learning
activities that enhance the acceptance of and the
adjustment to illness and subsequent treatment (e.g. the
client expressing a desire to stop smoking). Stating three
healthy snacks to substitute for sweets is a cognitive
objective. Ambulating the length of a hallway and
demonstrating crutch walking are psychomotor learning
objectives.
The nurse working in a culturally diverse communitybased setting knows that a person's cultural belief system
influences his or her health attitudes, beliefs, and
practices. Which of the following clients would be more
likely to look for a supernatural counterforce to get rid of
a health problem?
A) An Asian woman who has breast cancer
B) An Eastern European client who is experiencing
seizures
C) A client of Caribbean culture who is diagnosed with
lung cancer
D) An Arab client who is scheduled for a postatectomy
C
Rationale: The magico-religious view, practiced by people
from Hispanic and Caribbean cultures, sees illness as
having a supernatural force. People with this perspective
will look for a counterforce to rid them of the problem.
People of Arab or Asian descent may ascribe to the hot and
cold theory based on the balance of the four humors.
Assessment
Assurance
- what are activities that make certain that services are
provided?
- you must improve the level of "?" what
Case Management
- what is a systematic process by which a nurse assesses
clients needs, plans for & coordinates services, refers to
other appropriate providers, & monitors and evaluates
progress to ensure that clients multiple service needs are
met in a cost-effective manner?
Clinician
...
Collaborator
- what role of a community nurse involves working jointly
w/ others in a common endeavor, cooperating as partners?
- successful community health practice depends on this
multidisciplinary collegiality & leadership.
Policy Development
- what is enhanced by the synthesis & analysis of
information obtained during assessment?
- the nurse recommends specific training & programs to
meet identified health needs of target populations.
Researcher
- this role of the community nurse involves engaging in a
systematic investigation, collection & analysis of data for
solving problems & enhancing community health practice?
Management Behaviors
- these type of behaviors are grouped into 3 sets of
behaviors:
*Decision Making Behavior
*Transferring of Information Behaviors
*Interpersonal Relationships
Management Skills
- the three basic management skills include:
"Human Skills" which refers to ability to understand,
communicate, motivate, delegate & work well with ppl.
"Conceptual Skills" the mental ability to analyze & interpret
abstract ideas for the purpose of understanding &
diagnosing situations and formulating solutions.
"Technical Skills" the ability to apply special managementrelated knowledge & expertise to a particular situation.
Leadership Role
- this leadership role is separate from the manager role &
focuses on effecting change; thus the nurse becomes an
agent of change.
- as leaders, community health nurses seek to initiate
changes that positively effect ppl's health.
Epidemiology
The study of the distribution and the determinants of states
of health and illness in human populations.
Distribution
Refers to the frequency of occurrences of health and illness
Determinants
Refers to agents or factors that contribute to the cause of
various states of health and illness.
John Snow
Cholera epidemic, linked to the water source in the center
of the city.
Epidemiological triad
Agent (organism like the measles virus), host (human), and
environment
Web of Causation
Based on the belief that health status is multifactorial,
determined by the interaction of many agent, host, and
environment characteristics, and not by any single factor.
Ecological model
Expands epidemiological studies upward into broader
contexts such as neighborhood characteristics and
community and social contexts, and downward to the
genetic molecular level. Model encompasses determinants
at many levels: biological, emotional, behavioral,
socioeconomic, cultural, political, and environmental.
Risk
the probability that a particular event or outcome will occur
within a specified time period.
Genomics
is the study of all the genes in a person, as well as the
interaction of those genes with each other and a person's
environment.
Pre-pathogenesis
factors within individuals and their environments that may
predispose or precipitate the disease. The initial
interactions among agent, host, and environment occur
during this period.
Pathogenesis
begins when the host begins to respond with biological,
psychological, or other changes. Manifested by S&S until
the issue is resolved.
Primary prevention
Activities that prevent a disease from becoming established
and occurs during the pre pathogenesis period.
Secondary prevention
Includes activities designed to detect disease and provide
early treatment.
Tertiary prevention
the treatment, care, and rehabilitation of people with acute
and chronic illness to achieve their maximum potential.
Tertiary prevention is initiated after irreversible changes
have resulted.
Descriptive Epidemiology
Focuses on the frequency and distribution of states of
health within a population. Describe the problem (what
occurs) in terms of person, place , and time.
Risk factors
Factors that are associated primarily with the people who
have the illness.
Ratio
is a fraction that is obtained by dividing one quantity by
another quantity; it represents the relationship between
two numbers.
Proportion
is a type of ratio that include the quantity in the numerator
also as a part of the denominator.
Rate
A measure of frequency of an event or diagnosis in a
defined population within a given time period. (rate is a
proportion that includes the factor of time). best indications
of the probability that a disease, condition, or event will
occur.
Incidence
Measures the occurrence of new illness in a previously
disease-free group of people within a specific time frame.
Measure of the probability that people without a certain
condition will develop the condition over a period of time.
Mortality
Death
Morbidity
illness
Prevalence rates
Measures the amount of morbidity that exists in a
community as a result of the health problem under
investigation.
Period prevalence
indicates the existence of a condition during an interval of
time.
Point prevalence
refers to the existence of a condition at a specific point in
time.
Crude rates
Measure the experience of health problems in populations
of designated geographic areas.
Specific rates
Adjusted rates
Have been standardized, removing differences in
composition of populations, such as age.
Vital statistics
Data collected from the continuous recording of events
such as births, deaths, marriages, divorces, and adoptions,
usually by state agencies.
Person
Characterizes the "Who" develops the health problem.
Place
"Where" the rates of the health problem are the highest or
the lowest can be determined by examining the
characteristics of place.
Time
"When" health problems occur can be describe the
identifying short-term fluctuations measured in hours,
days, weeks, or months; buy periodic changes that are
seasonal or cyclical; or by long-term changes over decades
that reflect gradual changes.
Epidemic curve
Analytic Epidemiology
Focuses on the determinants of health problems, or the
"why". Uses 4 different types of studies: cross-sectional,
retrospective (case-control), prospective, and intervention
(experimental) studies.
What is implied by the web of causation model?
a. Variables interact resulting in higher probability of
illness.
b. One disease causes another, especially in vulnerable
populations.
c. The greater the poverty, the more likely people are to
have diseases.
d. Immunizations are necessary because vulnerable
populations spread disease.
a. Variables interact resulting in higher probability of
illness.
a. Women
a. Poor
b. Near poor
c. Medically indigent
d. Uninsured
c. Medically indigent
partnerships
b. Outreach and case finding
c. Elimination of disparities
d. Culturally and linguistically appropriate care
a. Community-based care and interorganizational
partnerships
b. Outreach and case finding
d. Culturally and linguistically appropriate care
What are the 10 great public health achievements in the
us from 1900-1999?
vaccinations, motor vehicle safety, safer workplaces,
control of infectious diseases, decrease in coronary heart
disease and stroke deaths, safer and healthier foods,
healthier mothers and babies, fluoridation of drinking
water, recognition of tobacco as a health hazard.
behavior models
motivational interviewing. behavior change models.
learning model. health belief model.
ontogenic system
personal factors
microsystem
relationship b/w women and their environment
exosystem
formal and informal social structures
macroculture
values and beliefs of culture
shattuck report
provided the 1st systematic use of birth and death records
and demographic data to describe the health
lemuel shattuck
recommended establishment of state health
dorothea dix
prison and mental health
clara barton
red cross/ civil war
lillian wald
founder of public health nursing. henry st settlement.
mary breckinridge
frontier of nursing service 1925 needs of health in the
mountain region. founded midwifery program
philanthropic organization
an organizations that used endowed funds or private
fundraising to address the needs of individuals, families,
and populations
nongovernmental organizations
agency that acquires resources to help others from
private(vs. public) sources
philanthropic organization
an organization that used endowed funds or private
fundraising to address the needs of individuals, families,
and populations
Definition of health
a state of complete physical, mental and social well-being,
not merely the absence of disease or infirmity
Health
a quality an ability to adapt to change or a resource to help
cope with challenges and processes of daily living
well-being
a subjective perception of full functional ability as human
beings
Primary prevention
maximizing health and wellness through strategies that are
set in place before illness or injury is present
secondary prevention
maximizing health and wellness through strategies that are
set in place at the early and active chronic stages of
parthenogenesis of illness and injury (mass screening,
selective screening)
Tertiary prevention
maximizing health and wellness through strategies that are
set in place at the palliation and end stage of disease and
injury trajectories.
epidemiology
study of the distribution and determinants of states of
health and illness in human populations used both as a
research methodology used to study states of health and
illness and as a body of knowledge that results from the
study of a specific state of health for or illness
epidemic
an outbreak that occurs when there is an increased
incidence of a diseases beyond that which is normally
found in the population
rates
the primary measurement used to describe either the
occurrence or or the existence of a specific state of health
or illness
epidemiological triad
host, agent, and environment
wheel of causation
emphasizing the interplay of physical biological and social
environments
when was the first state board of health formed in the us?
1869-north carolina
edward jenner
smallpox 1790
louis paster
1822-1895 pasteurization started as a wine experiment
joseph lister
antiseptic solution
robert koch
anthrax and cholera
john snow
first epidemiologist linked cholera rates with water street
pump golden square in london
isabel hampton
1890s helped found ANA
Margaret Sanger
1910s birth control
Lillian Wald
Clara Barton
civil war nurse leader, US red cross founder
population
group of people who have at least one thing in common
and who may or may not interact w/ one another
culture
the beliefs, values, and behavior that are shared by
members of a society and provide a design or "roadmap"
for a living
cultural diversity/plurality
a variety of cultural patterns coexist within a designated
geographic area
race
refers to biologically designated groups of people whose
distinguishing features, such as skin color, are inherited
ethnic group
a collection of people who have common origins and a
shared culture and identity; they may share a common
geographic origin, race, language, religion, traditions,
values, and food preferences
ethnicity
the group of qualities that mark one's association with a
particular ethnic group
subcultures
large aggregates of people w/in a society who share
separate distinguishing characteristics, such as ethnicity,
occupation, religion, geographic area, age, gender, or
sexual preferences
microcultures
systems of cultural knowledge characteristic of subgroups
within larger societies
ethnocentrism
the belief or feeling that one's own culture is best and
reflects our tendency to judge other people's beliefs and
behavior using values of our own native culture
ethnorelativism
seeing all behavior in a cultural context
Characteristics of culture
Culture is: learned, integrated, shared, mostly tacit,
dynamic
enculturation
learning about culture through socialization with the family
or significant group
biomedical view
relies on scientific principle and sees diseases/injuries as
life events controlled by physical and biochem processes
that can be manipulated through meds, surgery, and other
treatments
magicoreligious view
focus on the control of health and illness by supernatural
forces; illness - punishment of god, health - gift from god
holistic view
viewing the world in terms of harmonious balance - if
principles guiding natural laws to maintain order are
disturbed, an imbalance in the forces of nature is created,
resulting in chaos and disease
folk medicine
home remedies
individualized caregiving practices that are passed down
w/in families
complementary therapies
practices used to complement contemporary Western
medical and nursing care and are designed to promote
comfort, health, and wellbeing
primary prevention
a type of prevention that seeks to promote heath and
prevent disease from the beginning
secondary prevention
an intervention that seeks to detect disease early in its
progression (early pathogenesis) before clinical signs and
symptoms become apparent in order to make an early
diagnosis and begin treatment
tertiary prevention
intervention that begins once the disease is obvious; the
aim is to interrupt the course of the disease, reduce the
amount of disability that might occur, and begin
rehabilitation
medicaid
a jointly sponsored state and federal program that pays for
medical services for the aged, poor, blind, disabled, and
families with dependent children
medicare
a federally funded health insurance program for the elderly
and disabled and persons with end-stage renal disease
legal immigrant
not citizens, but they are by law allowed to both live and
work in the US, often because they have useful job skills or
family ties;
must live in US for 10 years to be eligible for all
entitlements, such as Aid to Families of Dependent
Children, food stamps, Medicaid, and unemployment
insurance
refugees
refugees are admitted outside the usual quota restrictions
based on fear of perseution due to their race, religion,
nationality, social group, or political views;
may receive Temporary Assistance for Needy Families,
Supplemental Securty Inome, and Medicaid
nonimmigrants
admitted to the US for a limited duration of time and for a
specific purpose
unauthorized immigrant
undocumented or illegal aliens;
eligible only for emergency medical services,
immunizations, treatment for the symptoms of
communicable diseases, and access to school lunches
assessment
systematic data collection on the population, monitoring
the populations health status, and making information
available about the health of the community
policy development
efforts to develop policies that support the health of the
population, including a scientific knowledge base to make
policy decisions
assurance
making sure that essential community-oriented health
services are available;
includes providing essential personal health services or
individuals, as well as a competent PH workforce
cultural shock
the feeling of helplessness, discomfort, and disorientation
experienced by an individual attempting to understand or
effectively adapt to another cultural group that differs in
practices, values, and beliefs. it results from the anxiety
caused by losing familiar sights, sounds, and behaviors
cultural repatterning
working with clients to make changes in health practices
when the clients cultural behaviors are harmful or decrease
their well-being
cultural preservation
the use by clients of those aspects of their culture that
promote healthy behaviors
cultural knowledge
the information necessary to provide nurses with an
understanding of the organizational elements of cultures
and to provide effective nursing care
cultural imposition
the process of imposing one's values on others
cultural encounter
interaction with a client related to all aspects of his or her
life
cultural blindness
when differences between cultures are ignored and persons
act as though these differences don't exist
quarantine
period of enforced isolation of persons exposed to a
communicable disease during the incubation period of the
disease to prevent its spread should infection occur
sanitation
promotion of hygiene and prevention of disease by
maintenance of health-enhancing (sanitary) conditions
Shattuck Report
advocate the establishment of state and local boards of
health, enviro sanitation, collection and use of vital
statistics, systematic study of diseases, control of food and
drugs, urban planning, est of nurses' training schools, and
preventive medicine
antigen
A live or inactivated substance (e.g., protein,
polysaccharide) capable of producing an immune response
antibody
Protein molecules (immunoglobulin) produced by B
lymphocytes to help eliminate an antigen
active immunity
Protection produced by the person's own immune system;
usually permanent
passive immunity
Protection transferred from another person or animal;
temporary protection
LAIV
Rotavirus
Herpes Zoster
inactivated vaccines
Toxoids (DTaP, Td, Tdap)
Whole (Hepatitis A, IPV)
Split (Influenza - TIV)
Recombinant vaccines (Hepatitis B, HPV4, HPV2)
Polysaccharide vaccines (PPSV23, MPSV4)
Conjugated vaccines (Hib, PCV13, MCV4)
retrospective payment
Fee established in advance
Reimburse after service rendered
Abused through the requesting and ordering of
unnecessary tests
Encouraged sickness rather than wellness
prospective payment
External authority sets rates
Rates derived from predictions set in advance
Fixed rates rather than cost coverage
Imposes constraints on spending
Providers at risk for losses or surpluses
Which statement about disasters is true?
a. They can be natural or human-made.
b. They can be relieved without assistance.
c. There is always injury and death when a disaster
occurs.
d. The timing of a disaster does not influence the types of
injuries that will occur.
a. They can be natural or human-made.
casualties because:
a. They cause the most widespread destruction.
b. Victims have little time to make evacuation
preparations.
c. Those with chronic conditions cannot escape in time.
d. The early warning systems are not effective.
b. Victims have little time to make evacuation preparations.
b. Communicable disease
c. Chronic illness
d. Injuries requiring first aid
a. Stress
c. Surveillance
d. Health teaching
a. Screening
immunizations
c. Should be aware of the laws in the state regarding
acceptable reasons for immunization exemption
d. Should allow the student to attend school without the
immunizations
c. Should be aware of the laws in the state regarding
acceptable reasons for immunization exemption
b. Educational services
c. Day care
d. Orthodontics
b. Educational services
The nurse caring for children when they need health care
is providing which of the following levels of prevention?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Health promotion
b. Secondary prevention
c. Vandalism
d. Victimizing
a. Venting
b. Vocalizing
c. Vandalism
d. Victimizing
Carrier
A person who harbors an infectious organism and transmits
the organism to others although having no symptoms of
the disease
colonization
The presence and multiplication of infectious organism
without invading damage to tissuse
Contagious
Able to be passed easily from one person to another.
endemic
The constant or ususal prevalence of a specific disease or
infectious agent within a population or geographic area
Epidemic
A widespread outbreak of an infectious disease.
Healthcare-associated infection
An infection that was not present on admission to the
hospital and develops during the course of treatment for
other conditions (nosocomial)
Incubation period
The period between infection and the appearance of
symptoms of the disease.
Infectious disease
A disease that is caused by a pathogen and that can be
spread from one individual to another.
propagated outbreak
an outbreak that spreads from person to person rather than
from a common source
pathogenicity
The ability to cause disease
Reservoir
A place where microorganisms survive, multiply, and await
transfer to a susceptible host
Secondary infection
caused by an opportunistic pathogen after the primary
infection has weakened the body's defense
Surveillance
- collecting, analyzing, & reporting data on rates of
occurrence, mortality, morbidity, and transmission of
infections
transmission
An incident in which an infectious disease is transmitted to
another person/people.
Antigenic drift
Slow and progressive genetic changes that take place in
DNA and RNA as organisms replicate in multiple hosts
Antigentic shift
dramatic change,
Convergence model
Model illustrating the interaction of 13 factors that
contribute to the emergence of infectious disease.
Ecosystem
A community of interdependent organisms and the physical
environment they inhabit.
Herd immunity
The resistance of a group to invasion and spread of an
infectious agent, based on the resistance to infection of a
high proportion of individual members of a group; the
resistance is a product of the number susceptible and the
probability that those who are susceptible will come into
contact with an infected person
Microbial adaption
Process by which organisms adjust and change to their
enviroment
Pandemic
A worldwide epidemic.
Femicide
A term used to refer to a homicide that occurs in the
context of intimate partner violence (IPV).
Gender-based violence
any act of gender violence that results in or is likely to
result in physical, sexual or psychological harm and
suffering to women, including theats of such acts, coercion,
or arbitrary deprivations of liberty, whether occuring in
public or private life.
Human rights
The basic rights to which all people are entitled as human
beings.
Incidence
Disease is the number of new cases occurring in a specific
period
Lethality assessment
Perpetrate
To commit, as a crime or other antisocial act
Prevalence
'The number or proportion of cases of a particular disease
or condition present in a population at a given time.'"snap
shot" (AIHW, 2008)
Violence
1. Violence is a broad concept that ranges from homicide to
physical assault or intentional use of force against another
person, community, or even against oneself (suicide)
Abstinence
Act of refraining from for 12 months or more
Addiction
habitual use of a drug, a disease in itself. Caused by taking
a chemically dependent drug "prescribed or illegally used
compulsively psycological and physiologicaL dependency
Craving
an intense desire for some particular thing
Intoxication
An altered state of consciousness as a result of drinking
alcohol or ingesting other substances
Substance abuse
A) Substance abuse differs from dependence in that
withdrawal or tolerance have never been present, but use
of the substance has caused significant impairment or
distress - e.g., missing work, school failure, DUI, legal
problems
Substance dependence
Substance use
This is the use of a substance that alters physical or mental
functions: It can be legal or illegal, therapeutic or
recreational and can be done by sniffing, snorting, inhaling,
swallowing, drinking, smoking, or injecting the substance or
absorbing it throught the skin.
Tolerance
A process in which your body needs more and more of a
drug to get the same effect
Withdrawal
Physical signs of discomfort associated with the
discontinuation of an abused substance.
Inmate
a person serving a sentence in a jail or prison
Trimorbidity
Three common chronic illnesses of homeless people
(mental illness, chronic physical illness, substance
addiction)
Underserved population
A subgroup of the population that has a higher risk of
developing health problems because of a greater exposure
to health risks because of marginalization in sociocultural
status, access to economic resources, age or gender
Bioavailabilty
The amount of a contaiminant that actually ends up inthe
systemic circulation
Biomonitoring
Analysis of blood, urine, tissues, and so forth to measure
chemical exposure in humans
Environmental epidemiology
field of public health science that focuses on the incidence
& prevalence of disease or illness in a population from
exposures in their enviroments
Environmental health
Environmental factors that influence human health and
ecological systems
Environmental justice
A legal strategy based on claims that racial minorities are
subjected disproportionately to environmental hazards
Exposure
A situation in which a person has had contact with blood,
body fluids, tissues, or airborne particles in a manner that
suggests disease transmission may occur.
Exposure estimate
Factors that determine a persons level of exposure to a
contaminant.
Exposure pathway
The pathway linking the environmental source of a
contaminant to the point of exposure
Exposure history
process to help determine whether an individual has been
exposed to environmental contaminants
Precautionary principle
States that when there is a threat of serious or irreversible
environmental damage, we shouldn't wait for scientific
proof before taking action.
Healthy communities
communities that optimize the physcial, social, and
economic environment of the community
Risk assessment
Assessing each risk involves determining likelihood that the
risk event will occur and the degree of impact the event
will have on the project objective.
Toxicology
study of poisonous substances and their effects upon body
parts
After-action report
Retrospective analysis used to evaluate emergency
response drills.
Decontamination
A process in which recently used and soiled medical
devices, including instruments, are rendered safe for
personnel to handle.
Evacation
Moving people from a dangerous place to safety
Invacuation
Moving people from one area to another, within the same
facility.
Point of distribution
centralized location where the public picks up emergency
supplies following a disaster
Real time
Means that the people who are conversing on a computer
are online at the same time.
Scenario
A sequence of events that is imagined, assumed, or
suggested
Shelter-in-place
Taking refuge inside an interior room with few or no
windows, in the event of the release of chemical biological,
or radiological contaminants:
Simulation
A representation of a situation or problem with a similar but
simpler model or a more easily manipulated model in order
to determine experimental results.
Terrorism
Is the use or threatened use of violence to gain a political
objective
Deinstitutionaliztion
a focus on reducing costly and neglectful institutional care
and on providing more humane services in the community
First-generation antipsychotics
improve positive symptoms of schizophrenia more
effectively than negative symptoms or cognitive
dysfunction.
Nonadherence
an informed decision on the part of the patient not to
adhere to or follow a therapeutic plan or suggestion. Same
thing as noncompliance.
Prodromal stage
This is the Initial stage of disease, characterized by
common general complaints of illness malasia and fever ?
Second-generation antipsychotics
drugs that alleviate schizophrenia without serious risk of
producing movement disorders
tardive dyskinesia
A side effect of long-term use of traditional antipsychotic
drugs causing the person to have uncontrollable facial tics,
grimaces, and other involuntary movements of the lips,
jaw, and tongue.
congregation
A gathering of people, especially for religious services
congregration-based model
faith based nurse serving a particular faith community by
virtue of a contract or job description
Institution-based model
the parish nurse serves as a liasion and helps plan and
coordinate care
Parish nursing
a model of care for members of a faith community that can
include wellness care through home visiting
Spiritual care
Recognition of spiritual needs and the assistance given
toward meeting those needs.
Adjuvant drugs
relieve pain either alone or in combination with analgesics.
These drugs can potentiate or enhance the effectiveness of
the analgesic.
Advance directives
Documents that indicate a patient's wishes in the event
that the patient becomes incapacitated and unable to
make decisions regarding medical care
Bereavement
Feeling of grief or desolation, especially at the death or loss
of a loved one.
Breakthrough pain
Pain that occurs between doses of pain medication. (p.
157)
Grief
Extreme sadness after someone dies or goes away.
Healthcare proxy
an individual who has been appointed to make health
decisions by the maker in the event of their incapacitation
Mourning
Outward, social expressions of grief and the behavior
associated with loss.
Pallative care
care designed not to treat an illness but to provide physical
and emotional comfort to the patient and support and
guidance to his or her family
Postmortem care
Care given immediately after death before the body is
moved to the mortuary usually by nurses
Biological hazards
Any living organisms or its properties that can cause an
adverse response in humans
Chemical hazards
Toxicity and the use of the chemicals. Excessive airborne
concentrations of mists, vapors, gases, or solids in the form
of dusts or fumes
Ergonomics
Physical hazards
Hazards that result from the transfer of physical energy to
workers
Psychosocial hazards
- all organizational factors and interpersonal relationships
in the workplace that may affect the health of the workers
How is TB transmitted?
Exposure to bacilli in airborne droplets form infected person
during coughing, sneezing, or talking
A patient with diabetes has her TB skin test read and the
nurse discovers 11 mm induration. Further testing reveals
no symptoms and a negative chess x-ray. What does the
nurse suspect?
A. Active TB infection
B. No TB infection
C. Latent TB infection
D. Further testing is required
C. Latent TB infection
Cheaper
More efficient - success rate 67%
2000 samples/day vs. technicians that can only process 20
samples/day
Bleeding problems
Flu-like symptoms
Rash
Turns urine, saliva, tears orange (discolors contact lens)
Photosensitivity
Birth control pills/implants less effective
Hepatic enzyme elevation
Peripheral neuropathy
Mild CNS effects
Joint aches
Hyperericemia (uric acid in blood)
Optic neuritis
Ototoxicity & nephrotoxicity
A. Agent-host-environment interaction.
C. Specificity.
D. Variability.
B. Sensitivity.
Quarantine is
- incubation (define)
ISOLATION during a communicable disease (especially
during incubation ) to prevent spread.
incubation: The development of an infection from the time
the pathogen enters the body until signs or symptoms first
appear.
Assessment
- define
- it is a continuous process of ____ (2) information about
__
- function?
- morbidity?
measuring and monitoring the health status and needs of a
designated community or population.
-a continuous process of collecting data and disseminating
information about health,diseases, injuries, air and water
quality, food safety, and
available resources.
This function helps to identify morbidity, mortality, and
causative factors.
- rate of incident
Assurance is
- 2 MORE FUNCTIONS?
the process of translating established policies into
services.
1. ensures that population based services are provided,
whether by public health agencies or private sources.
2. monitors the quality of and access to those services.
medically indigent
(those who are unable to pay for and totally lack medical
services)
DHHS
Department of Health and Human Services
Economics
science of making decisions regarding scarce resources.
(Study of how societies decide what to produce, how to
produce it, and how to distribute what they produce)
Economics permeates our social structureit affects and is
affected by policies.,
Microeconomic theory is
concerned with supply and demand.
Macroeconomic theory is
concerned with the broad variables that affect the status of
the economy as a whole.
Supply is
the quantity of goods or services that providers are willing
to sell at a particular price.
Demand
Consumer willingness and ability to buy products
adverse selection
-define
-ex
the tendency for people with the greatest probability of loss
to be the ones most likely to purchase insurance.
(ex: when high-risk patients are denied insurance or care)
deductible
( yearly health insurance bill)
A certain amount of money that the patient must pay each
year toward his or her medical expenses before health
insurance benefits begin.
cost sharing
a situation where insured individuals pay a portion of the
healthcare costs, such as deductibles, coinsurance or copayments.
( ex: auxilio mutuo private health insurance)
Medicare
A federal program of health insurance for persons 65 years
of age and older
Medicaid
A public assistance program designed to provide healthcare
to poor, disabled and disadvatanged americans
capitation rates
(fixed amounts of money paid per person by the health
plan to the provider for covered services)
retrospective payment
rendered
Provided, given
reimbursement
paying back
fee-for-service
A system under which doctors and hospitals receive a
separate payment for each service that they provide
Prospective payment
payment method based on rates derived from predictions
of
annual service costs that are set in advance of service
delivery.
-the payment amount or reimbursement with a set rate for
certain procedures is known in advance
cost shifting.
- read
- define
This practice of charging different prices to different
consumers most often affects those without health
insurance who are paying out-ofpocket for care.
- Lack of insurance, uninsured populations, and
uncompensated care are covered by charging more to
those who can pay. This practice is referred to as
managed care
It refers to systems that coordinate medical care for
specific
groups to promote provider efficiency and control costs.
Medical home
seeing the same health care provider for regular care
Competition means
a contest between rival health care organizations for
resources and clients
Regulation refers to
mandated procedures and practices affecting health
services delivery that are enforced by law
Managed competition,
- what does it combine?
combine with market competition to achieve cost
savings with government regulation to achieve expanded
coverage.
single-payer system
- this lead to?
When the government collects taxes for healthcare from all
citizens and then uses the collected money to pay for the
citizens healthcare services.
- universal coverage
universal coverage
(everyone would have health insurance of some type,
assuring better access to care).
SUMMARY
SUMMARY
history
Primitive practices of early centuries were replaced with
more advanced sanitary measures by the Greeks and
Romans. The Middle Ages saw a
serious health decline in Europe, with raging epidemics
leading to extensive 19th-century reform efforts in England
and, later, in the United States.
Private health services are the unofficial arm of the community health system. They include (2) agencies
voluntary nonprofit agencies
privately owned (proprietary) and for-profit
agencies.
OSHA
sets health and safety work standards employees are in
legally required to protect workers from hazards and
employees have a right to know what hazards they are
exposed to
passive immunity
newborns through maternal antibodies
.risk assessment
qualitative and quantitative evaluation of the risk posed to
human health for the environment by the actual or
potential presence or use of specific pollutants
needs assessment
needs assessment systemic appraisal of type depth and
scope of problems as perceived by clients health providers
or both
natural immunity
species determinate resistance to an infectious agent
WIC
woman and children Supplemental Nutrition Program
provides federal grants to states for supplemental food
health care referral and nutrition education for low-income
pregnant breastfeeding and non-breastfeeding postpartum
women infants and children up to five years of age who are
found to be at a nutritional risk
primary prevention
type of intervention that seeks to promote health and
prevent disease from the beginning involves health
promotion and education
secondary prevention
secondary prevention intervention that seeks to detect
disease by screening and providing healthcare early in the
progression before clinical signs and symptoms become a
apparent in order to make an early diagnosis and begin
treatment
tertiary prevention
SARS
severe acute respiratory syndrome spread via airborne
droplets indirect.contact and by close contact with an
infected person there is no cure as a person is suspected of
having sars they should be admitted to the hospital
immediately and kept under Isolation if in an outpatient
setting the person must be rapidly divertid to a separate
area to minimize transmission to others
palliative care
care to alleviate symptoms by meeting the special needs of
and providing comfort for the dying client and their families
by the nurse
color
food preferences include blue cornmeal fruits Game and
Fish.nutritional excess of carbohydrates and calories
risk factors are diabetes malnutrition tuberculosis infant
and maternal mortality
Good luck
...
3 shared commonalities
geographic, common interest, community of solution
community of solution
group of people who come together to solve problems that
affects all of them, ex: guidance counselors, counties
working for water pollution
common interest
collection of people with interest or goal that bind them
together, ex: MADD, disabled community, church groups,
gay community
population
all the people occupying an area, or all those who share
one more characteristic, may not necessarily interact
aggregates
a mass or grouping of distinct individuals who are
considered as a whole and are loosely associated with each
other, broader term then population
aggregates
communities and populations are types of
promotion of health
health education, preventative care services, healthy
people 2010, raise levels of wellness for individuals,
families, populations and communities
primary prevention
to keep illness from occurring, hand rails, immunizations
secondary prevention
efforts to detect and treat existing health problems.
Screenings: htn, drug abuse, breast exam, DM test; to
intervene to control or eradicate the problem
tertiary prevention
attempts to reduce the extent and severity of health
problems so as to minimize disability and restore or reserve
function: rehab after CVA.
tertiary prevention
someone that has an eating disorder, following up with
counseling
treatment of disorders
focuses on illness by: direct service, indirect service,
development of programs to correct unhealthy conditions
indirect service
referring to someone, calling another professional to help
solve problem for client
rehab
evaluation
process by which the practice is analysis, judged, and
improved according to established goals and standards
research
investigation to discover facts affecting community health
and community health practice, solve problems, and
explore improved methods of health science
determinant of health
biology
determinant of health
behavior
determinant of health
social & physical environment
determinant of health
polices and interventions
clinician
most familiar role, ensures health services are provided
educator / teacher
client is not acutely ill, so can absorb information better,
wide audience can be reached
advocate
2 goals: help clients gain greater independence or self
determination; make the system more responsible and
relevant to the needs of clients. Every client has the right
to receive just, equal and humane treatment
collaborator
work jointly with others, need communication skills
leader
focuses on change, nurse becomes an agent of change,
influence people to think and behave differently about their
health
researcher
evidence based practice, systematic investigation,
collection, and analysis of data for solving problems and
enhancing community heath practice
case manager
has become the standard method of managing health care
in delivery systems in US. Evaluates progress to ensure
that clients' multiple service needs are met in a costeffective manner.
Florence Nightingale
early 19th century, crimean war, record keeping and
statistics, organized nursing care, kitchens, laundries,
"notes on nursing"
Federal agencies
DHHS, EPA, Homeland security, D of Agriculture, Dept of
Ed, VA
State agencies
Medicare, Medicaid, SCHIPS
medicare
medicaid
a federally aided, state operated program that provides
medical benefits for low-income persons in need of medical
care
OASIS
outcome, assessment information set: very detailed form
supplies
thrown away after each use
multiplicity of problems
finding more then one problem
maintaining balance
hospice
medicare is the main payment, even if you're under 65
hospice
you have 6 months or less to live
hospice
pain medication or no aggressive chemo or procedures
compounding pharmacist
combining drugs in a unique way in a hospice setting
I-Prepare
prevent, resident, environment, past work, activities,
resources, education
web of causation
the combination of factors that lead to a problem
contaminant
organic or inorganic that enters medium that renders it
impure
toxic agent
poisonous substance in the environment
overpopulation
exceeds ability of it's ecosystem to either support needs; 4
factors (starvation, disease, wars, aide from other
countries)
air pollution
high in industrial areas
radon
odorless, colorless, causes cancer
lead poisoning
affects CNS, old paint,
psychological hazards
noise, overcrowding, lack of natural beauty
traditional nursing
work as part of team, acute setting, with other
professionals
hospice
concept of palliative care for terminally ill patients,
referral sources
hospitals (MD, MSW, Case Mgr), Clinics (RN or MD), Families
(self)
vectors
carry diseases such as mosquitoes, flies, ticks, roaches,
fleas, rats, mice, and squirrels
Public health
a system and social enterprise; a profession; a collection of
methods, knowledge, and techniques; governmental health
services, especially medical care for the poor and
underserved; and the health status of the public
Epidemiology
the study of the occurrence and distribution of healthrelated states or events in specified populations, including
the study of the determinants influencing such states, and
the application of this knowledge to control the health
problems
Descriptive epidemiology
seeks to describe the occurrence of a disease in terms of
person, place, and time.
Analytic epidemiology
focuses on investigation of causes and associations.
Distribution
determine who has the disease and where and when the
disease occurs
The RN will
Demonstrate an understanding of the relationship of
genetics and genomics to health, prevention, screening,
diagnostics, prognostics, selection of treatment, and
monitoring of treatment effectiveness. Demonstrate ability
to elicit a minimum of a three-generation family health
history information. Construct a pedigree from collected
family history information using standardized symbols and
terminology. Collect personal, health, and developmental
histories that consider genetic, environmental, and
genomic influences and risk factors. Critically analyze the
history and physical assessment findings for genetic,
environmental, and genomic influences and risk factors.
Assess patients' knowledge, perceptions, and responses to
genetic and genomic information. Develop a plan of care
that incorporates genetic and genomic assessment
information.
Genomics will
enable medicine to be tailored to each person's needs
Genetic screening
Evaluate >1600 genetic disorders, First used in the late
1970s
Genomics
the study of individual genes in order to understand the
structure of the genome, including the mapping of genes
and sequencing the DNA.
Genomics examines
the molecular mechanisms and the interplay of genetic and
environmental, cultural, and psychosocial factors in disease
Genes
the DNA segments that carry the genetic information
Chromosomes
long structures that organize DNA
DNA replication
chromosomes are duplicated before cells divide
Mutations
DNA Repair
process in which mutations are corrected; estimates
indicate repair mechanisms correct at least 99.9% of initial
errors
I
Investigate Potential Exposures Investigate potential
exposures by asking: Have you ever felt sick after coming
in contact with a chemical, such as a pesticide or other
substances? Do you have any symptoms that improve
when you are away from your home or work?
P
Present WorkAt your present work: Are you exposed to
solvents, dusts, fumes, radiation, loud noise, pesticides, or
other chemicals? Do you know where to find material
safety data sheets for chemicals with which you work? Do
you wear personal protective equipment? Are work clothes
worn home? Do co-workers have similar health problems?
R
Residence When was your residence built? What type of
heating do you have? Have you recently remodeled your
home? What chemicals are stored on your property? Where
is the source of your drinking water
E
Environmental Concerns Are there environmental concerns
in your neighborhood (e.g., air, water, soil)? What types of
industries or farms are near your home? Do you live near a
hazardous waste site or landfill?
P
Past Work What are your past work experiences? What job
did you have for the longest period of time? Have you ever
been in the military, worked on a farm, or done volunteer
or seasonal work?
A
Activities What activities and hobbies do you and your
family pursue? Do you burn, solder, or melt any products?
Do you garden, fish, or hunt? Do you eat what you catch or
R
Referrals and Resources Use these key referrals and
resources: Environmental Protection Agency
(http://www.epa.gov) National Library of MedicineToxnet
Programs (http://www.nlm.nih.gov) Agency for Toxic
Substances and Disease Registry
(http://www.atsdr.cdc.gov) Association of Occupational and
Environmental Clinics (http://www.aoec.org) Occupational
Safety and Health Administration (http://www.osha.gov)
EnviRN website (http://www.enviRN.umaryland.edu) Local
Health Department, Environmental Agency, Poison Control
Center
E
Educate (A Checklist) Are materials available to educate
the client? Are alternatives available to minimize the risk of
exposure? Have prevention strategies been discussed?
What is the plan for follow-up?
Epidemiology
The science that helps us understand the strength of the
association between exposures and health effects
Epidemiologic triangle
Agent, host, and environment, a simple model that belies
the often complex relationships between agent, which may
include chemical mixtures (i.e., more than one agent); host,
which may refer to a community with people of multiple
ages, genders, ethnicities, cultures, and disease states; and
environment, which may include dynamic factors, such as
air, water, soil, and food, as well as temperature, humidity,
and wind.
Agent
Chemical or disease
Host
Community, patient,
Environment
water, air, cleanliness, plumbing, sewer systems, soil,
temperatures, climates, habits and customs
Health departments
conduct assessments of community health status, a core
function of public health, on an ongoing basis
Executive branch
Suggests, administers, and regulates policy. President,
cabinet, various administrative and regulatory
departments, and agencies. U.S. Department of Health and
Human Services.
Legislative branch
Identifies problems and proposes, debates, passes, and
modifies laws to address those problems. Identifies
problems and proposes, debates, passes, and modifies laws
to address those problems. Senate and House of
Representatives.
Judicial branch
Interprets laws and their meaning. System of federal, state,
and local courts guided by opinions of the Supreme Court.
Machine Co. v. Davis.
Culture
A set of beliefs, values, and assumptions about life that are
widely held among a group of people and that are
transmitted intergenerationally. Develops over time and is
resistant to change. Each culture has its own unique
Race
A social classification that relies on physical markers, such
as skin color, to identify group membership. Individuals
may be the same race but of different cultures
Ethnicity
The shared feeling of peoplehood among a group of
individuals. Reflects membership in a cultural group and is
based on individuals sharing similar cultural patterns.
Represents the identifying characteristics of culture, such
as race, religion, or national origin, and affects beliefs,
behaviors, and access to resources. Members of an ethnic
group are likely to give up aspects of their identity and
society when they adopt characteristics of another group's
identity. However, when there is a strong ethnic identity,
the individual maintains the values, beliefs, behaviors,
practices, and ways of thinking of their group.
Legal immigrants
Make up 80% of immigrant population. Are not citizens but
are legally allowed to work and live in the United States.
Nonimmigrants
are admitted to the United States for a limited duration and
for a specified purpose. include students, tourists,
temporary workers, business executives, career diplomats
and their spouses and children, artists, entertainers, and
reporters.
Advocacy
Advocacy
Act in accordance with the patient's wishes and
instructions. Keep the patient properly informed. Carry out
instructions with diligence and competence. Act impartially
and offer frank, independent advice. Maintain patient
confidentiality.
Feminist ethics
encompasses the tenets that women's thinking and moral
experiences are important and should be taken into
account in any fully developed moral theory, and that the
oppression of women is morally wrong. Entails knowledge
about the social, cultural, political, legal, economic,
environmental, and professional contexts that insidiously
and overtly oppress women as individuals, or within a
family, group, community or society. Demand results.
Nurses were reluctant to embrace feminism and it's ethics
for many years.
competencies of PH
In the spring of 2010 this Council, funded by the Centers
for Disease Control and Prevention, Health and Human
Services (HHS), adopted an updated set of Core
Competencies ("a set of skills desirable for the broad
practice of public health")
(http://www.phf.org/link/corecompetencies.htm) for all
public health professionals, including nurses.
Shattuck Report
was published in 1850 by the Massachusetts Sanitary
Commission with an emphasis on the public's health. The
report called for major innovations: the establishment of a
state health department and local health boards in every
town; sanitary surveys and collection of vital statistics;
environmental sanitation; food, drug, and communicable
disease control; well-child care; health education; tobacco
and alcohol control; town planning; and the teaching of
preventive medicine in medical schools. However, these
recommendations were not implemented in Massachusetts
for 19 years, and in other states much later.
Crimean War
Disparities
Racial or ethnic differences in the quality of health care, not
based on access, clinical needs, preferences, or
appropriateness of an intervention
-Indicators that continue to cause disparities in the United
States' health care system:
Cost
Access
Quality
Primary care
Efficiency
Suggests that inputs are combined and used in such a way
that there is no better way to produce the service, or
output, and that no other improvements can be made
refers to producing maximal output, such as a good or
service, using a given set of resources (or inputs), such as
labor, time, and available money.
Effectiveness
For example, effectiveness of a mass immunization
program is related to the level of "herd immunity"
developed.
refers to the extent to which a health care service meets a
stated goal or objective, or how well a program or service
achieves what is intended.
macroeconomics
Focuses on the "big picture"the total, or aggregate, of all
individuals and organizations
Aggregate is usually a country or nation
Ethics
is concerned with a body of knowledge that addresses such
questions as the following: How should I behave? What
actions should I perform? What kind of person should I be?
What are my obligations to myself and to fellow humans?
There are general obligations that humans have as
members of society.
Ethical judgments
are concerned with values. The goal of an ethical judgment
is to choose that action or state of affairs that is good or
right in the circumstances.
Consequentialism
The decision is based on outcomes or consequences. That
approach to ethical decision making maintains that the
right action is the one that produces the greatest amount
of good or the least amount of harm in a given situation.
Utilitarianism
is a well-known consequentialist theory that appeals
exclusively to outcomes or consequences in determining
which choice to make.
Deontology
may conclude that the action is right or wrong in itself,
regardless of the amount of good that might come from it.
Non-maleficence
requires that we do no harm. It is impossible to avoid harm
entirely, but this principle requires that health care
professionals act according to the standards of due care,
always seeking to produce the least amount of harm
possible.
Beneficence
This principle is complementary to nonmaleficence and
requires that we do good. We are limited by time, place,
and talents in the amount of good we can do. We have
general obligations to perform those actions that maintain
or enhance the dignity of other persons whenever those
actions do not place an undue burden on health care
providers.
Distributive justice
Distributive justice requires that there be a fair distribution
of the benefits and burdens in society based on the needs
and contributions of its members. This principle requires
that, consistent with the dignity and worth of its members
and within the limits imposed by its resources, a society
must determine a minimal level of goods and services to be
available to its members.
Egalitarianism
is the view that everyone is entitled to equal rights and
equal treatment in society.
Libertarian
view of justice holds that the right to private property is the
most important right.
lillian wald
- first public health nurse--started public health nursing
- known fo establishmen of henry street settlements in new
york
- national organization of public health established in 1912was the president
Lina Rogers
-first school nurse
- focused on investigating the cause of absenteeism
- did not treat illness- physicians job at the time
segregation
- lasted until 1960s
- made it difficult for african american nurses to get
certification and graduate education
mary breckenridge
- developed health programs to improve healthcare in rural
and hard to reach populations in the applachians of
southern kentucky
ruth freeman
leading healh educator, author, consultant and leader of
national health organization of the 20th century
- offeren many professional oppurtunities
- saw nursing as intellectually challenging and was about
caring for people
WHO conference
- @ Alma Ata in 1978
- main focus of the conference was
worldwideimplementation of primary health
population health
holistic approach that considers the total health system
and focuses on the broad range of factors and conditions
that have a strong influenceon the health of population
- determinants social factors, social support netweorks,
education,m employmentm, and healthy child development
mulitlatral organizations
organizations that recieve fundings from mulple
governmental and non-governmental sources
bio terrorism
intentiaonal use of a pathogen or biological product to
cause harm to living organisms to influence or intimidatt eh
conduct of a government and cause harm to other
people. :
- role of PHN and healh officieals is to detect pathogen ,
manage services, and communicate during threat
- anthrax, plague, and smallpox biological agens highest
concern
environmental health
chemical exposure
nurses have made discoveries based on assessing people
presenting with signs and symptoms related to known
chemical toxicity
epidemiology
studies the incidence and prevalence of disease, in
POPULATIONS
- helps us to understand the strength of the association
between exposure and health effects
- monitors health of populations , understands
determinants of health and disease in communities, and
investigates and evaluates interventions to prevent disease
and maintain health
- father of epidemiology is JOHN SNOW_ because of his
work with cholera
toxicology
study of health effects associated with chemical exposures
rule of seven
native american concept, what will be the effect of this
decision in 7 years. .
- native americans believe humans are stewards, not
propieters of the land
attack rate
-a measure of morbididity often used in infectious disease
investigations
- often specific to an exposure such as food specific attack
rates
-rate that best indicates the proportion of people exposed
to an agent who deelop the disease.
mortality rates
reflect serious health problems and changing patterns of
disease
- do not give direct info about level of existing disease or
the risk of getting a disease
-informative only for fatal diseases
descriptive epidemiology
seeks to describe a desiease entitiy according to person,
place, and time
analytical epidemiology
directed toward understanding the etiology of the disease
and attempts to dienitfy the determinants of disease in
individuals
- determinants may be indvidiual, social , communal, or
environmental
- Examples- cohort studies (prospective and retrospective);
case control studies, cross sectional studies, ecological
studies
rate
measure of frequency of a health event in a "definied
population in a specified period of time
- not a proportion because the denominator is a function of
both the population size and the dimension of time while
the numberator is the number of events
- one cannot tell the degree of seriousness or if it is an
epidemic if you do not have a deonomiator which
represents the total population
risk
the probability an even will occur within a specified time
incidence rate
the number of new cases developing in a population at risk
during a sepcified period
formula= # of new cases (divided by) total population at
risk x 1,000
incidence
quantifies the rate of development of new cases in a
population at risk
epidemic
when the rate of disease injury or other condition exceeds
the usual level of that position
- Examples- an isolatedcase of smallpox in Africa because
there is no smallpox; nursing shortage in US, adult obesity
in the US,
primary prevention
secondary prevention
focuses on ealy detection and prompt treatment of disease
injury or disability. things before symptoms occur . ie
screening for hearig defects, mammograms
tertiary prevention
interventions aimed at disability limitation, and
rehabilitation from disease, injury and disability
- EXAMPLES- rehbilitative job training, vocational training
specificity
a screening test has high specificity - meaning that the test
accuately identifies those without the trait
-the test accuractely identigying those without the trait
point epidemic
- temporal and spatial pattern of disease distribution
- illustrated with freuqncy of disease plotted against time
0 shapr peak indicates concentration of cases in some
short interval of time
- example- outbreak of GI illness from a food borne
pathogen
cohort study
describes a group of persons enroled in a study that share
the same characteristic of interest for a period of time
community trial
as opposed to clinical trials * treatment of existing disease)
is focused on health promotion and disease prevention
Example: Residents of a city have recently voted to add
fluoride to the H20. Epidemiologists wanting to study the
effect on dental caries would be conducting a....
systemetic review
- one of the two ways nurses can read research in
condenced format
- method of identifying, appraising and synthesizing
research evidence to evaluate all available research to a
particular question
- usually done by more than one person and describes the
methods used to search for the evidence
population
a collection of individuals who share at least one common
characteristic
aggregate
definied poplation made up of individuals in communities fo
a specific geographic regions
assurance
making sure that community oriented helath servies are
avaiable .
a core function
core functions
assurance, policy development, assessment, and ascietific
based care
CDC
- implement quality performance standards in public
health. which are used to guid e improvents in the public
health system.
- 1998
assessment
policy development
one of the core functions of public health needed to provide
leadership in deveoping policies.
determinants
- factors, exposures, characteristics and behaviors that
determine patterns of disease.
- may be individual , relational or social, communal, or
environmental
prevalence
the measure of existing disease in a population at a
particular time
Ex: a screening for HTN revleaed 20 previously diagnosed
hypertensive individuals and 10 probable new cases ,
which were later confirmed for a total of 30 cases.
total # of cases divided by total population at risk times
100,000
predictive value
Positive predictor value refers to the proportion of persons
with a positive test who actually have the disease,
interpreted as the probability that an individual with a
positive test has the disease.
nursing model
a tangible schematic and often visual representation of
relationships between and among key concepts that
explain how something works
core
people and their demographics, vital statistics, values,
beliefs, community perception, and history; center which
represents things necessary for life
8 subsystems
physical environment, education, safety and transportation,
politics and government, health and social services,
communication, economics, and recreation
lines of resistance
internal mechanisms that act to defend against stressors;
community strength; an evening recreational program for
young people implemented to decrease vandalism
stressor
tension-producing stimuli that have the potential of causing
disequilibrium in the system; may originate outside the
community or inside the community--inadequate,
inaccessible, or unaffordable services
degree of reaction
stressors and lines of resistance become a part of
community and nursing diagnosis; amount of
disequilibrium or disruption that results
vulnerability
social groups who have an increased relative risk or
susceptibility to adverse health outcomes; increased
morbidity, premature mortality, and diminished quality of
life
CareLink
financial assistance program for medical services received
within University Health System and our providers;
payment plan and payer of last resort; not health insurance
and not free
cultural competence
the ability to express an awareness of one's own culture, to
recognize differences between oneself and others, to adapt
behaviors to appreciate and accommodate those
differences; recognize that people with cultural
backgrounds different from our own have unique values,
life ways, health practices, and interpersonal styles.
population
could include a race, ethnic group, religious group,
profession, a company, people with a certain sexual
preference, or gender; even from the area of the country
that one resides
cultural proficiency
having a vision that you can create an environment for
social change and social justice in your interactions with
colleagues, families and communities to effectively serve
the needs of all cultural groups
family
cultural encounter
process which encourages the healthcare professional to
directly engage in face-to-face cultural interactions and
other types of encounters with clients from culturally
diverse backgrounds in order to modify existing beliefs
about a cultural group and to prevent possible
stereotyping; exposure and practice
cultural knowledge
process in which the healthcare professional seeks and
obtains a sound educational base about culturally diverse
groups; healthcare professionals must focus on the
integration of three specific issues: health-related beliefs
practices and cultural values; disease incidence and
prevalence; cultural views, theoretical and conceptual
framework
cultural awareness
conducting self examination; acknowledgment and
awareness of one's own culture and willingness to explore
one's own feelings and biases; awareness of how culture
influences own ways of thinking and making decisions;
acknowledgement of how day-to-day behaviors reflect
cultural norms and values perpetuated by our families and
larger social networks
cultural assessment
use client's preferred language; be aware of client's
priorities; check client's understanding of diagnoses, and
treatment plan; ask whether client is using alternative
treatments; what or who is the support system; ask what
they think about the problem; ask what treatment they
think will help; what do they hope to receive from your
care; what do they fear most about the problem or
treatment; keep in mind background and individual and
biological differences
education
Religion-does the patient/family have beliefs that you need
to respect and accommodate for to enable you to care for
them
family forms and meaning of family
ethnocentrism
the belief that your cultural values, beliefs, and life ways
are superior to all others; the standard by which one judges
all other cultural patterns; one must be self aware of
perceptions and subsequent judgments are not
ethnocentric
health disparities
differences in the incidence, prevalence, mortality, and
burden of diseases and other health conditions among
specific population groups.
Health Leads
national nonprofit organization that connects low-income
patients with the basic resources they need to be healthy
upstream determinants
features of the social environment, such as socioeconomic
status and discrimination, that influence individual
behavior, disease, and health status.-preventive, health
promotion
downstream preventions/interventions
short-term, problem-specific, individual-based
interventions; after the fact--after disease process has
started.
community assessment
act of becoming acquainted with a community; assessing a
community to identify factors (both positive and negative)
that impinge on the health of the people to develop
strategies for health promotion
Lillian Wald
recognized the intertwining of health status, environmental
sanitation, and social and political forces; mother of public
health nursing; contributions include establishing nursing
schools, advocating for better housing, working to change
child labor laws, teaching preventive practices, advocating
occupational health nursing, and improving the education
of public health nurses
windshield survey
crucial to community assessment because it serves as a
model, or map, to direct and guide that assessment
process; it guides the community assessment; learning
about the community of foot/drive by
CAP Assessment
CAP will guide assessment process; assess core and 8
subsystems (relationships); many methods used to assess
data-observation, interviews, data collection
CAP Planning
goals derived from stressors (weaknesses): aim to mitigate,
alleviate, eliminate the stressor; strengthen the
community's lines of defense; plan interventions to
strengthen lines of resistance
CAP Interventions
all are preventive in nature; Primary-aims at strengthening
the lines of defense, secondary-applied after stressor has
penetrated the community, and tertiary-applied after
stressor pentrates and the degree of reaction has taken
place resulting in system disequilibrium
CAP Evaluation
based on feedback from the community: involves
community in all phases of the nursing process to ensure
success
outcomes: may use same parameters as used in
assessment
bioterrorism
intentional release of pathogens or biologic agents to cause
harm--biological disaster
pandemic
steady occurrence of disease over a large geographic area
or worldwide, such as malaria in Africa
epidemic
unexpected increase of an infectious disease in a
geographic area over an extended period of time; defined
relative to the infectious agent and the history of the
disease in the area
endemic
occur at a consistent, expected level in a geographic areaSTI, tuberculosis
outbreak
unexpected occurrence of an infectious disease in a limited
geographic area during limited period of time
unable to move
Sort: categorize victims based on urgency of care
Send: transport injured persons away from the scene
triage in disaster
emphasis may shift from meeting the most urgent
individual need to meeting the needs of the largest
numbers of victims to maximize the number of lives saved;
should be an ongoing activity. Assess, Assess, Assess-move
move move.
SARS
severe acute respiratory syndrome, outbreak in 2003
disaster
occurs as the result of an event where "normal conditions
of existence are disrupted and the level of suffering
exceeds the capacity of the hazard-affected community to
respond to it"
emergency
occurs as the result of an event where "normal procedures
are suspended and extraordinary measures are taken in
order to avert the impact of a hazard on the community"-can become a disaster
hazard
occurs when an event "has the potential to cause
disruption or damage to the community; earthquake, flood,
typhoon and cyclone--some may become emergencies but
not all become disasters
early colonial PH
efforts
Principles of Nursing
William Rathborne
founded first district nursing association in liverpool,
england
rathbone and nightingale recommended steps to provide
nursing in the home, and district nursing was organized
thorughout england
1870s
first nightingale model nursing schools started
1877
women's board of the new york city mission hired frances
root
1878
ethical culture society of new york hired four nurses to
work in dispensaries
1885-1886
visiting nurses association were established
lina rodges
first united states school nurse
worked with children in NYC schools
She and her other school nurses found illness was often not
the reason for absence
late in 1800s
local health departments formed
1918
Economic depression
agenecies and communities not prepared to address the
increased needs and numbers of impoverished (decreased
funding)
Agencies that helped to support nurse employment
(Federal Emergency relief administration, works progress
administration, relief nursing service, civil works
administratin)
1932 survery
found only 7% of nurses working in PH were adequtely
prepared
world war II
accelerated need for nurses, both for war effort and home
nursing council on national defense
many nurses joined the army, and navy nurse corps.
bolton act of 1943 established cadet nurses corps
some expansion of PHN scope of practice
Emergency maternity and infant care act of 1943
Job opportunities
1960s
medicare and medicad
did not include coverage for preventive services
home health care only reimbursed if ordered by a physician
increase in for-profit home health agencies
reduction in health promotion and disease prevention by
local and state departmetns
1970s
Nurse made significant contribution to:
the hospital movement
the development of birthing centers
1980s
concern about high health costs
fundign shifted away from health promotion and disease
prevention to acute care
national center for nursing research (NCNR) established in
1985 (gained offical status within NIH in 1993, beocming
NINR
IOM's report the future of public health 1988
Healthy people initaitve began
1990s
health care debate focused on cost, quality, and access to
direct care services
nursing organizations joined to support health care reform
2000s
health care reform finally passed in 2010 with the federal
patient protection and affordable care act
PHN organizations develop position papers on:
graduate education for advance practice PHN
faculty qualifactions for community/public health nursing
educators
importance of PHN within PH systems
Better nutrition, water, antibiotics, immunizations. PUBLIC
HEALTH.
Life Expectancy - U.S.
What factors/events resulted in the 21+ additional years of
life from 1900-1950???
What factors/events resulted in the 7 additional years of
life from 1950-1990?
1. Upstream
2. Downstream
There are two views of the health care picture
We need to question the way we have thought of health
and health care...
Should we focus on treatment of illness or prevention of
disease in the first place?
1. Microscopic
2. Medical Model
3. Downstream
_______ approach to solving community health problems
(the _____ or _____):
- Individual (family) response to health and illness
- Emphasizes behavioral responses to illness or lifestyle
patterns
- Nursing interventions aimed at the individual
------Changing lifestyles
------Changing perceptions or belief system
- The individual is the locus of change
- Focuses on the "cure"
1. Macroscopic
2. Public Health
3. Upstream
______ approach to solving community health problems
(______ or _______)
- Interfamily and intercommunity themes
- Emphasizes social, economic, and environmental
precursors of illness
- Nursing interventions may include modifying social or
environmental variables
- May involve social or political action
- society (social system) is the locus of change
- focuses on "prevention"
1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
Transtheoretical Model (Stages of Change):
1. _______: No intention to change behavior in the next 6
months
------May be lack of information about consequences or
previous failure.
2. _______: Individual intends to change behavior in the next
6 months.
------Weighs pros and cons
3. _______: Individual intends to act within the next month
and has taken steps toward change
------Has a plan of action
4. _______: Individual has changed behavior for less than 6
months
------Change is sufficient to reduce disease risk.
5. _______: Individual has changed behavior for more than 6
months.
------Tries to prevent relapse
------Phase may last months to years
1. Smoking cessation
2. Injury prevention
3. RNs assisting families obtain health insurance
1. Health Disparities
2. Health and social justice
Examples of applying critical social theory:
1.
2.
1. Purposeful actions
2. Processes
3. Responses
4. Behaviors
Definitions of Health:
Health consists of:
_____, ______, _____, or _____ that leads to: "soundness,"
"wholeness," or "well-being"
1. Physical Environment
2. Social Environment
3. Individual Behavior
4. Biology & Genetics
5. Health Services
6. Policy making
Determinants of Health:
Health Outcomes due to:
1.
2.
3.
4.
5.
6.
Physical Environment
Determinants of Health - Examples of ______ factors:
- Natural environment (ie plants, weather, climate change)
- Worksites, schools and recreational settings
- Housing, homes, neighborhoods
- Exposure to toxic substances
- Physical barriers
- Aesthetic elements (ie good lighting, trees, parks)
Social Factors
Determinants of Health - Examples of ______ factors:
- Availability of resources (ie educational and job
opportunities, living wages, healthful foods)
- Social norms and attitudes
- Exposure to crime and violence
- Social interactions
- Exposure to emerging technology (ie the Internet)
- Transportation options
Individual Behaviors
Determinants of Health - Examples of ______ factors:
- Diet
- Physical activity
- Alcohol, tobacco and other drug use
- Sexual behavior
- Hand washing
Health Service
Determinants of Health - Examples of ______ factors:
- Barriers (lack of availability, high cost, lack of insurance,
language issues)
------- Unmet health needs
Policy Making
Determinants of Health - Examples of ______ factors:
- Health curricula requirements
- Increased taxes on tobacco
- Prohibitions on smoking
- Drinking age restrictions
- Seat belt laws and child restraints
1. Life expectancy
2. Health life expectancy
3. Years of potential life lost
4. Physically and mentally unhealthy days
5. Self-assessed health status
6. Limitation of activity
7. Chronic Disease Prevalence
Indicators of General Health Status:
1.
2.
3.
4.
5.
6.
7.
Community
___________:
- It can be a physical place or a geopolitical community.
- Has boundaries
- It can be a relational, interactive group. - A community
with no physical boundaries. A phenomenological
community is abstract. Churches, universities, online
groups are examples
Community
__________:
"A collection of people who interact with one another and
whose common interests or characteristics form the basis
for a sense of unity or belonging." (Nies and McEwen,
2011)
Community
__________:
"A group of people who share something in common and
interact with one another, who may exhibit a commitment
to one another and may share a geographic boundary."
1. People
2. They must interact with each other in some way
3. Something in common: an interest, a geographical
location, a commitment
A community has to have:
1.
2.
3.
1. Primary Prevention
2. Secondary Prevention
3. Tertiary Prevention
Levels of Prevention:
1.
2.
3.
Primary Prevention
_______ level of prevention
- activities preventing a problem before it occurs
- Health promotion
- Specific protection
- Immunizations
Secondary Prevention
________ level of prevention
- Early detection and prompt intervention
- Screening
- Early referral for treatment
- Screening for STDs
Tertiary Prevention
_______ level of prevention
- Focus on limitation of disability and rehabilitation
- Prevention progression of disease
- Reduce the effects of the disease
- Teaching insulin administration
---------------------------------
Community-based nursing
___________:
o Nursing of individuals and families to improve their
health
o Goals: Help them manage illness while they move among
health care settings
o Promote self-care and rehabilitation; prevent disease
o Processes: NP; diagnosis and treatment
Community clinics
School clinics
Workplace clinics
Rehabilitation centers
Settings for Community-based nursing:
1.
2.
3.
4.
5.
6.
Clinical Nursing
_________:
o Goal: improve the health of patients
o Clients: Patients of the health care system
o Processes used: nursing process, treatment and patient
care procedures
o Settings: inpatient
1. Surveillance
2. Disease and other health event investigation
3. Outreach
4. Screening
5. Case finding
6. Referral and Follow-up
7. Case management
8. Delegated functions
9. Health Teaching
10. Counseling
11. Consultation
12. Collaboration
13. Coalition Building
14. Community Organizing
15. Advocacy
16. Social Marketing
17. Policy and enforcement
Public Health Interventions:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
12.
13.
14.
15.
16.
17
Surveillance
Describes and monitors health events through ongoing and
systematic collection, analysis and interpretation of health
data for the purpose of planning, implementing and
evaluating public health interventions
Outreach
Locates populations of interest or populations at risk and
provides information about the nature of the concern, what
can be done about it, and how services can be obtained
Screening
Identifies individuals with unrecognized health risk factors
or asymptomatic disease conditions in populations
Case finding
Locates individuals and families with identified risk factors
and connects them with resources
Case Management
Optimizes self-care capabilities of individuals and families
and the capacity of systems and communities to coordinate
and provide services
Delegated Functions
Direct care tasks a registered professional nurse carriers
out under the authority of a health care practitioner as
allowed by law
Health Teaching
Communicates facts, ideas, and skills that change
knowledge, attitudes, values, beliefs, behaviors, and
practices of individuals, families, systems, and/or
communities
Counseling
Establishes an interpersonal relationship intended to
increase or enhance capacity for self-care and coping with
a community, system, and family or individual
Consultation
Collaboration
Commits two or more persons or organization to achieve a
common goal through enhancing the capacity of one or
more of the members to promote and protect health
Coalition Building
Promotes and develops alliances among organizations or
constituencies for a common purpose
Community Organizing
Helps community groups to identify common problems or
goals, mobilize resources, and develop and implement
strategies for reaching the goals they collectively have set
Advocacy
Plead someone's cause or act on someone's behalf, with a
focus on developing the community, system, and individual
or family's capacity to plead their own cause or act on their
own behalf
Social Marketing
Utilizes commercial marketing principles and technologies
for programs designed to influence the knowledge,
attitudes, values, beliefs, behaviors, and practices of the
population of interest
John Snow
_______: Father of epidemiology
1. Pasteur
2. Lister
3. Koch
____, _____, _____: On "germs" and disease causation (late
1800s)
1. Edward Jenner
2. Edwick Chadwick
History of Public Health Nursing:
Pre 1850: Home visiting to sick as an act of charity.
- ______ observed people who worked around cattle were
less likely to have smallpox.
- _______ called attention to the consequences of unsanitary
conditions that resulted in health disparities that shortened
the life span of the laboring class in particular.
1. John Snow
2. Florence Nightingale
3. Pasteur, Lister, Koch
4. Lilian Wald
5. Mary Brewster
History of Public Health Nursing:
1850-1900: Home visiting to sick
- _______ demonstrated that cholera was transmissible
through contaminated water.
-________ - credited with establishing "modern nursing."
- ________: On "germs" and disease causation (late 1800s)
- In 1893, nurses _______ ("mother of community nursing")
and _______ established a district nursing service on the
lower east side of New York City called The House on Henry
Street.
1. 1900-1960s
History of Public Health Nursing:
________:
- Nursing in community centers for the poor
- Communicable disease control
- Communicable disease control/immunization
- Rise in PHN, home visits, school and OH nursing
1. 1960-1980
History of Public Health Nursing:
________: Care provided in public health clinics
1. 1980s-present
History of Public Health Nursing:
_________:
- Health promotion and education
- Health care access improvement
1. Poverty
2. Violence
3. HIV/AIDS
4. TB
5. Bioterrorism
Public/Community Health Nursing Today in U.S.
- Concerned with contemporary problems such as _____,
______, ______, _______, and _______.
- Practice is everywhere in public health agencies, schools,
occupational settings, community-based agencies, etc.
Healthy People
__________:
- provides science-based, 10-year national objectives for
improving the health of all Americans. For 3 decades, this
has established benchmarks and monitored progress over
time in order to:
o Encourage collaborations across communities and
sectors.
o Empower individuals toward making informed health
decisions.
o Measure the impact of prevention activities.
- Vision: A society in which all people live long, healthy lives
A.
B.
C.
Community organizing
Nursing process
Community diagnosis
Epidemiologic process
4. R.A. 1054 is also known as the Occupational Health Act. Aside from
number of employees, what other factor must be considered in determining
the occupational health privileges to which the workers will be entitled?
Type of occupation: agricultural, commercial, industrial
Location of the workplace in relation to health facilities
Classification of the business enterprise based on net profit
D.
A.
B.
C.
D.
21
101
201
301
6. When the occupational health nurse employs ergonomic principles, she is
performing which of her roles?
A.
B.
C.
D.
A.
B.
C.
D.
A.
For
For
For
For
10. We say that a Filipino has attained longevity when he is able to reach the
average lifespan of Filipinos. What other statistic may be used to determine
attainment of longevity?
A.
B.
C.
D.
A.
A.
B.
C.
D.
Primary
Secondary
Intermediate
Tertiary
15. Which is true of primary facilities?
A.
B.
C.
D.
A.
Effectiveness
Efficiency
Adequacy
Appropriateness
18. You are a new B.S.N. graduate. You want to become a Public Health
Nurse. Where will you apply?
A.
B.
C.
D.
Department of Health
Provincial Health Office
Regional Health Office
Rural Health Unit
19. R.A. 7160 mandates devolution of basic services from the national
government to local government units. Which of the following is the major goal
of devolution?
A.
B.
C.
D.
A.
B.
C.
D.
Mayor
Municipal Health Officer
Public Health Nurse
Any qualified physician
21. Which level of health facility is the usual point of entry of a client into the
health care delivery system?
A.
B.
C.
D.
Primary
Secondary
Intermediate
Tertiary
22. The public health nurse is the supervisor of rural health midwives. Which
of the following is a supervisory function of the public health nurse?
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
1
2
3
The RHU does not need any more midwife item.
25. If the RHU needs additional midwife items, you will submit the request for
additional midwife items for approval to the
A.
B.
C.
D.
A.
B.
Act 3573
R.A. 3753
C.
D.
R.A. 1054
R.A. 1082
27. According to Freeman and Heinrich, community health nursing is a
developmental service. Which of the following best illustrates this statement?
A.
Poliomyelitis
Measles
Rabies
Neonatal tetanus
29. The public health nurse is responsible for presenting the municipal health
statistics using graphs and tables. To compare the frequency of the leading
causes of mortality in the municipality, which graph will you prepare?
A.
B.
C.
D.
Line
Bar
Pie
Scatter diagram
30. Which step in community organizing involves training of potential leaders
in the community?
A.
B.
C.
D.
Integration
Community organization
Community study
Core group formation
10. We say that a Filipino has attained longevity when he is able to reach the average
life span of Filipinos. What other statistic may be used to determine attainment of
longevity?
A. Age-specific mortality rate
B. Proportionate mortality rate
C. Swaroops index
D. Case fatality rate
11. Which of the following is the most prominent feature of public health nursing?
A. It involves providing home care to sick people who are not confined in the hospital
B. Services are provided free of charge to people within the catchment area
C. The public health nurse functions as part of a team providing a public health nursing
service
D. Public health nursing focuses on preventive, not curative services
12. According to Margaret Shetland, the philosophy of public health nursing is based
on which of the following?
A. Health and longevity as birthrights
B. The mandate of the state to protect the birthrights of its citizens
C. Public health nursing as a specialized field of nursing
D. The worth and dignity of man
13. Which of the following is the mission of the Department of Health?
A. Health for all Filipinos
B. Ensure the accessibility and quality of health
C. Improve the general health status of the population
D. Health in the hands of the Filipino people by the year 2020
14. Region IV Hospital is classified as what level of facility?
A. Primary
B. Secondary
C. Intermediate
D. Tertiary
15. What is true of primary facilities?
30. Which step in community organizing involves training of potential leaders in the
community?
A. Integration
B. Community organization
C. Community study
D. Core group formation
31. In which step are plans formulated for solving community problems?
A. Mobilization
B. Community organization
C. Follow-up/extension
D. Core group formation
32. The public health nurse takes an active role in community participation. What is
the primary goal of community organizing?
A. To educate the people regarding community health problems
B. To mobilize the people to resolve community health problems
C. To maximize the communitys resources in dealing with health problems
33. An indicator of success in community organizing is when people are able to:
A. Participate in community activities for the solution of a community problem
B. Implement activities for the solution of the community problem
C. Plan activities for the solution of the community problem
D. Identify the health problem as a common concern
34. Tertiary prevention is needed in which stage of the natural history of disease?
A. Pre-pathogenesis
B. Pathogenesis
C. Predromal
D. Terminal
35. Isolation of a child with measles belongs to what level of prevention?
A. Primary
B. Secondary
C. Intermediate
D. Tertiary
36. On the other hand, Operation Timbang is_____ prevention?
A. Primary
B. Secondary
C. Intermediate
D. Tertiary
37. Which type of family-nurse contact will provide you with the best opportunity to
observe family dynamics?
A. Clinic consultation
B. Group conferences
C. Home visit
D. Written communication
38. The typology of family nursing problems is used in the statement of nursing
diagnosis in the care of families. The youngest child of the delos Reyes family has
been diagnosed as mentally retarded. This is classified as:
A. Health threat
B. Health deficit
C. Foreseeable crisis
D. Stress point
39. The delos Reyes couple have 6-year old child entering school for the first time.
The delos Reyes family has a:
A. Health threat
B. Health deficit
C. Foreseeable crisis
D. Stress point
40. Which of the following is an advantage of a home visit?
A. It allows the nurse to provide nursing care to a greater number of people
B. It provides an opportunity to do first hand appraisal of the home situation
A. Epidemic occurrence
B. Cyclical variation
C. Sporadic occurrence
D. Secular occurrence
51. In the year 1980, the World Health Organization declared the Philippines, together
with some other countries in the Western Pacific Region, free of which disease?
A. Pneumonic plaque
B. Poliomyelitis
C. Small pox
D. Anthrax
52. In the census of the Philippines in 1995, there were about 35,299,000 males and
about 34,968,000 females. What is the sex ratio?
A. 99.06:100
B. 100.94:100
C. 50.23%
D. 49.76%
53. Primary health care is a total approach to community development. Which of the
following is an indicator of success in the use of the primary health care approach?
A. Health services are provided free of charge to individuals and families
B. Local officials are empowered as the major decision makers in matters of health
C. Health workers are able too provide care based on identified health needs of the people
D. Health programs are sustained according to the level of development of the community
54. Sputum examination is the major screening tool for pulmonary tuberculosis.
Clients would sometimes get false negative results in this exam. This means that the
test is not perfect in terms of which characteristic of a diagnostic examination?
A. Effectiveness
B. Efficacy
C. Specificity
D. Sensitivity
55. Use of appropriate technology requires knowledge of indigenous technology.
Which medical herb is given for fever, headache and cough?
A. Sambong
B. Tsaang gubat
C. Akapulko
D. Lagundi
56. What law created the Philippine institute of Traditional and Alternative Health
Care?
A. RA 8483
B. RA4823
C. RA 2483
D. RA 3482
57. In traditional Chinese medicine, the yielding, negative and feminine force is
termed:
A. Yin
B. Yang
C. Qi
D. Chai
58. What is the legal basis of Primary Health Care approach in the Philippines?
A. Alma Ata Declaration of PHC
B. Letter of Instruction No 949
C. Presidential Decree No. 147
D. Presidential Decree 996
59. Which of the following demonstrates inter-sectoral linkages?
A. Two-way referral system
B. Team approach
C. Endorsement done by a midwife to another midwife
D. Cooperation between PHN and public school teacher
60. The municipality assigned to you has a population of about 20/000. Estimate the
number of 1-4 year old children who be given Retinol capsule 200.000 every 6
months.
A. 1,500
B. 1,800
C. 2,000
D. 2,300
61. Estimate the number of pregnant women who will be given tetanus toxoid during
an immunization outreach activity in a barangay with a population of about 1,500.
A. 265
B. 300
C. 375
D. 400
62. To describe the sex composition of the population, which demographic tool may
be used?
A. Sex ratio
B. Sex proportion
C. Population pyramid
D. Any of these maybe used
63. Which of the following is a natality rate?
A. Crude birth rate
B. Neonatal mortality rate
C. Infant mortality rate
D. General fertility rate
64. You are computing the crude rate of your municipality, with a total population o
about 18,000 for last year. There were 94 deaths. Among those who died, 20 died
because of diseases of the heart and 32 were aged 50 years or older. What is the
crude death rate?
A. 4.1/1000
B. 5.2/1000
C. 6.3/1000
D. 7.3/1000
65. Knowing that malnutrition is a frequent community health problem, you decided
to conduct nutritional assessment. What population is particularly susceptible to
protein energy malnutrition (PEM)?
A. Pregnant women and the elderly
B. Under 5 year old children
C. 1-4 year old children
D. School age children
66. Which statistic can give the most accurate reflection of the health status of a
community?
A. 1-4 year old age-specific mortality rate
B. Infant mortality rate
C. Swaroops index
D. Crude death rate
67. In the past year, Barangay A had an average population of 1655. 46 babies were
born in that year, 2 of whom died less than 4 weeks after they were born. They were 4
recorded stillbirths. What is the neonatal mortality rate?
A. 27.8/1000
B. 43.5/1000
C. 86.9/1000
D. 130.4/1000
68. Which statistic best reflects the nutritional status of a population?
A. 1-4 year old age-specific mortality rate
B. Proportionate mortality rate
C. Infant mortality rate
D. Swaroops index
69. What numerator is used in computing general fertility rate?
A. Estimated midyear population
B. Number of registered live births
C. Number of pregnancies in the year
D. Number of females of reproductive age
70. You will gather data for nutritional assessment of a purok. You will gather
information only from families with members who belong to the target population for
PEM. What method of delta gathering is best for this purpose?
A. Census
B. Survey
C. Record Review
D. Review of civil registry
71. In the conduct of a census, the method of population assignment based on the
actual physical location of the people is termed;
A. De jure
B. De locus
C. De facto
D. De novo
72. The Field Health Services and information System (FHSIS) is the recording and
reporting system in public health) care in the Philippines. The monthly field health
service activity report is a form used in which of the components of the FHSIS?
A. Tally report
B. Output report
C. Target/client list
D. Individual health record
73. To monitor clients registered in long-term regimens, such as the Multi-Drug
Therapy, which component will be most useful?
A. Tally report
B. Output report
C. Target/client list
D. Individual health record
74. Civil registries are important sources of data. Which law requires registration of
births within 30 days from the occurrence of the birth?
A. PD 651
B. Act 3573
C. RA 3753
D. RA 3375
75. Which of the following professionals can sign the birth certificate?
A. Public health nurse
B. Rural health midwife
C. Municipal health officer
D. Any of these health professionals
76. Which criterion in priority setting of health problems is used only in community
health care?
A. Modifiability of the problem
B. Nature of the problem presented
C. Magnitude of the health problem
D. Preventive potential of the health problem
77. The Sentrong Sigla Movement has been launched to improve health service
delivery. Which of the following is/are true of this movement?
A. This is a project spearheaded by local government units
B. It is a basis for increasing funding from local government units
C. It encourages health centers to focus on disease prevention and control
D. Its main strategy is certification of health centers able to comply with standards
78. Which of the following women should be considered as special targets for family
planning?
A. Those who have two children or more
B. Those with medical conditions such as anemia
C. Those younger than 20 years and older than 35 years
D. Those who just had a delivery within the past 15 months
79. Freedom of choice in one of the policies of the Family Planning Program of the
Philippines. Which of the following illustrates this principle?
A. Information dissemination about the need for family planning
B. Support of research and development in family planning methods
C. Adequate information for couples regarding the different methods
D. Encouragement of couples to take family planning as a joint responsibility
80. A woman, 6 months pregnant, came to the center for consultation. Which of the
following substances is contraindicated?
A. Tetanus toxoid
B. Retinol 200,000 IU
C. Ferrous sulfate 200mg
D. Potassium iodate 200 mg, capsule
81. During prenatal consultation, a client asked you if she can have her delivery at
home. After history taking and physical examination, you advised her against a home
delivery. Which of the following findings disqualifies her for a home delivery?
A. Her OB score is G5P3
B. She has some palmar pallor
C. Her blood pressure is 130/80
D. Her baby is in cephalic presentation
82. Inadequate intake by the pregnant woman of which vitamin may cause neural
tube defects?
A. Niacin
B. Riboflavin
C. Folic Acid
D. Thiamine
83. You are in a clients home to attend to a delivery. Which of the following will you
do first?
A. Set up a sterile area
B. Put on a clean gown and apron
C. Cleanse the clients vulva with soap and water
D. Note the interval, duration and intensity of labor and contractions
84. In preparing a primigravida for breastfeeding, which of the following will you do?
A. Tell her that lactation begins within a day after delivery
B. Teach her nipple stretching exercises if her nipples are everted
C. Instruct her to wash her nipples before and after each breastfeeding
D. Explain to her that putting the baby to breast will lessen blood loss after delivery
85. A primigravida is instructed to offer her breast to the baby for the first time within
30 minutes after delivery. What is the purpose of offering the breast this early?
A. To initiate the occurrence of milk letdown
B. To stimulate milk production by the mammary acini
C. To make sure that the baby is able to get the colustrum
D. To allow the woman to practice breastfeeding in the presence of the health worker
86. In a mothers class, you discuss proper breastfeeding technique. Which of these
is a sign that the baby has lactated on the breast property?
A. The baby takes shallow, rapid sucks
B. The mother does not feel nipple pain
C. The babys mouth is only partly open
D. Only the mothers nipple is inside the babys mouth
87. You explain to a breastfeeding mother that breastmilk is sufficient for all of the
babys nutrient needs only up to:
A. 3 months
B. 6 months
C. 1 year
D. 2 years
88. What is given to a woman within a month after the delivery of a baby?
A. Malunggay capsule
B. Ferrous sutfate l00mg O.D.
C. Retinol 200.000 IU 1 capsule
D. Potassium Iodate 200 mg, 1 capsule
89. Which biological used in EPI is stored in the freezer?
A. DPT
B. Tetanus toxoid
C. Measles vaccine
D. Hepatitis B vaccine
90. Unused BCG should be discarded how many hours after reconstitution?
A. 2
B. 4
C. 6
D. At the end of the day
91. In immunity school entrants with BCG, you not obliged to secure parental
consent. This is because of which legal document?
A. PD 996
B. RA 7864
C. Presidential Proclamation No. 6
D. Presidential Proclamation No. 46
92. Which immunization produces a permanent scar?
A. DPT
B. BCG
C. Measles vaccination
D. Hepatitis B vaccination
93. A 4 week old baby was brought to the health center for his first immunization.
Which can be given to him?
A. DPT1
B. OPV1
C. Infant BCG
D. Hepatitis B Vaccin
94. You will not give DPT 2 if the mother says that the infant had?
A. Seizures a day after DPT1
B. Fever for 3 days after DPT1
C. Abscess formation after DPT1
D. Local tenderness for 3 days after DPT1
95. A 2-month old infant was brought to the health center for immunization. During
assessment, the infants temperature registered at 38.1 C. Which is the best course
of action that you will take?
and his eyes are sunken. Using the IMCI guidelines, you will classify this infant in
which category?
A. No signs of dehydration
B. Some dehydration
C. Severe dehydration
D. The data is insufficient
101. Based on the assessment, you classified a 3-month old infant with the chief
complaint of diarrhea in the category of SOME DEHYDRATION. Based on the IMCI
management guidelines, which of the following will you do?
A. Bring the infant to the nearest facility where IV fluids can be given
B. Supervise the mother in giving 200 to 400 ml of Oresol in 4 hours
C. Give the infants mother instructions on home management
D. Keep the infant in your health center for close observation
102. A mother is using Oresol in the management of diarrhea of her 3-year old child.
She asked you what to do if her child vomits. You will tell her to:
A. Bring the child to the nearest hospital for further assessment
B. Bring the child to the health center for IV therapy
C. Bring the child to the health center for assessment by the physician
D. Let the child rest for 10 minutes then continue giving Oresol more slowly
103. A 1 1/2 year old child was classified as having 3rd degree of protein energy
malnutrition, kwashjorkor. Which of the following signs will be most apparent in this
child?
A. Voracious appetite
B. Wasting
C. Apathy
D. Edema
104. Assessment of a 2-year old child revealed baggy pants. Using the IMCI
guidelines, how will you manage this child?
A. Refer the child urgently to a hospital for confinement
B. Coordinate with the social worker to enroll the child in a feeding program
C. Make a teaching plan for the mother, focusing on the menu planning for her child
D. Assess and treat the child for health problems like infections and intestinal parasitism
105. During the physical examination of a young child, what is the earliest sign of
xerophthalmia that may observe?
A. Keratomalacia
B. Corneal opacity
C. Night blindness
D. Conjunctival xerosis
106. To prevent xerophthalmia, young children are given Retinol capsule every 6
months. What is the dose given to preschoolers?
A. 10, 000 IU
B. 20, 000 IU
C. 100, 000 IU
D. 200, 000 IU
107. The major sign of iron deficiency anemia is pallor. What part is best examined
for pallor?
A. Palms
B. Nailbeds
C. Around the lips
D. Lower conjunctival sac
108. Food fortification is one of the strategies to prevent micronutrient deficiency
conditions. RA 8976 mandates fortification of certain food items. Which of the
following is among these food items?
A. Sugar
B. Bread
C. Margarine
D. Filled milk
109. What is the best course of action when there is a measles epidemic in a nearby
municipality?
A. Give measles vaccine to babies aged 6 to 3 months
B. Give babies aged 6 to 11 months one dose of 100,000 IU of Retinol
C. Instruct mother to keep their babies at home to prevent disease transmission
D. Instruct mothers to feed their babies adequately to enhance their babies resistance
110. A mother brought her daughter, 4 years old, to the RHU because of cough and
colds. Following the IMCI assessment guide, which of the following is a danger sign
that indicates the need for urgent referral to a hospital?
A. Inability to drink
B. High grade fever
C. Signs of severe dehydration
D. Cough for more than 30 days
111. Management of a child with measles includes the administration of which of the
following?
A. Gentian violet on mouth lesions
B. Antibiotic to prevent pneumonia
C. Tetracycline eye ointment for corneal opacity
D. Retinol capsule regardless of when the last dose was given
112. A mother brought her 10 month old infant for consultation because of fever
which started 4 days prior to consultation. To determine malaria risk, what will you
do?
A. Do a tourniquet test
B. Ask where the family resides
C. Get a specimen for blood smear
D. Ask if the fever is present everyday
113. The following are strategies implemented by the DOH to prevent mosquito-borne
diseases. Which of these is most effective in the control of Dengue fever?
A. Stream seeding with larva-eating fish
B. Destroying breeding places of mosquitoes
C. Chemoprophylaxis of non-immune persons going to endemic areas
D. Teaching people in endemic areas to use chemically treated mosquito nets
114. Secondary prevention for malaria includes?
A. Planting of neem or eucalyptus trees
B. Residual spraying of insecticides at night
C. Determining whether a place is endemic or not
D. Growing larva-eating fish in mosquito breeding places
115. Scotch tape swab is done to check for which intestinal parasite?
A. Ascaris
B. Pinworm
C. Hookworm
D. Schistosoma
116. Which of the following signs indicates the need for sputum examination for
AFB?
A. Hematemesis
B. Fever for 1 week
C. Cough for 3 weeks
D. Chest pain for 1 week
117. Which clients are considered targets for DOTS category?
A. Sputum negative cavitary cases
B. Clients returning after default
C. Relapses and failures of previous PTB treatment regimens
D. Clients diagnosed for the first time through a positive sputum exam
118. To improve compliance to treatment, what innovation is being implemented in
DOTS?
A. Having the health worker follow up the client at home
B. Having the health worker or a responsible family member monitor drug intake
C. Having the patient come to the health center every month to get his medications
D. Having a target list to check on whether the patient has collected his monthly supply of
drugs
119. Diagnosis of leprosy is highly dependent on recognition of symptoms. Which of
the following is an early sign of leprosy?
A. Macular lesions
B. Inability to close eyelids
C. Thickened painful nerves
D. Sinking of the nose bridge
125. Which biological used in EPI should not be stored in the freezer?
A. DPT
B. OPV
C. Measles vaccine
D. MMR
126. You will conduct outreach immunization in a barangay with a population of
about 1500. Estimate the number of infants in the barangay.
A. 45
B. 50
C. 55
D. 60
127. In IMCI, severe conditions generally require urgent referral to a hospital. Which
of the following severe conditions Does not always require urgent referral to
hospital?
A. Mastoiditis
B. Severe dehydration
C. Severe pneumonia
D. Severe febrile disease.
128. A client was diagnosed as having Dengue Fever. You will say that there is slow
capillary refill when the color of the nailbed that you pressed does not return within
how many seconds?
A. 3
B. 5
C. 8
D. 10
129. A 3-year old child was brought by his mother to the health center because of
fever of 4-day duration. The child had a positive tourniquet test result. In the absence
of other signs, which of the most appropriate measure that the PHN may carry out to
prevent Dengue shock syndrome?
A. Insert an NGT and give fluids per NGT
B. Instruct the mother to give the child Oresol
A. I
B. II
C. III
D. IV
140. You are the PHN in the city health center. A client underwent screening for AIDS
using ELISA. His result was positive. What is the best course of action that you may
take?
A. Get a thorough history of the client, focusing on the practice of high risk behavior
B. Ask the client to be accompanied by a significant person before revealing the result.
C. Refer the client to the physician since he is the best person to reveal the result to the
client
D. Refer the client for a supplementary test, such as Western blot, since the ELISA result
maybe false
141. Which is the BEST control measure for AIDS?
A. Being faithful to a single sexual partner
B. Using a condom during each sexual contact
C. Avoiding sexual contact with commercial sex workers
D. Making sure that ones sexual partner does not have signs of AIDS
142. The most frequent causes of death among clients with AIDS are opportunistic
diseases. Which of the following opportunistic infections is characterized by
tonsilllopharyngitis?
A. Respiratory candidiasis
B. Infectious mononucleosis
C. Cytomegalovirus disease
D. Pneumocystis carinii pneumonia
143. To determine the possible sources of sexually transmitted infections, which is
the BEST method that may be undertaken by the public health nurse?
A. Contact tracing
B. Community survey
C. Mass screening tests
D. Interview suspects
144. Antiretroviral agents, such as AZT are used in the management of AIDS. Which
of the following is not an action expected of these drugs?
A. They prolong the life of the client with AIDS
B. They reduce the risk of opportunistic infections
C. They shorten the period of communicability of the disease
D. They are able to bring about a cure of the disease condition
145. A barangay had an outbreak of German measles. To prevent congenital rubella,
what is the BEST advice that you can give to women in the first trimester of
pregnancy in the barangay?
a. Advice them on the sign of German Measles
b. Avoid crowded places, such as markets and moviehouses
c. Consult at the health center where rubella vaccine may be given
d. Consult a physician who may give them rubella immunoglobulin
The community health nurse develops the health capability of people through health
education and community organizing activities.
28. Answer: (B) Measles
Presidential Proclamation No. 4 is on the Ligtas Tigdas Program.
29. Answer: (B) Bar
A bar graph is used to present comparison of values, a line graph for trends over time or
age, a pie graph for population composition or distribution, and a scatter diagram for
correlation of two variables.
30. Answer: (D) Core group formation
In core group formation, the nurse is able to transfer the technology of community
organizing to the potential or informal community leaders through a training program.
31. Answer: (B) Community organization
Community organization is the step when community assemblies take place. During the
community assembly, the people may opt to formalize the community organization and
make plans for community action to resolve a community health problem.
32. Answer: (D) To maximize the communitys resources in dealing with health problems
Community organizing is a developmental service, with the goal of developing the peoples
self-reliance in dealing with community health problems. A, B and C are objectives of
contributory objectives to this goal.
33. Answer: (A) Participate in community activities for the solution of a community problem
Participation in community activities in resolving a community problem may be in any of the
processes mentioned in the other choices.
34. Answer: (D) Terminal
Tertiary prevention involves rehabilitation, prevention of permanent disability and disability
limitation appropriate for convalescents, the disabled, complicated cases and the terminally
ill (those in the terminal stage of a disease)
35. Answer: (A) Primary
The purpose of isolating a client with a communicable disease is to protect those who are
not sick (specific disease prevention).
test is 100% sensitive, all the cases tested will have a positive result, i.e., there will be no
false negative results.
55. Answer: (D) Lagundi
Sambong is used as a diuretic. Tsaang gubat is used to relieve diarrhea. Akapulko is used
for its antifungal property.
56. Answer: (A) R.A. 8423 or AN ACT CREATING THE PHILIPPINE INSTITUTE OF
TRADITIONAL AND ALTERNATIVE HEALTH CARE (PITAHC) TO ACCELERATE THE
DEVELOPMENT OF TRADITIONAL AND ALTERNATIVE HEALTH CARE IN THE
PHILIPPINES, PROVIDING FOR A TRADITIONAL AND ALTERNATIVE HEALTH CARE
DEVELOPMENT FUND AND FOR OTHER PURPOSES signed to a law on December 9,
1997.
57. Answer: (A) Yin
Yang is the male dominating, positive and masculine force.
58. Answer: (B) Letter of Instruction No. 949
Letter of Instruction 949 was issued by then President Ferdinand Marcos, directing the
formerly called Ministry of Health, now the Department of Health, to utilize Primary Health
Care approach in planning and implementing health programs.
59. Answer: (D) Cooperation between the PHN and public school teacher
Intersectoral linkages refer to working relationships between the health sector and other
sectors involved in community development.
60. Answer: (D) 2,300
Based on the Philippine population composition, to estimate the number of 1-4 year old
children, multiply total population by 11.5%.
61. Answer: (A) 265
To estimate the number of pregnant women, multiply the total population by 3.5%.
62. Answer: (D) Any of these may be used.
Sex ratio and sex proportion are used to determine the sex composition of a population. A
population pyramid is used to present the composition of a population by age and sex.
63. Answer: (A) Crude birth rate
Natality means birth. A natality rate is a birth rate.
only BCG is discarded 4 hours after reconstitution. This is why BCG immunization is
scheduled only in the morning.
91. Answer: (A) P.D. 996
Presidential Decree 996, enacted in 1976, made immunization in the EPI compulsory for
children under 8 years of age. Hepatitis B vaccination was made compulsory for the same
age group by R.A. 7846.
92. Answer: (B) BCG
BCG causes the formation of a superficial abscess, which begins 2 weeks after
immunization. The abscess heals without treatment, with the formation of a permanent scar.
93. Answer: (C) Infant BCG
Infant BCG may be given at birth. All the other immunizations mentioned can be given at 6
weeks of age.
94. Answer: (A) Seizures a day after DPT 1.
Seizures within 3 days after administration of DPT is an indication of hypersensitivity to
pertussis vaccine, a component of DPT. This is considered a specific contraindication to
subsequent doses of DPT.
95. Answer: (A) Go on with the infants immunizations.
In the EPI, fever up to 38.5C is not a contraindication to immunization. Mild acute
respiratory tract infection, simple diarrhea and malnutrition are not contraindications either.
96. Answer: (A) 1 year
The baby will have passive natural immunity by placental transfer of antibodies. The mother
will have active artificial immunity lasting for about 10 years. 5 doses will give the mother
lifetime protection.
97. Answer: (C) Normal
In IMCI, a respiratory rate of 50/minute or more is fast breathing for an infant aged 2 to 12
months.
98. Answer: (D) Chest indrawing
In IMCI, chest indrawing is used as the positive sign of dyspnea, indicating severe
pneumonia.
Mobilization
Community organization
Follow-up/extension
Core group formation
2. The public health nurse takes an active role in community participation.
What is the primary goal of community organizing?
A.
B.
C.
A.
B.
C.
D.
Pre-pathogenesis
Pathogenesis
Prodromal
Terminal
5. Isolation of a child with measles belongs to what level of prevention?
A.
B.
C.
D.
Primary
Secondary
Intermediate
Tertiary
6. On the other hand, Operation Timbang is _____ prevention.
A.
B.
C.
D.
Primary
Secondary
Intermediate
Tertiary
7. Which type of family-nurse contact will provide you with the best opportunity
to observe family dynamics?
A.
B.
C.
D.
Clinic consultation
Group conference
Home visit
Written communication
8. The typology of family nursing problems is used in the statement of nursing
diagnosis in the care of families. The youngest child of the de los Reyes family
has been diagnosed as mentally retarded. This is classified as a:
A.
B.
C.
D.
Health threat
Health deficit
Foreseeable crisis
Stress point
9. The de los Reyes couple have a 6-year old child entering school for the first
time. The de los Reyes family has a:
A.
B.
C.
D.
Health threat
Health deficit
Foreseeable crisis
Stress point
10. Which of the following is an advantage of a home visit?
A.
B.
A.
Descriptive
Analytical
Therapeutic
Evaluation
15. Which of the following is a function of epidemiology?
A.
A.
B.
C.
20. The number of cases of Dengue fever usually increases towards the end
of the rainy season. This pattern of occurrence of Dengue fever is best
described as
A.
B.
C.
D.
Epidemic occurrence
Cyclical variation
Sporadic occurrence
Secular variation
21. In the year 1980, the World Health Organization declared the Philippines,
together with some other countries in the Western Pacific Region, free of
which disease?
A.
B.
C.
D.
Pneumonic plague
Poliomyelitis
Small pox
Anthrax
22. In the census of the Philippines in 1995, there were about 35,299,000
males and about 34,968,000 females. What is the sex ratio?
A.
B.
C.
D.
99.06:100
100.94:100
50.23%
49.76%
23. Primary health care is a total approach to community development. Which
of the following is an indicator of success in the use of the primary health care
approach?
A.
Effectiveness
Efficacy
C.
D.
Specificity
Sensitivity
25. Use of appropriate technology requires knowledge of indigenous
technology. Which medicinal herb is given for fever, headache and cough?
A.
B.
C.
D.
Sambong
Tsaang gubat
Akapulko
Lagundi
26. What law created the Philippine Institute of Traditional and Alternative
Health Care?
A.
B.
C.
D.
R.A. 8423
R.A. 4823
R.A. 2483
R.A. 3482
27. In traditional Chinese medicine, the yielding, negative and feminine force
is termed
A.
B.
C.
D.
Yin
Yang
Qi
Chai
28. What is the legal basis for Primary Health Care approach in the
Philippines?
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
1,500
1,800
2,000
D.
2,300
11.
Answer: (C) A home visit should be conducted in the
manner prescribed by the RHU.The home visit plan should be
flexible and practical, depending on factors, such as the familys
needs and the resources available to the nurse and the family.
12.
Answer: (B) Should minimize if not totally prevent the
spread of infection. Bag technique is performed before and after
handling a client in the home to prevent transmission of infection to
and from the client.
13.
Answer: (A) Wash his/her hands before and after
providing nursing care to the family members. Choice B goes
against the idea of utilizing the familys resources, which is
encouraged in CHN. Choices C and D goes against the principle of
asepsis of confining the contaminated surface of objects.
14.
Answer: (B) Analytical. Analytical epidemiology is the study
of factors or determinants affecting the patterns of occurrence and
distribution of disease in a community.
15.
Answer: (D) Evaluating the effectiveness of the
implementation of the Integrated Management of Childhood
Illness. Epidemiology is used in the assessment of a community or
evaluation of interventions in community health practice.
16.
Answer: (C) Participating in the investigation to
determine the source of the epidemic. Epidemiology is the
study of patterns of occurrence and distribution of disease in the
community, as well as the factors that affect disease patterns. The
purpose of an epidemiologic investigation is to identify the source of
an epidemic, i.e., what brought about the epidemic.
17.
Answer: (A) Delineate the etiology of the
epidemic. Delineating the etiology of an epidemic is identifying its
source.
18.
Answer: (D) There is a gradual build up of cases before
the epidemic becomes easily noticeable. A gradual or insidious
onset of the epidemic is usually observable in person-to-person
propagated epidemics.
19.
Answer: (A) Establishing the epidemic. Establishing the
epidemic is determining whether there is an epidemic or not. This is
done by comparing the present number of cases with the usual
number of cases of the disease at the same time of the year, as well
as establishing the relatedness of the cases of the disease.
20.
Answer: (B) Cyclical variation. A cyclical variation is a
periodic fluctuation in the number of cases of a disease in the
community.
21.
Answer: (C) Small pox. The last documented case of Small
pox was in 1977 at Somalia.
22.
Answer: (B) 100.94:100. Sex ratio is the number of males
for every 100 females in the population.
23.
Answer: (D) Health programs are sustained according to
the level of development of the community. Primary health
care is essential health care that can be sustained in all stages of
development of the community.
24.
Answer: (D) Sensitivity. Sensitivity is the capacity of a
diagnostic examination to detect cases of the disease. If a test is
100% sensitive, all the cases tested will have a positive result, i.e.,
there will be no false negative results.
25.
Answer: (D) Lagundi. Sambong is used as a diuretic. Tsaang
gubat is used to relieve diarrhea. Akapulko is used for its antifungal
property.
26.
Answer: (A) R.A. 8423
27.
Answer: (A) Yin. Yang is the male dominating, positive and
masculine force.
28.
Answer: (B) Letter of Instruction No. 949. Letter of
Instruction 949 was issued by then President Ferdinand Marcos,
directing the formerly called Ministry of Health, now the Department
of Health, to utilize Primary Health Care approach in planning and
implementing health programs.
29.
Answer: (D) Cooperation between the PHN and public
school teacher. Intersectoral linkages refer to working
relationships between the health sector and other sectors involved
in community development.
30.
Answer: (D) 2,300. Based on the Philippine population
composition, to estimate the number of 1-4 year old children,
multiply total population by 11.5%.
1. Estimate the number of pregnant women who will be given tetanus toxoid
during an immunization outreach activity in a barangay with a population of
about 1,500.
A.
B.
C.
D.
265
300
375
400
2. To describe the sex composition of the population, which demographic tool
may be used?
A.
B.
C.
D.
Sex ratio
Sex proportion
Population pyramid
Any of these may be used.
3. Which of the following is a natality rate?
A.
B.
C.
D.
A.
B.
C.
D.
4.2/1,000
5.2/1,000
6.3/1,000
7.3/1,000
5. Knowing that malnutrition is a frequent community health problem, you
decided to conduct nutritional assessment. What population is particularly
susceptible to protein energy malnutrition (PEM)?
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
27.8/1,000
43.5/1,000
86.9/1,000
130.4/1,000
A.
B.
C.
D.
A.
B.
C.
D.
Census
Survey
Record review
Review of civil registry
11. In the conduct of a census, the method of population assignment based on
the actual physical location of the people is termed
A.
B.
C.
D.
De jure
De locus
De facto
De novo
12. The Field Health Services and Information System (FHSIS) is the
recording and reporting system in public health care in the Philippines. The
Monthly Field Health Service Activity Report is a form used in which of the
components of the FHSIS?
A.
B.
C.
D.
Tally report
Output report
Target/client list
Individual health record
13. To monitor clients registered in long-term regimens, such as the Multi-Drug
Therapy, which component will be most useful?
A.
B.
C.
D.
Tally report
Output report
Target/client list
Individual health record
14. Civil registries are important sources of data. Which law requires
registration of births within 30 days from the occurrence of the birth?
A.
B.
C.
D.
P.D. 651
Act 3573
R.A. 3753
R.A. 3375
15. Which of the following professionals can sign the birth certificate?
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
A.
B.
C.
Tetanus toxoid
Retinol 200,000 IU
Ferrous sulfate 200 mg
Potassium iodate 200 mg. capsule
21. During prenatal consultation, a client asked you if she can have her
delivery at home. After history taking and physical examination, you advised
her against a home delivery. Which of the following findings disqualifies her for
a home delivery?
A.
B.
C.
D.
A.
B.
C.
D.
Niacin
Riboflavin
Folic acid
Thiamine
23. You are in a clients home to attend to a delivery. Which of the following
will you do first?
A.
B.
C.
D.
A.
B.
C.
D.
Explain to her that putting the baby to breast will lessen blood
loss after delivery.
25. A primigravida is instructed to offer her breast to the baby for the first time
within 30 minutes after delivery. What is the purpose of offering the breast this
early?
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
3 months
6 months
1 year
2 years
28. What is given to a woman within a month after the delivery of a baby?
A.
B.
C.
D.
Malunggay capsule
Ferrous sulfate 100 mg. OD
Retinol 200,000 I.U., 1 capsule
Potassium iodate 200 mg, 1 capsule
29. Which biological used in Expanded Program on Immunization (EPI) is
stored in the freezer?
A.
B.
C.
D.
DPT
Tetanus toxoid
Measles vaccine
Hepatitis B vaccine
30. Unused BCG should be discarded how many hours after reconstitution?
A.
B.
2
4
C.
D.
6
At the end of the day
12.
Answer: (A) Tally report. A tally report is prepared monthly
or quarterly by the RHU personnel and transmitted to the Provincial
Health Office.
13.
Answer: (C) Target/client list. The MDT Client List is a
record of clients enrolled in MDT and other relevant data, such as
dates when clients collected their monthly supply of drugs.
14.
Answer: (A) P.D. 651. P.D. 651 amended R.A. 3753, requiring
the registry of births within 30 days from their occurrence.
15.
Answer: (D) Any of these health professionals. D. R.A.
3753 states that any birth attendant may sign the certificate of live
birth.
16.
Answer: (C) Magnitude of the health problem. Magnitude
of the problem refers to the percentage of the population affected
by a health problem. The other choices are criteria considered in
both family and community health care.
17.
Answer: (D) Its main strategy is certification of health
centers able to comply with standards. Sentrong Sigla
Movement is a joint project of the DOH and local government units.
Its main strategy is certification of health centers that are able to
comply with standards set by the DOH.
18.
Answer: (D) Those who just had a delivery within the
past 15 months. The ideal birth spacing is at least two years. 15
months plus 9 months of pregnancy = 2 years.
19.
Answer: (C) Adequate information for couples regarding
the different methods. To enable the couple to choose freely
among different methods of family planning, they must be given full
information regarding the different methods that are available to
them, considering the availability of quality services that can
support their choice.
20.
Answer: (B) Retinol 200,000 IU. Retinol 200,000 IU is a
form of megadose Vitamin A. This may have a teratogenic effect.
21.
Answer: (A) Her OB score is G5P3. Only women with less
than 5 pregnancies are qualified for a home delivery. It is also
advisable for a primigravida to have delivery at a childbirth facility.
22.
Answer: (C) Folic acid. It is estimated that the incidence of
neural tube defects can be reduced drastically if pregnant women
have an adequate intake of folic acid.
23.
Answer: (D) Note the interval, duration and intensity of
labor contractions.. Assessment of the woman should be done
first to determine whether she is having true labor and, if so, what
stage of labor she is in.
24.
Answer: (D) Explain to her that putting the baby to
breast will lessen blood loss after delivery. Suckling of the
nipple stimulates the release of oxytocin by the posterior pituitary
gland, which causes uterine contraction. Lactation begins 1 to 3
days after delivery. Nipple stretching exercises are done when the
nipples are flat or inverted. Frequent washing dries up the nipples,
making them prone to the formation of fissures.
25.
Answer: (B) To stimulate milk production by the
mammary acini. Suckling of the nipple stimulates prolactin reflex
(the release of prolactin by the anterior pituitary gland), which
initiates lactation.
26.
Answer: (B) The mother does not feel nipple pain.. When
the baby has properly latched on to the breast, he takes deep, slow
sucks; his mouth is wide open; and much of the areola is inside his
mouth. And, youre right! The mother does not feel nipple pain.
27.
Answer: (B) 6 months. After 6 months, the babys nutrient
needs, especially the babys iron requirement, can no longer be
provided by mothers milk alone.
28.
Answer: (C) Retinol 200,000 I.U., 1 capsule. A capsule of
Retinol 200,000 IU is given within 1 month after delivery. Potassium
iodate is given during pregnancy; malunggay capsule is not
routinely administered after delivery; and ferrous sulfate is taken for
two months after delivery.
29.
Answer: (C) Measles vaccine. Among the biologicals used in
the Expanded Program on Immunization, measles vaccine and OPV
are highly sensitive to heat, requiring storage in the freezer.
30.
Answer: (B) 4. While the unused portion of other biologicals
in EPI may be given until the end of the day, only BCG is discarded 4
hours after reconstitution. This is why BCG immunization is
scheduled only in the morning.
1. In immunizing school entrants with BCG, you are not obliged to secure
parental consent. This is because of which legal document?
A.
B.
C.
D.
A.
P.D. 996
R.A. 7846
Presidential Proclamation No. 6
Presidential Proclamation No. 46
2. Which immunization produces a permanent scar?
DPT
B.
C.
D.
BCG
Measles vaccination
Hepatitis B vaccination
3. A 4-week old baby was brought to the health center for his first
immunization. Which can be given to him?
A.
B.
C.
D.
DPT1
OPV1
Infant BCG
Hepatitis B vaccine 1
4. You will not give DPT 2 if the mother says that the infant had
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
1 year
3 years
10 years
Lifetime
7. A 4-month old infant was brought to the health center because of cough.
Her respiratory rate is 42/minute. Using the Integrated Management of Child
Illness (IMCI) guidelines of assessment, her breathing is considered
A.
B.
C.
D.
Fast
Slow
Normal
Insignificant
8. Which of the following signs will indicate that a young child is suffering from
severe pneumonia?
A.
B.
C.
D.
Dyspnea
Wheezing
Fast breathing
Chest indrawing
9. Using IMCI guidelines, you classify a child as having severe pneumonia.
What is the best management for the child?
A.
B.
C.
D.
Prescribe an antibiotic.
Refer him urgently to the hospital.
Instruct the mother to increase fluid intake.
Instruct the mother to continue breastfeeding.
10. A 5-month old infant was brought by his mother to the health center
because of diarrhea occurring 4 to 5 times a day. His skin goes back slowly
after a skin pinch and his eyes are sunken. Using the IMCI guidelines, you will
classify this infant in which category?
A.
B.
C.
D.
No signs of dehydration
Some dehydration
Severe dehydration
The data is insufficient.
11. Based on assessment, you classified a 3-month old infant with the chief
complaint of diarrhea in the category of SOME DEHYDRATION. Based on
IMCI management guidelines, which of the following will you do?
A.
13. A 1 year old child was classified as having 3rd degree protein energy
malnutrition, kwashiorkor. Which of the following signs will be most apparent
in this child?
A.
B.
C.
D.
Voracious appetite
Wasting
Apathy
Edema
14. Assessment of a 2-year old child revealed baggy pants. Using the IMCI
guidelines, how will you manage this child?
A.
B.
Keratomalacia
Corneal opacity
Night blindness
Conjunctival xerosis
16. To prevent xerophthalmia, young children are given Retinol capsule every
6 months. What is the dose given to preschoolers?
A.
B.
C.
D.
10,000 IU
20,000 IU
100,000 IU
200,000 IU
17. The major sign of iron deficiency anemia is pallor. What part is best
examined for pallor?
A.
B.
C.
D.
Palms
Nailbeds
Around the lips
Lower conjunctival sac
18. Food fortification is one of the strategies to prevent micronutrient
deficiency conditions. R.A. 8976 mandates fortification of certain food items.
Which of the following is among these food items?
A.
B.
C.
D.
Sugar
Bread
Margarine
Filled milk
19. What is the best course of action when there is a measles epidemic in a
nearby municipality?
A.
B.
Inability to drink
High grade fever
Signs of severe dehydration
Cough for more than 30 days
21. Management of a child with measles includes the administration of which
of the following?
A.
B.
C.
D.
A.
B.
C.
D.
Do a tourniquet test.
Ask where the family resides.
Get a specimen for blood smear.
Ask if the fever is present everyday.
23. The following are strategies implemented by the Department of Health to
prevent mosquito-borne diseases. Which of these is most effective in the
control of Dengue fever?
A.
B.
C.
A.
B.
C.
D.
Ascaris
Pinworm
Hookworm
Schistosoma
26. Which of the following signs indicates the need for sputum examination for
AFB?
A.
B.
C.
D.
Hematemesis
Fever for 1 week
Cough for 3 weeks
Chest pain for 1 week
27. Which clients are considered targets for DOTS Category I?
A.
B.
C.
D.
A.
B.
A.
B.
C.
D.
Macular lesions
Inability to close eyelids
Thickened painful nerves
Sinking of the nosebridge
30. Which of the following clients should be classified as a case of
multibacillary leprosy?
3
3
5
5
skin
skin
skin
skin
lesions,
lesions,
lesions,
lesions,
2.
3.
4.
5.
6.
7.
8.
9.
19.
Answer: (A) Give measles vaccine to babies aged 6 to 8
months. Ordinarily, measles vaccine is given at 9 months of age.
During an impending epidemic, however, one dose may be given to
babies aged 6 to 8 months. The mother is instructed that the baby
needs another dose when the baby is 9 months old.
20.
Answer: (A) Inability to drink. A sick child aged 2 months to
5 years must be referred urgently to a hospital if he/she has one or
more of the following signs: not able to feed or drink, vomits
everything, convulsions, abnormally sleepy or difficult to awaken.
21.
Answer: (D) Retinol capsule regardless of when the last
dose was given. An infant 6 to 12 months classified as a case of
measles is given Retinol 100,000 IU; a child is given 200,000 IU
regardless of when the last dose was given.
22.
Answer: (B) Ask where the family resides. Because
malaria is endemic, the first question to determine malaria risk is
where the clients family resides. If the area of residence is not a
known endemic area, ask if the child had traveled within the past 6
months, where he/she was brought and whether he/she stayed
overnight in that area.
23.
Answer: (B) Destroying breeding places of
mosquitoes. Aedes aegypti, the vector of Dengue fever, breeds in
stagnant, clear water. Its feeding time is usually during the daytime.
It has a cyclical pattern of occurrence, unlike malaria which is
endemic in certain parts of the country.
24.
Answer: (C) Determining whether a place is endemic or
not. This is diagnostic and therefore secondary level prevention.
The other choices are for primary prevention.
25.
Answer: (B) Pinworm. Pinworm ova are deposited around the
anal orifice.
26.
Answer: (C) Cough for 3 weeks. A client is considered a PTB
suspect when he has cough for 2 weeks or more, plus one or more
of the following signs: fever for 1 month or more; chest pain lasting
for 2 weeks or more not attributed to other conditions; progressive,
unexplained weight loss; night sweats; and hemoptysis.
27.
Answer: (D) Clients diagnosed for the first time through
a positive sputum exam. Category I is for new clients diagnosed
by sputum examination and clients diagnosed to have a serious
form of extrapulmonary tuberculosis, such as TB osteomyelitis.
28.
Answer: (B) Having the health worker or a responsible
family member monitor drug intake. Directly Observed
Treatment Short Course is so-called because a treatment partner,
Liver cancer
Liver cirrhosis
Bladder cancer
Intestinal perforation
2. What is the most effective way of controlling schistosomiasis in an endemic
area?
A.
B.
C.
D.
Use of molluscicides
Building of foot bridges
Proper use of sanitary toilets
Use of protective footwear, such as rubber boots
3. When residents obtain water from an artesian well in the neighborhood, the
level of this approved type of water facility is
A.
B.
C.
D.
I
II
III
IV
4. For prevention of hepatitis A, you decided to conduct health education
activities. Which of the following is IRRELEVANT?
A.
B.
C.
D.
A.
B.
C.
D.
DPT
Oral polio vaccine
Measles vaccine
MMR
6. You will conduct outreach immunization in a barangay with a population of
about 1500. Estimate the number of infants in the barangay.
A.
B.
C.
D.
45
50
55
60
7. In Integrated Management of Childhood Illness, severe conditions generally
require urgent referral to a hospital. Which of the following severe conditions
DOES NOT always require urgent referral to a hospital?
A.
B.
C.
D.
Mastoiditis
Severe dehydration
Severe pneumonia
Severe febrile disease
8. A client was diagnosed as having Dengue fever. You will say that there is
slow capillary refill when the color of the nailbed that you pressed does not
return within how many seconds?
A.
B.
C.
D.
3
5
8
10
9. A 3-year old child was brought by his mother to the health center because
of fever of 4-day duration. The child had a positive tourniquet test result. In the
absence of other signs, which is the most appropriate measure that the PHN
may carry out to prevent Dengue shock syndrome?
A.
B.
C.
D.
A.
B.
C.
Nasal mucosa
Buccal mucosa
Skin on the abdomen
D.
A.
B.
C.
D.
Viral conjunctivitis
Acute poliomyelitis
Diphtheria
Measles
12. Among children aged 2 months to 3 years, the most prevalent form of
meningitis is caused by which microorganism?
A.
B.
C.
D.
Hemophilus influenzae
Morbillivirus
Steptococcus pneumoniae
Neisseria meningitidis
13. Human beings are the major reservoir of malaria. Which of the following
strategies in malaria control is based on this fact?
A.
B.
C.
D.
Stream seeding
Stream clearing
Destruction of breeding places
Zooprophylaxis
14. The use of larvivorous fish in malaria control is the basis for which strategy
of malaria control?
A.
B.
C.
D.
Stream seeding
Stream clearing
Destruction of breeding places
Zooprophylaxis
15. Mosquito-borne diseases are prevented mostly with the use of mosquito
control measures. Which of the following is NOT appropriate for malaria
control?
A.
B.
C.
D.
A.
B.
Giardiasis
Cholera
C.
D.
Amebiasis
Dysentery
17. In the Philippines, which specie of schistosoma is endemic in certain
regions?
A.
B.
C.
D.
S. mansoni
S. japonicum
S. malayensis
S. haematobium
18. A 32-year old client came for consultation at the health center with the
chief complaint of fever for a week. Accompanying symptoms were muscle
pains and body malaise. A week after the start of fever, the client noted
yellowish discoloration of his sclera. History showed that he waded in flood
waters about 2 weeks before the onset of symptoms. Based on his history,
which disease condition will you suspect?
A.
B.
C.
D.
Hepatitis A
Hepatitis B
Tetanus
Leptospirosis
19. MWSS provides water to Manila and other cities in Metro Manila. This is
an example of which level of water facility?
A.
B.
C.
D.
I
II
III
IV
20. You are the PHN in the city health center. A client underwent screening for
AIDS using ELISA. His result was positive. What is the best course of action
that you may take?
A.
B.
C.
D.
AIDS
22. The most frequent causes of death among clients with AIDS are
opportunistic diseases. Which of the following opportunistic infections is
characterized by tonsillopharyngitis?
A.
B.
C.
D.
Respiratory candidiasis
Infectious mononucleosis
Cytomegalovirus disease
Pneumocystis carinii pneumonia
23. To determine possible sources of sexually transmitted infections, which is
the BEST method that may be undertaken by the public health nurse?
A.
B.
C.
D.
Contact tracing
Community survey
Mass screening tests
Interview of suspects
24. Antiretroviral agents, such as AZT, are used in the management of AIDS.
Which of the following is NOT an action expected of these drugs.
A.
B.
C.
D.
A.
B.
C.
B.
Pregnant women
Elderly clients
Young adult males
Young infants
2.
3.
4.
5.
16.
Answer: (B) Cholera. Passage of profuse watery stools is the
major symptom of cholera. Both amebic and bacillary dysentery are
characterized by the presence of blood and/or mucus in the stools.
Giardiasis is characterized by fat malabsorption and, therefore,
steatorrhea.
17.
Answer: (B) S. japonicum. S. mansoni is found mostly in
Africa and South America; S. haematobium in Africa and the Middle
East; and S. malayensis only in peninsular Malaysia.
18.
Answer: (D) Leptospirosis. Leptospirosis is transmitted
through contact with the skin or mucous membrane with water or
moist soil contaminated with urine of infected animals, like rats.
19.
Answer: (C) III. Waterworks systems, such as MWSS, are
classified as level III.
20.
Answer: (D) Refer the client for a supplementary test,
such as Western blot, since the ELISA result may be false. A
client having a reactive ELISA result must undergo a more specific
test, such as Western blot. A negative supplementary test result
means that the ELISA result was false and that, most probably, the
client is not infected.
21.
Answer: (A) Being faithful to a single sexual
partner. Sexual fidelity rules out the possibility of getting the
disease by sexual contact with another infected person.
Transmission occurs mostly through sexual intercourse and exposure
to blood or tissues.
22.
Answer: (B) Infectious mononucleosis. Cytomegalovirus
disease is an acute viral disease characterized by fever, sore throat
and lymphadenopathy.
23.
Answer: (A) Contact tracing. Contact tracing is the most
practical and reliable method of finding possible sources of personto-person transmitted infections, such as sexually transmitted
diseases.
24.
Answer: (D) They are able to bring about a cure of the
disease condition. There is no known treatment for AIDS.
Antiretroviral agents reduce the risk of opportunistic infections and
prolong life, but does not cure the underlying immunodeficiency.
25.
Answer: (D) Consult a physician who may give them
rubella immunoglobulin. Rubella vaccine is made up of
attenuated German measles viruses. This is contraindicated in
pregnancy. Immune globulin, a specific prophylactic against German
measles, may be given to pregnant women.
26.
Answer: (D) Proper handwashing during food
preparation is the best way of preventing the
condition. Symptoms of this food poisoning are due to
staphylococcal enterotoxin, not the microorganisms themselves.
Contamination is by food handling by persons with staphylococcal
skin or eye infections.
27.
Answer: (A) The older one gets, the more susceptible he
becomes to the complications of chicken pox. Chicken pox is
usually more severe in adults than in children. Complications, such
as pneumonia, are higher in incidence in adults.
28.
Answer: (C) Young adult males. Epididymitis and orchitis
are possible complications of mumps. In post-adolescent males,
bilateral inflammation of the testes and epididymis may cause
sterility.
1. May arrives at the health care clinic and tells the nurse that her last
menstrual period was 9 weeks ago. She also tells the nurse that a home
pregnancy test was positive but she began to have mild cramps and is now
having moderate vaginal bleeding. During the physical examination of the
client, the nurse notes that May has a dilated cervix. The nurse determines
that May is experiencing which type of abortion?
A.
Inevitable
B.
Incomplete
C.
Threatened
D.
Septic
2. Nurse Reese is reviewing the record of a pregnant client for her first
prenatal visit. Which of the following data, if noted on the clients record, would
alert the nurse that the client is at risk for a spontaneous abortion?
A.
Age 36 years
B.
History of syphilis
C.
History of genital herpes
D.
History of diabetes mellitus
3. Nurse Hazel is preparing to care for a client who is newly admitted to the
hospital with a possible diagnosis of ectopic pregnancy. Nurse Hazel develops
a plan of care for the client and determines that which of the following nursing
actions is the priority?
A.
Monitoring weight
B.
Assessing for edema
C.
Monitoring apical pulse
D.
Monitoring temperature
D.
Continuous CPR
10. A trial for vaginal delivery after an earlier caesareans, would likely to be
given to a gravida, who had:
A.
First low transverse cesarean was for active herpes type 2
infections; vaginal culture at 39 weeks pregnancy was positive.
B.
First and second caesareans were for cephalopelvic
disproportion.
C.
First caesarean through a classic incision as a result of severe
fetal distress.
D.
First low transverse caesarean was for breech position. Fetus in
this pregnancy is in a vertex presentation.
11.Nurse Ryan is aware that the best initial approach when trying to take a
crying toddlers temperature is:
A.
Talk to the mother first and then to the toddler.
B.
Bring extra help so it can be done quickly.
C.
Encourage the mother to hold the child.
D.
Ignore the crying and screaming.
12.Baby Tina a 3 month old infant just had a cleft lip and palate repair. What
should the nurse do to prevent trauma to operative site?
A.
Avoid touching the suture line, even when cleaning.
B.
Place the baby in prone position.
C.
Give the baby a pacifier.
D.
Place the infants arms in soft elbow restraints.
13. Which action should nurse Marian include in the care plan for a 2 month
old with heart failure?
A.
Feed the infant when he cries.
B.
Allow the infant to rest before feeding.
C.
Bathe the infant and administer medications before feeding.
D.
Weigh and bathe the infant before feeding.
14.Nurse Hazel is teaching a mother who plans to discontinue breast feeding
after 5 months. The nurse should advise her to include which foods in her
infants diet?
A.
Skim milk and baby food.
B.
Whole milk and baby food.
C.
Iron-rich formula only.
D.
Iron-rich formula and baby food.
15.Mommy Linda is playing with her infant, who is sitting securely alone on
the floor of the clinic. The mother hides a toy behind her back and the infant
looks for it. The nurse is aware that estimated age of the infant would be:
A.
6 months
B.
4 months
C.
D.
8 months
10 months
16.Which of the following is the most prominent feature of public health
nursing?
A.
It involves providing home care to sick people who are not
confined in the hospital.
B.
Services are provided free of charge to people within the
catchments area.
C.
The public health nurse functions as part of a team providing a
public health nursing services.
D.
Public health nursing focuses on preventive, not curative,
services.
17.When the nurse determines whether resources were maximized in
implementing Ligtas Tigdas, she is evaluating
A.
Effectiveness
B.
Efficiency
C.
Adequacy
D.
Appropriateness
18.Vangie is a new B.S.N. graduate. She wants to become a Public Health
Nurse. Where should she apply?
A.
Department of Health
B.
Provincial Health Office
C.
Regional Health Office
D.
Rural Health Unit
19.Tony is aware the Chairman of the Municipal Health Board is:
A.
Mayor
B.
Municipal Health Officer
C.
Public Health Nurse
D.
Any qualified physician
20.Myra is the public health nurse in a municipality with a total population of
about 20,000. There are 3 rural health midwives among the RHU personnel.
How many more midwife items will the RHU need?
A.
1
B.
2
C.
3
D.
The RHU does not need any more midwife item.
21.According to Freeman and Heinrich, community health nursing is a
developmental service. Which of the following best illustrates this statement?
A.
The community health nurse continuously develops himself
personally and professionally.
B.
A.
B.
C.
D.
80 to 100 beats/minute
100 to 120 beats/minute
120 to 160 beats/minute
160 to 180 beats/minute
28.The skin in the diaper area of a 7 month old infant is excoriated and red.
Nurse Hazel should instruct the mother to:
A.
Change the diaper more often.
B.
Apply talc powder with diaper changes.
C.
Wash the area vigorously with each diaper change.
D.
Decrease the infants fluid intake to decrease saturating
diapers.
29.Nurse Carla knows that the common cardiac anomalies in children with
Down Syndrome (tri-somy 21) is:
A.
Atrial septal defect
B.
Pulmonic stenosis
C.
Ventricular septal defect
D.
Endocardial cushion defect
30.Malou was diagnosed with severe preeclampsia is now receiving I.V.
magnesium sulfate. The adverse effects associated with magnesium sulfate
is:
A.
Anemia
B.
Decreased urine output
C.
Hyperreflexia
D.
Increased respiratory rate
31.A 23 year old client is having her menstrual period every 2 weeks that last
for 1 week. This type of menstrual pattern is bets defined by:
A.
Menorrhagia
B.
Metrorrhagia
C.
Dyspareunia
D.
Amenorrhea
32. Jannah is admitted to the labor and delivery unit. The critical laboratory
result for this client would be:
A.
Oxygen saturation
B.
Iron binding capacity
C.
Blood typing
D.
Serum Calcium
33.Nurse Gina is aware that the most common condition found during the
second-trimester of pregnancy is:
A.
Metabolic alkalosis
B.
Respiratory acidosis
C.
Mastitis
D.
Physiologic anemia
34.Nurse Lynette is working in the triage area of an emergency department.
She sees that several pediatric clients arrive simultaneously. The client who
needs to be treated first is:
A.
A crying 5 year old child with a laceration on his scalp.
B.
A 4 year old child with a barking coughs and flushed
appearance.
C.
A 3 year old child with Down syndrome who is pale and asleep
in his mothers arms.
D.
A 2 year old infant with stridorous breath sounds, sitting up in
his mothers arms and drooling.
35.Maureen in her third trimester arrives at the emergency room with painless
vaginal bleeding. Which of the following conditions is suspected?
A.
Placenta previa
B.
Abruptio placentae
C.
Premature labor
D.
Sexually transmitted disease
36.A young child named Richard is suspected of having pinworms. The
community nurse collects a stool specimen to confirm the diagnosis. The
nurse should schedule the collection of this specimen for:
A.
Just before bedtime
B.
After the child has been bathe
C.
Any time during the day
D.
Early in the morning
37.In doing a childs admission assessment, Nurse Betty should be alert to
note which signs or symptoms of chronic lead poisoning?
A.
Irritability and seizures
B.
Dehydration and diarrhea
C.
Bradycardia and hypotension
D.
Petechiae and hematuria
38.To evaluate a womans understanding about the use of diaphragm for
family planning, Nurse Trish asks her to explain how she will use the
appliance. Which response indicates a need for further health teaching?
A.
I should check the diaphragm carefully for holes every time I
use it
B.
I may need a different size of diaphragm if I gain or lose
weight more than 20 pounds
C.
The diaphragm must be left in place for atleast 6 hours after
intercourse
D.
I really need to use the diaphragm and jelly most during the
middle of my menstrual cycle.
B.
C.
D.
12 inches
18 inches
24 inches
46. In a mothers class, Nurse Lhynnete discussed childhood diseases such
as chicken pox. Which of the following statements about chicken pox is
correct?
A.
The older one gets, the more susceptible he becomes to the
complications of chicken pox.
B.
A single attack of chicken pox will prevent future episodes,
including conditions such as shingles.
C.
To prevent an outbreak in the community, quarantine may be
imposed by health authorities.
D.
Chicken pox vaccine is best given when there is an impending
outbreak in the community.
47.Barangay Pinoy had an outbreak of German measles. To prevent
congenital rubella, what is the BEST advice that you can give to women in the
first trimester of pregnancy in the barangay Pinoy?
A.
Advice them on the signs of German measles.
B.
Avoid crowded places, such as markets and movie houses.
C.
Consult at the health center where rubella vaccine may be
given.
D.
Consult a physician who may give them rubella
immunoglobulin.
48.Myrna a public health nurse knows that to determine possible sources of
sexually transmitted infections, the BEST method that may be undertaken is:
A.
Contact tracing
B.
Community survey
C.
Mass screening tests
D.
Interview of suspects
49.A 33-year old female client came for consultation at the health center with
the chief complaint of fever for a week. Accompanying symptoms were muscle
pains and body malaise. A week after the start of fever, the client noted
yellowish discoloration of his sclera. History showed that he waded in flood
waters about 2 weeks before the onset of symptoms. Based on her history,
which disease condition will you suspect?
A.
Hepatitis A
B.
Hepatitis B
C.
Tetanus
D.
Leptospirosis
50.Mickey a 3-year old client was brought to the health center with the chief
complaint of severe diarrhea and the passage of rice water stools. The client
is most probably suffering from which condition?
A.
Giardiasis
B.
Cholera
C.
Amebiasis
D.
Dysentery
51.The most prevalent form of meningitis among children aged 2 months to 3
years is caused by which microorganism?
A.
Hemophilus influenzae
B.
Morbillivirus
C.
Steptococcus pneumoniae
D.
Neisseria meningitidis
52.The student nurse is aware that the pathognomonic sign of measles is
Kopliks spot and you may see Kopliks spot by inspecting the:
A.
Nasal mucosa
B.
Buccal mucosa
C.
Skin on the abdomen
D.
Skin on neck
53.Angel was diagnosed as having Dengue fever. You will say that there is
slow capillary refill when the color of the nailbed that you pressed does not
return within how many seconds?
A.
3 seconds
B.
6 seconds
C.
9 seconds
D.
10 seconds
54.In Integrated Management of Childhood Illness, the nurse is aware that the
severe conditions generally require urgent referral to a hospital. Which of the
following severe conditions DOES NOT always require urgent referral to a
hospital?
A.
Mastoiditis
B.
Severe dehydration
C.
Severe pneumonia
D.
Severe febrile disease
55.Myrna a public health nurse will conduct outreach immunization in a
barangay Masay with a population of about 1500. The estimated number of
infants in the barangay would be:
A.
45 infants
B.
50 infants
C.
55 infants
D.
65 infants
B.
C.
D.
8 hours
At the end of the day
68.The nurse explains to a breastfeeding mother that breast milk is sufficient
for all of the babys nutrient needs only up to:
A.
5 months
B.
6 months
C.
1 year
D.
2 years
69.Nurse Ron is aware that the gestational age of a conceptus that is
considered viable (able to live outside the womb) is:
A.
8 weeks
B.
12 weeks
C.
24 weeks
D.
32 weeks
70.When teaching parents of a neonate the proper position for the neonates
sleep, the nurse Patricia stresses the importance of placing the neonate on
his back to reduce the risk of which of the following?
A.
Aspiration
B.
Sudden infant death syndrome (SIDS)
C.
Suffocation
D.
Gastroesophageal reflux (GER)
71.Which finding might be seen in baby James a neonate suspected of having
an infection?
A.
Flushed cheeks
B.
Increased temperature
C.
Decreased temperature
D.
Increased activity level
72.Baby Jenny who is small-for-gestation is at increased risk during the
transitional period for which complication?
A.
Anemia probably due to chronic fetal hyposia
B.
Hyperthermia due to decreased glycogen stores
C.
Hyperglycemia due to decreased glycogen stores
D.
Polycythemia probably due to chronic fetal hypoxia
73.Marjorie has just given birth at 42 weeks gestation. When the nurse
assessing the neonate, which physical finding is expected?
A.
A sleepy, lethargic baby
B.
Lanugo covering the body
C.
Desquamation of the epidermis
D.
Vernix caseosa covering the body
C.
D.
92. Cammile with sickle cell anemia has an increased risk for having a sickle
cell crisis during pregnancy. Aggressive management of a sickle cell crisis
includes which of the following measures?
A.
Antihypertensive agents
B.
Diuretic agents
C.
I.V. fluids
D.
Acetaminophen (Tylenol) for pain
93. Which of the following drugs is the antidote for magnesium toxicity?
A.
Calcium gluconate (Kalcinate)
B.
Hydralazine (Apresoline)
C.
Naloxone (Narcan)
D.
Rho (D) immune globulin (RhoGAM)
94. Marlyn is screened for tuberculosis during her first prenatal visit. An
intradermal injection of purified protein derivative (PPD) of the tuberculin
bacilli is given. She is considered to have a positive test for which of the
following results?
A.
An indurated wheal under 10 mm in diameter appears in 6 to
12 hours.
B.
An indurated wheal over 10 mm in diameter appears in 48 to
72 hours.
C.
A flat circumcised area under 10 mm in diameter appears in 6
to 12 hours.
D.
A flat circumcised area over 10 mm in diameter appears in 48
to 72 hours.
95. Dianne, 24 year-old is 27 weeks pregnant arrives at her physicians office
with complaints of fever, nausea, vomiting, malaise, unilateral flank pain, and
costovertebral angle tenderness. Which of the following diagnoses is most
likely?
A.
Asymptomatic bacteriuria
B.
Bacterial vaginosis
C.
Pyelonephritis
D.
Urinary tract infection (UTI)
96. Rh isoimmunization in a pregnant client develops during which of the
following conditions?
A.
Rh-positive maternal blood crosses into fetal blood, stimulating
fetal antibodies.
B.
Rh-positive fetal blood crosses into maternal blood,
stimulating maternal antibodies.
C.
Rh-negative fetal blood crosses into maternal blood,
stimulating maternal antibodies.
D.
4.
33.
Answer: (D) Physiologic anemia. Hemoglobin values and
hematocrit decrease during pregnancy as the increase in plasma
volume exceeds the increase in red blood cell production.
34.
Answer: (D) A 2 year old infant with stridorous breath
sounds, sitting up in his mothers arms and drooling. The
infant with the airway emergency should be treated first, because of
the risk of epiglottitis.
35.
Answer: (A) Placenta previa. Placenta previa with painless
vaginal bleeding.
36.
Answer: (D) Early in the morning. Based on the nurses
knowledge of microbiology, the specimen should be collected early
in the morning. The rationale for this timing is that, because the
female worm lays eggs at night around the perineal area, the first
bowel movement of the day will yield the best results. The specific
type of stool specimen used in the diagnosis of pinworms is called
the tape test.
37.
Answer: (A) Irritability and seizures. Lead poisoning
primarily affects the CNS, causing increased intracranial pressure.
This condition results in irritability and changes in level of
consciousness, as well as seizure disorders, hyperactivity, and
learning disabilities.
38.
Answer: (D) I really need to use the diaphragm and
jelly most during the middle of my menstrual cycle. The
woman must understand that, although the fertile period is
approximately mid-cycle, hormonal variations do occur and can
result in early or late ovulation. To be effective, the diaphragm
should be inserted before every intercourse.
39.
Answer: (C) Restlessness. In a child, restlessness is the
earliest sign of hypoxia. Late signs of hypoxia in a child are
associated with a change in color, such as pallor or cyanosis.
40.
Answer: (B) Walk one step ahead, with the childs hand
on the nurses elbow. This procedure is generally recommended
to follow in guiding a person who is blind.
41.
Answer: (A) Loud, machinery-like murmur. A loud,
machinery-like murmur is a characteristic finding associated with
patent ductus arteriosus.
42.
Answer: (C) More oxygen, and the newborns metabolic
rate increases. When cold, the infant requires more oxygen and
there is an increase in metabolic rate. Non-shievering thermogenesis
is a complex process that increases the metabolic rate and rate of
52.
Answer: (B) Buccal mucosa. Kopliks spot may be seen on
the mucosa of the mouth or the throat.
53.
Answer: (A) 3 seconds. Adequate blood supply to the area
allows the return of the color of the nailbed within 3 seconds.
54.
Answer: (B) Severe dehydration. The order of priority in
the management of severe dehydration is as follows: intravenous
fluid therapy, referral to a facility where IV fluids can be initiated
within 30 minutes, Oresol or nasogastric tube. When the foregoing
measures are not possible or effective, then urgent referral to the
hospital is done.
55.
Answer: (A) 45 infants. To estimate the number of infants,
multiply total population by 3%.
56.
Answer: (A) DPT. DPT is sensitive to freezing. The appropriate
storage temperature of DPT is 2 to 8 C only. OPV and measles
vaccine are highly sensitive to heat and require freezing. MMR is not
an immunization in the Expanded Program on Immunization.
57.
Answer: (C) Proper use of sanitary toilets. The ova of the
parasite get out of the human body together with feces. Cutting the
cycle at this stage is the most effective way of preventing the
spread of the disease to susceptible hosts.
58.
Answer: (D) 5 skin lesions, positive slit skin smear. A
multibacillary leprosy case is one who has a positive slit skin smear
and at least 5 skin lesions.
59.
Answer: (C) Thickened painful nerves. The lesion of
leprosy is not macular. It is characterized by a change in skin color
(either reddish or whitish) and loss of sensation, sweating and hair
growth over the lesion. Inability to close the eyelids (lagophthalmos)
and sinking of the nosebridge are late symptoms.
60.
Answer: (B) Ask where the family resides. Because
malaria is endemic, the first question to determine malaria risk is
where the clients family resides. If the area of residence is not a
known endemic area, ask if the child had traveled within the past 6
months, where she was brought and whether she stayed overnight
in that area.
61.
Answer: (A) Inability to drink. A sick child aged 2 months to
5 years must be referred urgently to a hospital if he/she has one or
more of the following signs: not able to feed or drink, vomits
everything, convulsions, abnormally sleepy or difficult to awaken.
62.
Answer: (A) Refer the child urgently to a hospital for
confinement. Baggy pants is a sign of severe marasmus. The
best management is urgent referral to a hospital.
63.
Answer: (D) Let the child rest for 10 minutes then
continue giving Oresol more slowly. If the child vomits
persistently, that is, he vomits everything that he takes in, he has to
be referred urgently to a hospital. Otherwise, vomiting is managed
by letting the child rest for 10 minutes and then continuing with
Oresol administration. Teach the mother to give Oresol more slowly.
64.
Answer: (B) Some dehydration. Using the assessment
guidelines of IMCI, a child (2 months to 5 years old) with diarrhea is
classified as having SOME DEHYDRATION if he shows 2 or more of
the following signs: restless or irritable, sunken eyes, the skin goes
back slow after a skin pinch.
65.
Answer: (C) Normal. In IMCI, a respiratory rate of 50/minute
or more is fast breathing for an infant aged 2 to 12 months.
66.
Answer: (A) 1 year. The baby will have passive natural
immunity by placental transfer of antibodies. The mother will have
active artificial immunity lasting for about 10 years. 5 doses will give
the mother lifetime protection.
67.
Answer: (B) 4 hours. While the unused portion of other
biologicals in EPI may be given until the end of the day, only BCG is
discarded 4 hours after reconstitution. This is why BCG immunization
is scheduled only in the morning.
68.
Answer: (B) 6 months. After 6 months, the babys nutrient
needs, especially the babys iron requirement, can no longer be
provided by mothers milk alone.
69.
Answer: (C) 24 weeks. At approximately 23 to 24 weeks
gestation, the lungs are developed enough to sometimes maintain
extrauterine life. The lungs are the most immature system during
the gestation period. Medical care for premature labor begins much
earlier (aggressively at 21 weeks gestation)
70.
Answer: (B) Sudden infant death syndrome
(SIDS). Supine positioning is recommended to reduce the risk of
SIDS in infancy. The risk of aspiration is slightly increased with the
supine position. Suffocation would be less likely with an infant
supine than prone and the position for GER requires the head of the
bed to be elevated.
71.
Answer: (C) Decreased temperature. Temperature
instability, especially when it results in a low temperature in the
neonate, may be a sign of infection. The neonates color often
changes with an infection process but generally becomes ashen or
mottled. The neonate with an infection will usually show a decrease
in activity level or lethargy.
72.
Answer: (D) Polycythemia probably due to chronic fetal
hypoxia. The small-for-gestation neonate is at risk for developing
polycythemia during the transitional period in an attempt to
decreasehypoxia. The neonates are also at increased risk for
developing hypoglycemia and hypothermia due to decreased
glycogen stores.
73.
Answer: (C) Desquamation of the epidermis. Postdate
fetuses lose the vernix caseosa, and the epidermis may become
desquamated. These neonates are usually very alert. Lanugo is
missing in the postdate neonate.
74.
Answer: (C) Respiratory depression. Magnesium sulfate
crosses the placenta and adverse neonatal effects are respiratory
depression, hypotonia, and bradycardia. The serum blood sugar isnt
affected by magnesium sulfate. The neonate would be floppy, not
jittery.
75.
Answer: (C) Respiratory rate 40 to 60 breaths/minute. A
respiratory rate 40 to 60 breaths/minute is normal for a neonate
during the transitional period. Nasal flaring, respiratory rate more
than 60 breaths/minute, and audible grunting are signs of
respiratory distress.
76.
Answer: (C) Keep the cord dry and open to air. Keeping
the cord dry and open to air helps reduce infection and hastens
drying. Infants arent given tub bath but are sponged off until the
cord falls off. Petroleum jelly prevents the cord from drying and
encourages infection. Peroxide could be painful and isnt
recommended.
77.
Answer: (B) Conjunctival hemorrhage. Conjunctival
hemorrhages are commonly seen in neonates secondary to the
cranial pressure applied during the birth process. Bulging fontanelles
are a sign of intracranial pressure. Simian creases are present in
40% of the neonates with trisomy 21. Cystic hygroma is a neck
mass that can affect the airway.
78.
Answer: (B) To assess for prolapsed cord. After a client
has an amniotomy, the nurse should assure that the cord isnt
prolapsed and that the baby tolerated the procedure well. The most
effective way to do this is to check the fetal heart rate. Fetal wellbeing is assessed via a nonstress test. Fetal position is determined
by vaginal examination. Artificial rupture of membranes doesnt
indicate an imminent delivery.
79.
Answer: (D) The parents interactions with each
other. Parental interaction will provide the nurse with a good
d) peripheral neuritis
14. The client with AIDS is diagnosed with cutaneous
Kaposi's sarcoma. Based on this diagnosis, the nurse
understands that his has been determined by which of the
following?
a) appearance of reddish blue lesions noted on the skin
b) swelling in the lower extremities
c) punch biopsy of the cutaneous lesions
d) swelling in the genital area
15. Which of the following individuals is least likely at risk
for the development of Kaposi's sarcoma?
a) a man with a history of same sex partners
b) a renal transplant client
c) a client receiving antineoplastic medications
d) an individual working in an environment where exposure
to asbestos exists
16. The clinic nurse assesses the skin of the client with a
diagnosis of psoriasis. Which of the following
characteristics is not associated with this skin disorder?
a) discoloration and pitting of the nails
b) silvery white, scaly patches on the scalp, elbows, knees,
and sacral regoins
c) complaints of pruritus
d) red purplish, scaly lesions
17. The nurse is assigned to care for a client with herpes
zoster. Which of the following characteristics does the
nurse expect to note when assessing the lesions of this
infection?
a) a generalized body rash
b) small, blue-white spots with a red base
c) a fiery red, edematous rash on the cheeks
d) clustered skin vesicles
18. The nurse manager is panning in the clinical
assignments for the day. Which of the following staff
members would not be assigned to the client with herpes
zoster?
a) the nurse who had chicken fox during child hood
b) the new nurse who never had german measles
c) the nurse who never had enteric fever
d) the new nurse who had flu vaccine
19. The nurse plans to instruct a client with candidiasis
(thrush) of the oral cavity about how to care for the disorder.
Which of the following is not a component of instructions?
a) to rinse the mouth four times daily with a commercial
mouthwash
b) to avoid spicy foods
c) to avoid citrus fruits and hot liquids
d) to eat foods that are liquid
20. The clinic nurse inspects the skin of client suspect of
having scabies.Which of the following
assessment findings would the nurse note if this disorder
were present?
a. the appearance of vesicles or pustules with a thick,
honey colored crust
b) the presence of white patches scattered about the trunk
c) multiple straight or wavy, threadlike lines beneath the
skin
d) patchy hair loss and round neck macules with scales
ANSWERS
1) C ..... 2) D ..... 3) D ..... 4) A ..... 5) B
6) C ..... 7) D ..... 8) D ..... 9) A ..... 10) A
11) D ..... 12) C ..... 13) D ..... 14) A ..... 15) C
16) D ..... 17) D ..... 18) B ..... 19) A ..... 20) C
Situation: Bobby, 3 years old, from a family of four older
siblings, a mother and a father, was admitted to the hospital
with a temperature of 101 F, a sore throat of four days
duration, with difficulty of swallowing, and a moderate
cervical adenitis. A diagnosis of pharyngeal diphtheria was
made.
61. The best means for providing complete bed rest for the
child include:
a) feeding the patient
b) giving sedation
c) providing quiet diversion
d) giving complete physical care
62. A positive nose and throat culture in a member of the
family in whom no signs of the disease are present would
indicate:
a) that he is developing diphtheria
b) that he is a carrier
c) that he is susceptible to diphtheria
d) that he is immune to diphtheria
Situation: Charles, an 8 year old boy, one of several
siblings in the family, is kept home by his mother because
he has a temperature of 100.2F and a history of hacking
cough for two weeks. A definite whoop has been heard and
the doctor made a diagnosis of whooping cough. The
visiting nurse is to instruct the mother in proper care of this
patient.
64. This young boy should be:
a) kept in warm, dry room
b) placed in a sunny room
c) kept in a room with a temperature of 60F
d) allowed free run of the house
65. The organism causing whooping cough is:
a) hemolytic streptococcus
b) hemophilus influenza
c) hemophilus pertussis
d) streptococcus albus
66. Whooping cough is most contagious:
a) in the paroxysmal stage
b) in the catarrhal stage
c( in the febrile stage
d) in the incubation stage
67. During the second stage of the disease the
characteristic paroxysm is frequently accompanied by:
a) involuntary micturation
b) spontaneous epistaxis
c) inspiratory whoop
d) expulsion of mucous from the trachea
68. The diagnosis of pertussis is confirmed by which of the
following tests?
a) nose and throat culture
b) nasopharyngeal culture
c) "rapid" culture of nose and throat organism
d) sputum culture
69. Oxygen is used in whooping cough for which of the
following reasons:
a) prevents the pertussis organism from multiplying
b) seems to lessen the occurrence of paroxysms
c) reduces the danger of convulsions
d) prevents atelectasis
70. One of the first signs of mumps is:
a) pain in the back
b) diarrhea
c) pain in the region of the parotid gland
d) otitis media
sites
c) deciding upon the appropriate to be antibiotic to be
administered to the client
d) supporting the client's body defense mechanisms
78. When giving a history, the patient reports that he had
discharge from his penis and burning when he urinates. A
nurse should recognize these as indicative of:
a) herpes
b) chlamydia
c) syphilis
d) HIV infection
79. When insect serves as the host for transmission, this is
called
a) airborne
b) vectorborne
c) vehicle
d) contact
80. When a health care worker is washing her/his hands,
which of the following observations made by the nurse
would indicate that the worker understands the principle of
proper hand washing?
a) washes hands prior to removing gloves
b) wash hands for 5 seconds
c) rinses hands with fingers pointed up
d) removes rings before washing
ANSWERS
61) B ..... 62) B ..... 63) ..... 64) A .....65) C
66) B .....67) C ..... 68) A ..... 69) B ..... 70) C
71) D ..... 72) C ..... 73) D ..... 74) C ..... 75) A
76) D ..... 77) C ..... 78) A ..... 79) B ..... 80) D
Infectious Agent or its toxic products - AGENT
Directly or Indirectly - MODE OF TRANSMISSION
Person, Animal or Intermediate Vector HOST
Environment - ENVIRONMENT
ECOLOGIC TRIAD OF DISEASE
Agent element, substance, animate or inanimate
that may serve as stimulus to initiate a disease
process
Host organism that provides nourishment for
another organism
Environment physical (climate), biological (plants
& animals)
CONTAGIOUS VS. INFECTIOUS
Contagious
Diseases that are easily spread directly transmitted
from person to person (direct contact) through an
intermediary host
Infectious
Diseases that caused by a pathogen not transmitted
by ordinary contact but require a direct inoculation
through a break in the skin or mucous membrane.
NOTE: ALL CONTAGIOUS DISEASE ARE INFECTIOUS
BUT INFECTIOUS DISEASE IS NOT ALWAYS
CONTAGIOUS
What is Infection?
INFECTION - "the state or condition in which the
body or part of the body is invaded by a pathogenic
agent ( bacteria, virus, parasites etc.) which under
favorable conditions multiplies and produces effects
which are injurious"
Infectious Agent
A. RESIDENT ORGANISMS
deeply seated in the epidermis, not easily removed
by simple handwashing,
Ex: Staphylococci
B. TRANSIENT ORGANISM
represent recent contamination,
survive for a limited period of time, acquired during
contact with the infected colonized patient or
environment,
easily removed by good handwashing
Ex: ( Klebsiella & Pseudomonas)
Infectious Agent
Bacteria heama organism, systemic
Virus nuero organism, systemic
Fungi skin organism, local
Protozoa GI organism, local
Infectious Agent
FACTORS THAT AFFECTS THE AGENT TO
DEVELOP A DISEASE
Pathogenicity ability to cause a disease
Infective dose no of organism to initiate infection
Virulence ability to enter or move through tissues
Specificity ability of the organism to develop
antigens
cyclical variation
a periodic increase in the number of cases of a
disease
a seasonal disease, an increase is expected or there
is usual increase- dengue fever during rainy seasons
are increased but it is not considered an epidemic
because it is expected to rise at this particular time
hot spot-a rising increase that may lead to an
epidemic
Time Related Patterns of Occurrence
Short time fluctuation
A change in the frequency of occurrence of a
disease over a short period of time
Maybe (+) or (-)
Secular variation
A change in the frequency of occurrence of a diseae
taking place over a long period of time
Ex: a.) the change in the pattern of occurrence of
polio after being eradicated in 2000, then sudden
repport of cases in 2001 due to mutant restraints.
b.) small pox virus-eradicated in 1979 (last case
reported) and no another incidence as of today
Types of Epidemiology
Descriptive Epidemiology - concerned with disease
frequency & distribution
Analytic Epidemiology
Is a study of the factors affecting occurrence and
distribution of the disease.
Ex. Epidemiologic investigation
Therapeutic/Clinical
Study of the efficacy of a treatment of a particular
disease
Ex. Clinical trial of a newly proposed therapeutic
regimen
Evaluation Epidemiology
Study of the over-all effectiveness of a total/
comprehensive public health program.
Ex. Evaluation of the under five clinic
Note: We make use of the epidemiology in CHN in
order to come up a community diagnosis and also
to determine the effectiveness of a particular
treatment
Types of Epidemiologic Data
Demographic data
Demography is the study of population groups
Ex. Population size and distribution
Vital Statistics
Environmental data
Health services data
Ex. Ratio between nurse and the population being
served
Contact precautions
skin to skin
Example: RSV Hep A, impetigo
Airborne infection
TB, chicken pox ( Varicella) , measles ( rubeola),
Droplets precaustion
when a patient cough and sneezing
Influenza, Pertussis.
pathogen
an agent that causes a communicable disease
viruses
______ are smaller than bacteria and cannot reproduce on
their own.
cancer
the uncontrolled growth of abnormal cells
person's behavior
A ________ can affect the risk of developing cancer.
cured
Some noncommunicable diseases can be _____.
arthrosclerosis
a disease in which fatty substances build up on the inside
of arteries
fungi
protist
Which kind of disease causes malaria?
skin
What is a major line of defense to keep pathogens out?
vaccine
A _______ is a dose of weakened or killed pathogens of one
kind.
cardiovascular disease
a disease of the heart and blood vessels
emphysema
a disease of the lungs in which air sacs are damaged
early diagnosis
What is the key to curing, controlling, damage done by
noncommunicable diseases?
immunity
the body's resistance to a disease through the presence of
antibodies
antibody
a substance made by certain white blood cells that
attaches to a pathogen and makes it harmless
vaccines
What is one way to develop immunity without getting sick?
smoking
What is the main cause of emphysema?
antibiotic
a medicine that kills bacteria
bacteria
Doctors give you an antibiotic when you have a disease
caused by a ________.
non-communicable disease
an illness that cannot spread and is not caused by a
pathogen
heredity
What is the main causes of noncommunicable diseases?
allergy
harmful reaction to certain substances
asthma
allergy that affects the respiratory system and may result
in breathing difficulty and wheezing
infectious dieseases
Communicable diseases are sometimes called _______,
infections, or contagious.
allergic reaction
All of the following are examples of _______:
itchy skin, rash, hives, stomach upset, swelling of lips or
tongue, sneezing
pollen
What triggers hay fever?
Pathogens
Disease causing microorganisms
Virus
Bacteria
One-celled organisms that multiply rapidly and make up
sick by releasing toxins.
Fungi
Feed on both living and dead organic matter. Most are
harmless but some can cause infections such as ringworm
and athlete's foot.
Protozoa (Protists)
Single-celled organisms that can have parasitic like
characteristics and may contain flagellum.
Symptoms
A physical or mental feature- fever, swelling, rash, aches,
runny nose, cough, headache- that indicates a specific
infection
Contagious Period
Length of time that a disease can spread from person to
person
Infectious Diseases
Often called communicable diseases as they can be
passed from one person to the next.
Infected animals
When pathogens spread diseases through bites
Occurs when there is physical contact with body fluidssaliva, blood, vomit, urine, feces, nasal secretionsbetween an infected person and a susceptible person via
touching, kissing & other sexual contact, direct contact
with body fluids, or contact with open wounds.
Agent
Germ that produced infection- Bacteria, Virus, Fungi,
Protozoa
Reservior
Place germ can live such as humans, animals, soil, objects,
air, water and food
Place of Exit
Where germ leaves reservoir such as through the mouth,
nose, rectum, genitals and wounds
Method of Transmission
How germ travels from point A to point B such as through
saliva, sneeze, wind, feces, urine, blood, water, soils,
kissing, infected sore
Place of Entry
Place where germ enters a person such as breathing in
through nose & mouth, germs in food- mouth and
digestive, cuts in skin, direct contact
Susceptible Host
Things that make a person more likely to get a disease.
These include behaviors (taking care of cuts, nutrition,
exercise, sleep, hygiene, abstaining from smoking and
drinking), conditions (receiving Chemo, AIDS/HIV+),
environment and inherited factors.
Skin
Hair
Around eyes and nose they trap germs and keep germs
from entering the body. The trachea has cilia that keep
germs from entering the lungs.
Tears
Wash away germs from eyes
Mucus
Sticky substance that exists in the nose & other places that
traps germs and contains chemicals defenses that attack
and destroy germs.
Antibodies
Specialize proteins that lock onto specific antigens and
mark invaders for other cells to destroy
Leukocytes
WBC or White Blood Cells
Phagocytes
Attach/engulf invaders
Lymphocytes
Remember & help destory
T lymphocytes
Destroy invaders
B lymphocytes
Seek out targets, produce antibodies, and send defenses
Antigens
Surface structures or markings that antibodies attach onto
Macrophage
Engulf invaders and trigger immune response
Vaccination
Contains weakened or dead strain of the organism/virus
which is injected into the body to prepare B-Cells and TCells to remember and destroy it quickly thus giving the
person immunity towards a specific disease and prevents
them from getting sick.
Antibotics
Treatment for bacterial infections
What process enhances topical
corticosteriods efficacy?
Soaking in water for 10-15 minutes
HIV
iatrogenic immunosuppression
prior lymphoma
typical prodromal sx
fever, malaise, HA, lack of appetite, rash
hand-foot-mouth disease
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-viral
-coxsackieviruses A16
-contact with body fluids or droplet
-fever, sore throat, malaise. In 1-2 days herpangina and
this disease begins with a low grade fever HA, mild cold
sx. these pass and the illness seems gone until a fine lacy
rash appears a few days later
fifth disease
Hep A
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-viral
-Hep A
-food born transmission
-fever, abd pain, N/V, diarrhea, jaundice.
tx: prevention, hydration, antipyretic, analgesics
Hep B
-transmission
-clinical manifestation
-treatment
-contact with bodily fluids
-jaundice, dark urine, fatigue, abd pain, loss of appetite,
N/V, and joint pain, skin rash
Hep c
-transmission
-clinical manifestation
-treatment
-contact with bodily fluids
-asymptomatic for a very long time. Can lead to liver
cancer and death. Non-specific sx: malaise, fatigue, weight
loss, vague abd pain.
-tx: prevention, antiviral meds, long term management.
may be passed from mom--> baby
Influenza
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-viral
-influenza A (H1N1) and B
-direct contact
-abrupt fever, progressive URI-like sx, malaise, anorexia
-prevention, antiviral (tammaflu) if detected early,
supportive care
Rubella
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-viral
-rubella virus
-droplets and contact with bodily fluids
-prodromal phase is ABSENT in kids. See rash starts on
face-->neck, arms, trunk, legs
-prevention, anti-pyretics, analgesics
chicken pox
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-viral
-varicella-zoster
-direct contact and droplet
-prodromal phase: slight fever and malaise. pruritic rash
begins as macule-->vesicle. pattern is centripetal
appearing on extremities, face
tx: acyclovir 20mg/kg/dose, 4 x day, also prevention,
antihistamines and skin care
shingles may develop at any age group but you are more
likely to get it if...
-you are older than 60
-you had chicken pox before the are of 1
-your immune syst is weakened by meds or disease
-you are a teen who was not immunized with two varicella
vaccines
rotovirus
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-viral
-rotovirus A-G
-contact with bodily fluids
-in kids 3-24mo, it is the most common cause of diarrhea.
also fever, vomiting, dehydration
-tx: prevention, hydration, antipyretics
Polyomyelitis (polio)
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-virus
-enterovirus
-contact with bodily fluids
-three different forms; abortive/inapparent, non-paralytic,
paralytic
-tx: prevention, bed rest, RT, PT, skin integrity, ADL's
this type of polio you see these sx: sore throat, HA,
vomiting, abdominal pain
abortive/inapparent
measles (rubeola)
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-viral
-mobillivirus
droplet and contact with bodily fluids
-prodromal state: fever and malaise, coryza (stuffy nose),
cough, conjunctivitis. Then Koplick Spots on mucosa, rash
appears on day 3-4 of illness
tx: prevention, vit A, bed rest, antipyretics
Roseola
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-viral
-contact with body fluids
-herpesvirus ty 6
-fever >103 for 3-7 days. a macular rash that is blanchable
-tx: antipyretics
mumps (parotitis)
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-viral
-droplet or direct contact
-paramyxovirus
-fever, HA, swelling of parotid gland on 3d day
tx: prevention, analgesics, antipyretics, hydration, AIRWAY
precautions.
condyloma/genital warts/HPV
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
viral
-human papillomavirus
-contact with body fluids
-lesions found on butt, vulva, vagina, anus, cervix
-tx: prevention, removal of warts, antimitotic drugs. not
sure if treatment actually reduces transmission...
Diptheria
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-bacterial
-corynebacterium dptheriae
-direct contact with bodily fluids
-URI which progresses to "bull's neck", white/gray mucus
membranes, fever cough
-antibiotics, bed rest, AIRWAY precautions, support
meningococcal meningitis
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-bacterial
-neisseria meningitidis
-contact with bodily fluids
-fever, HA, stiff neck, NV, photophobia, altered mental
status
-tx: prevention, antipyretics, anti inflamm, anti B
pneumococcal disease
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-bacterial
-streptococcus pneumonia
-direct contact with body fluids and droplet
-many manifestations (strep throat, scarletina, scarlet
fever, pneumonia, otis media, sinustitis, localized infec
scarlet fever
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-bacteria
-group A beta-hemolytic streptococci
-droplets and direct contact with body fluids
-prodromal: abrupt high fever, halitosis, HA enanthema:
tonsils large, edematous, "strawberry tongue, both white
then red...
tx: penicillin, bed rest, analgesics, antipruritis, hydration
tetanus
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-bacterial
-clostridium tetani
-spores in soil, dust, excretions
-muscle contractions of masseter, neck, and trunk
-tx: immunoglobulin, tetanus toxoid, analgesics
meningitis
onset
clinical manifestations
-tx
rapid onset; bac, viral, fungal, aseptic
-nucchal rigidity, change in mental status, fever, rash
-tx: antipyretics, analgesics, antifungal/antibiotics,
hydration
giardiasis
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-protozoan
-giardia intestinalis
-direct contact with contaminated water or food
-diarrhea, NV, anorexia, failure to thrive, abd cramps,
constipation, bloating, flatulence
-tx: flagyl, tindamax, and prevention of reoccurance
enterboiasis (pinworms)
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-diagnosis
-treatment
protozoan
-nematode enerobius vermicularis
-inhalation or ingestion of eggs from contaminated hands
-itchy butt, restless, bed wetting, short attention span, poor
sleep, possible urethral infection
-dx: tape test
tx: pyrantel pamoate or albendazole x1 then again in 2
wks. treat whole family. prevent occurrence
lyme disease
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-vector borne
-borrelia burhdorferi
-transmitted by deer tick bite
{stage 1: }"bull's eye", fever, HA, malaise
{stage 2:} (1-4mo) rash on hands/feet, fever, HA, malaise,
fatigue, lymphadenopathy, cough, stiff neck
{stage 3:} systemic involvement (2-12mo)
arthritis, CNS changes, cardio complications,
encephalopathy, cognitive and behavioral changes, chronic
arthritis
tx for lyme
>8 yo, doxycycline
<8 yo, amoxicillin
-transmission
-clinical manifestation
-treatment
-vector borne
-ricketsia ricketsi
-gradual or abrupt onset of fever, malaise, HA, rash on
palms/feet
-tx: antipyretic, analgesic, antibiotics
lice
-scientific name
-clinical manifestation
-treatment
-pediculus humanus capitis
-intense pruritus of scalp, behind ears, nape of neck, nits
(eggs) attached to hair shaft
-pediculicide and removal of nits, education and support.
kid infected, family and home must all be treated.
scabies
-scientific name
-transmission
-clinical manifestation
-treatment
-sarcoptes scabiei
-prolonged close contact. mites burrow into skin and lay
eggs in CLUSTERS
-intense itching, excoriation and burrows, inflammation
btwn fingers, neck folds and groin
tx: scabicide, >2 yr permethrin, wash linen and clothes and
dry high heat, supportive care for itching 2-3 weeks
bedbugs
-scientific name
-transmission
-clinical manifestation
-treatment
-cimex lectularis
-contact with infested mattress. mites burrow and feed on
blood.
-intense itching, all over bites, may progress to
follicularitis/cellulitis. may trigger asthma/anaphylaxis
-identification and eradication of bugs, topical application
of steroids, hygiene of linens and clothing, supportive care
pruritis 2-3 wks
goals of stomatitis?
NSAIDs, anesthetics, prevent spread by oral secretions and
poor handwashing
sx of encephalitis
personality changes, seizures, weakness
communicable disease
...a disease that can be given from one person to another
microbe (microorganism)
...a living thing that cannot be seen with the naked eye;
examples include bacteria and viruses
pathogens
...a microbe that can cause illness
opportunistic microbes
...microbes that are considered normal (resident) flora
when they are in or on one part of the body, but can cause
infection if they move out of that area and into or onto
another part of the body
colonies
...groups of bacteria
aerobic
...bacteria that need oxygen in order to live
anaerobic
...bacteria that can survive withhout oxygen
antibodies
...specialized proteins produced by the immune system
that help our bodies to fight specific microbes, preventing
infection.
infection
...disease caused by pathogenic microbes
chain of infection
...the six key conditions that must be met for a person to
get a communicable infection: pathogen, reservoir, portal
of exit, method of transmission, portal of entry, and a
susceptible host.
contaminated
...describes an object that is soiled by pathogens
fomite
...a non-living object that has been contaminated (soiled)
by pathogens
vector
...a living creature, such as an insect, that can transmit
disease
virulence
...the strength or disease-producing potential of a
pathogen
nosocomial infections
...Infections that a patient or resident get while receiving
treatment in a hospital or other health care facility; a type
of health-care associated infection (HAI)
infection control
...basic practices designed to decrease the chance that an
infection will spread from one person to another in a health
care facility
medical asepsis
sanitization
...practices associated with basic cleanliness,such as hand
washing, cleansing of eating utensils and other surfaces
with soap and water, and providing clean linens and
clothing; one of the techniques of medical asepsis
antisepsis
...practices that kill microbes or stop them from growing;
one of the techniques associated with medical asepsis
(compare with sanitization, disinfection, and sterilization)
disinfection
...the use of strong chemicals to kill pathogens on nonliving objects that come in contact with body fluids or
substances, such as bed pans, urinals, and over the bed
tables; one of the techniques of medical asepsis (compare
with sanitization, disinfection, and sterilization)
sterilization
...the process of completely eliminating microbes from the
surface of an object using an autoclave (sterilizer) or
chemicals; (compare with sanitization, disinfection, and
sterilization)
transient flora
...microbes that are picked up by touching contaminated
objects or people who have an infectious disease
isolation precautions
...guidelines, based on a pathogen's method of
transmission, that health care workers follow to contain the
pathogen and limit others' exposure to it as much as
possible
standard precautions
transmission-based precautions
...precautions that a health care worker takes when a
person is known to have a disease that is transmitted in a
certain way; include airborne precautions, droplet
precautions, and contact precautions
airborne precautions
...used when caring for patients or residents infected with
pathogens that can be transmitted through the air; include
placing the patient or resident in a private room with the
door closed, wearing a mask when caring for the patient or
resident, and minimizing the amount of time the person
spends out of his or her private room
droplet precautions
...used when caring for patients or residents infected with
pathogens that can be transmitted by direct exposure to
droplets released from the mouth or nose (for example
when the person coughs, sneezes or talks)
contact precautions
...used when caring for patients or residents infected with
pathogens that can be transmitted directly (by touching
the person), or indirectly (by touching fomites); include
using barrier methods whenever contact with the infected
person or items contaminated with wound drainage or
body substances is necessary
Callose
is a large polysacchride that blocks old sieve tubes
Tylose
a balloon-like swelling, also blocks old xylem vessels
primary defences
which prevent entry of pathogens into the body
Secondary defences
help to remove a pathogen after it has entered the body.
immune response
the body's response to invasion by pathogens.
Blood clots
reduce the loss of blood and make a temporary seal,
preventing access by pathogens
Inflammation
the swelling and redness seen in infected tissues. Infected
tissue often feels hot and tender. This is caused by a cellsignalling substance called histamine.
Antibodies
proteins that are secreted in response to stimulation by the
appropriate antigen. They have specific binding sites and
are capable of acting against the pathogen.
Antigens
molecules on the surface of cells that the immune system
can use to recognise pathogens.
Antigen presentation
primary response
the immune system's response to a first infection
secondary response
the immune system's response to a second or subsequent
infection by the same pathogen.
Active immunity
immunity acquired by activation of the immune system
Passive immunity
when someone is given antibodies produced by someone
else
autoimmune disease
one in which the immune system attacks the body's own
healthy cells and tissues
Vaccination
the deliberate introduction of antigenic material in order to
stimulate the production of antibodies
vector
an organism that carries the pathogen from one host to
another.
disease
an illness
communicable disease
caused by pathogens from one living thing to another
pathogen
a disease causing organism
non-communicable disease
a disease that can not be spread other than through
heredity (no pathogens-heart disease)
virus
smallest pathogens (ex: common cold, herpes)
bacteria
singled-celled microorganisms (ex: strep throat,
tuberculosis, syphilis, and lyme disease)
rickettsia
pathogens that grow in living cells and resemble bacteria
(ex: rocky mountain spotted fever and typhus)
fungi
single-celled or multi-cellular plantlike organisms, yeast
and mold (ex: athlete's foot, jock itch, nail infection,
ringworm)
protozoa
tiny, single-celled organisms that produce toxins that
cause disease (ex: malaria and dysentery)
direct contact
sexual intercourse, intimate kissing, blood transfusion,
touching ulcers or sores, handling body fluids (blood or
urine)
indirect contact
contact with an object that has been used by an infected
person
skin
unbroken skin prevents pathogens from entering the bodybathing rids the body of the pathogens
mucous membranes
tissues that line the body opening and secrete mucus
mucus
is thick secretions that coats the mucous membranes
stomach acid
acid in stomach that kills most pathogens
T cells
white blood cells that regulate the action of the immune
system
phagocytes
white blood cells that surround and kill pathogens by
ingesting them
B cells
...
What is the primary prevention of disease?
Immunization
What is Varicella?
Chicken Pox
Incubation of Varicella
14-16 days but can be as long as 18-21 days
Varicella-Manifestations
Rash erupts 1 day after prodromal period
Very itchy
Begins as a macule and progresses to a papule
Then becomes a fluid filled vesicle resembling a dew drop,
which breaks and forms a crust
starts in trunk and progress to proximal extremities and
face
Varicella-Treatment
Acyclovir and Varicella Zoster Immune Globin in High Risk
Children After Transmission
Strict Isolation
Skin care-Comfort, Cool Bath, Calamine
Avoid use of aspirin/salicylates
Manage itching w/distraction, benadryl in moderation
Varicella-Complications
Secondary bacterial infections
Encephalitis
Pneumonia
Hemorrhagic Varicella
Chronic or transient thrombocytopenia
Erythema Infectiosum-Manifestations
Mild Fever
Joint Pain
Lethargy
Rash-3 stages
Erythema Infectiosum-Management
Self Limiting, can only manage symptoms
*anti-pyretics
*analgesics
Erythema Infectiosum-Complications
chronic joint pain
aplastic crisis
myocarditis
Exanthem Subitum-Characteristics
High fever with unknown etiology for several days
Followed by rash once fever is resolved
may have lymphadenopathy, inflamed pharynx, cough,
coryza
Exanthem Subitum-Treatment
Self limiting. Treat the symptoms!
What is Pertussis?
Whooping Cough
Caused by bordetella pertussis
Pertussis-Characteristics
Short, rapid coughs followed up a crowing or "whoop"
sound
What is Rubeola?
Measles
Viral Infection
Rubeola-Characteristics
Fever and Malaise
Followed by coryza, cough, conjunctivitis, Koplik spots,
anorexia, lymphadenopathy then rash
Rubeola-Treatment
Treatment includes supplementation w/vitamin A;
supportive care
Maintain isolation until 5th day of rash, bedrest
Rubeola-Complications
Complications include otitis media, pneumonia,
bronchiolitis, obstructive laryngitis/laryngotracheitis,
encephalitis
Mumps-Characterized
Mumps-Treatment
Supportive: analgesics, antipyretics; IV fluids if unable to
drink/vomiting due to meningoencephalitis
Maintain isolation
Mumps-Complications
sensorineural deafness, postinfectious encephalitis,
myocarditis, arthritis, hepatitis, epididymo-orchitis, sterility
in adult males (rare)
German Measles-Characteristics
No prodromal symptoms in children; in adults, adolescents:
low grade fever, headache, malaise, anorexia,
conjunctivitis, coryza, sore throat, cough,
lymphadenopathy; followed by rash, starting on face and
progressing downward, by end of 1st day body is covered
German Measles-Treatment
Self limiting, treatment includes antipyretics, analgesics
German Measles-Complications
Rare-but include arthritis, encephalitis, purpura
What is Poliomyelitis?
3 types of enteroviruses
No wild type virus since 1979; few vaccine-induced cases
until 1998, development of IPV
Poliopmyelitis-Chracteristics
May be inapparent (fever, sore throat, headache, vomiting,
abdominal pain), nonparalytic (sl. more severe than
inapparent)
Poliomyelitis-Treatment
No treatment other than supportive
Poliomyelitis-Complications
Complications include complete paralysis, respiratory
arrest, hypertension, and those things caused by
immobility
Scarlet Fever-Characteristics
Fever, malaise, headache, lymphadenopathy, vomiting,
chills, abdominal pain, enlarged tonsils w/exudate,
erythematous pharynx, strawberry tongue, and RASH
Scarlet Fever-Treatment
antibiotics (penicillin, erythromycin) x 10 days, analgesics,
antipyretics.
Scarlet Fever-Complications
otitis media, peritonsillar/retropharyngeal abcess, sinusitis,
glomerulonephritis, carditis/polyarthritis
Conjunctivitis-Causes in Newborns
chlamydia, gonorrhea, or herpes simplex virus
Conjunctivitis-Causes in Infants
may be sign of tear duct obstruction
Conjunctivitis-Causes in Children
bacterial (most common), viral, allergic, or foreign body
Hep B
RV
Definition of Immunization?
Process when an animal or person becomes protected
against a disease
Definition of Vaccination?
Injection of a killed or weakened infectious organism to
prevent a disease
Definition of Vaccine?
Product that produces immunity to protect the body from a
disease.
Safety of Vaccines?
Studied before giving to public
Scientist monitor safety of vaccines
Serious adverse effects are rare
Multiple vaccines at one visit is considered safe and
quickest protection against diseases
What is infection?
Invasion of bacteria or viruses
communicable disease
a disease that can be passed from one person to another
pathogen
a disease causing organism when germs enter your body,
you can develop an infection
infection
a condition that occurs when pathogens enter your body,
multiply and cause harm
virus
the smallest pathogen that can be heeled with antibiotics
bacteria
tiny one celled organism that can be cured with antibiotics
fungi
more complex organism than bacteria but cannot make
their own food. Thrive in warm, moist areas ex. ringworm,
athletes foot
protozoa
one celled organism that are more complex then bacteria
skin
first line of defense,
covers and protects body
mucous membranes
lines the mouth, nose , throat and eyes,
their job is to trap jerms
saliva
destroys harmful organisms
tears
wash away germs
stomach acid
vaccine
a preparation of dead or weakened pathogens that causes
the immune system to produce antibiotics
immunization
helps the immune system make antibiotics for certain
diseases
immunity
your body's ability to resist the germs that causes a
particular disease
specific reactions
some pathogens survive the nonspecific reaction. when this
happens your body is self off a specific immune system.
Our immune system recognizes a pathogen it has already
battled so it is ready to re attack
antigen
substance realised by invading pathogens
types of immunization
Hepatitis B, Polio, measles, chicken pox, tetanus shot
not only do they help you but they also surround you
colds
are caused by hundreds of different viruses and can be
spread by direct and indirect contact
treatments of cold
getting rest and drinking fluids, OTC medicines can help,
stay home for at least 24 hours
flu (influenza)
symptoms are fever, chills/ fatigue, headaches/muscle
aches and respiratory pain
mononucleosis
''mono'' or the ''kissing disease'' is a viral diseases
characterized by a severe sore throat and swelling of the
lymph glands in the neck and throat area
hepatitis
a viral disease if the liver characterized by yellowing of the
skin and whites of the eye
3 types of hepatitis
hep A,B and C
hepatitis A
common in areas of poor sanitation , like food or water
contaminated with human waste or enters the body
through an open wound
hepatitis B,C
spread through contact with contaminated blood or other
body fluids. There are vaccines to protect people with Hep
A and B. There are medicines to treat people with Hep.C
tuberculosis (TB)
bacterial disease that affects the lungs. TB can be spread
easily through air ,sometimes no symptoms but can still be
spread.
pneumonia
serious inflammation to the lungs
symptoms are fever, chills, and difficultly breathing
strep throat
sore throat causes by streptococcal bacteria
symptoms are red and painful throat, fever,and swollen
lymph nodes in neck
H.i.v
human, immunodeficiency, virus
human
immunodeficiency
this disease attacks the immune system
virus
the smallest and simplest form of life
A.I.D.S
acquired, immune, deficiency, syndrome
Acquired
this disease comes from outside the body. A person must
do something to take it in
Immune
this disease attacks the immune system
deficiency
lack of something. Aids destroys the T-cells
syndrome
a medical condition that has no cure
opportunistic disease
a disease that takes advantage of a weakness in the body.
People die from it because aids kill the immune system.
Hiv
2-10 years looks and feels good
Arc,Aid
body shuts down
death
male 3 years
females 1-5 years
A.R.C
aids realistic complex
what is arc
symptoms of arc
lost of appetite
symptoms of arc
fatigue
symptoms of arc
weight loss
symptoms of arc
fever
symptoms of arc
night sweats
symptoms of arc
diarrhea
what it does
slows down the disease
what it does
decreases the number of immune cells
is there a cure
no
C) C. C/HCV
D) D. D/delta
C
C) a. Communicable period
D) c. Latent period
A
C) b. Hand-to-hand contact
D) d. Sexual intercourse
D
The condition that results in bacteria passing the bloodbrain barrier and increasing cerebral vascular
permeability, thus increasing intracranial pressure, is
known as:
A) d. Tuberculosis
B) c. Meningitis
C) a. Hepatitis
D) b. HIV
B
Trichinosis
Escherichia coli (E. coli)
Cholera
Diphtheria
Encephalitis
Giardiasis
Gonorrhea
Hepatitis A-D
Influenza activity
Legionellosis/Legionnaires' disease
Leprosy
Lyme disease
Malaria
Meningococcal infections
Mumps
Pertussis
Poliomyelitis
Rabies
Rocky Mountain spotted fever
Rubella
Rubeola (measles)
Salmonellosis
Shigellosis
Severe acute respiratory syndrome-associated
Coronavirus disease (SARSCoV)
Syphilis
Smallpox
Tetanus
Toxic shock syndrome
Trichinosis
Tuberculosis
Typhoid fever
Vancomycin-resistant Staphylococcus aureus (VRSA)
Varicella (chickenpox)
bioterrorist attack.
Set up protocols for
different biosafety levels
of infection control and
containment.
mortality rates.
Examples include smallpox (variola), botulism toxin,
anthrax, tularemia,
hemorrhagic viral fevers, and plague.
Antigen
Substance capable of triggering an immune response
Antibodies
Protein that fights against a specific antigen
Lymphocytes
Specialized white blood cells (t & b)
Active immunity
Developed from natural or artificial processes (flu vaccine)
Passive immunity
Your body receives antibodies from another person or
injection
HIV
Damages T cells and leads to aids
Physical barriers
Skin, nose, hair
Chemical barriers
Tears, stomach acid, mucus
Immune system
A network of cells, tissues, organs, and chemicals that fight
off pathogens
Inflammatory response
A reaction to tissue damage caused by injury or infection
Phagocytes
White blood cells that attack invading pathogen
Helper T cells
Trigger the production of B cells and killer T cells
Killer T cells
Attack and destroy infected body cells
Suppressor T cells
Turn off T cells when infection is cleared
B cells
Produce antibodies
CDC
Centers for disease control
WHO
World health organization
Live-virus vaccines
Vaccines made from pathogens in labs
Killed-virus vaccines
Vaccines using dead pathogens
Toxoids
Vaccines with inactivated toxins from pathogens &
simulates the growth of antibodies
Pathogens
Microorganisms that cause disease
Rickettsias
Resembles a bacteria and enters the body through insect
bites
Protazoan
Single celled microorganisms that are larger and more
complex than bacteria
Vectors
And organism that carries and transmits pathogens to
humans or animals
Communicable disease
Disease that is spread from one living organism to another
or through the environment
This policy serves as the Sheriff's Office
"Infectious Disease Exposure Control Plan" and the
"Biomedical Waste Operating Plan."
1.
2.
3.
4.
5.
6.
Gloves;
Masks, Eyewear, and Gowns;
CPR mask;
Boot or shoe covers;
Disposable Personal respirator
Water-soluble plastic bags (clear w/ red stripe).
Influenza Type B
* Vancomycin
or
*Chloramphenicol
* short
* 1 min to 6 hours
* Soil
* Marine sediment
* Honey
* Meat Pies
* Gravies
*
*
*
*
Modes of transmission
Droplet, Vector (vehicle transmission... aka mosquitoes),
Airborne (droplet nuclei, remain suspended in air, varicella)
Passive artificial
What are some signs and symptoms for the Chicken Pox?
Fever, Fatigue, Upper Respiratory Infection
Maculare Rash that is more concentrated toward the center
at the body and thins out towards the distal part of the
body.
Nurse's Role
in Infection Control
Promote infection control strategies
Report infectious and communicable diseases to state
health officials
Active immunity
An antigen is introduced into the body in a vaccine, which
stimulates antibody production without causing clinical
disease
Passive immunity
Antibodies produced in another human or animal host is
given.
Provides immediate protection
Does not provide lasting immunity
Example: Tetanus immune globulin
Immunization Type
Inactivated
DTaP, IPV, Hep B, Hib, PCV, Hep A, Influenza
Fever Benefits
Rid of organisms that thrive in lower body temperatures
Mobilizes immune response
plasma iron concentration - limits microorganism growth
Fever Risk
When body temp reaches 41 C (105.9)
Febrile seizure
Sepsis
Definition: Overwhelming infection in the bloodstream
Causes from infectious diseases:
Infected pox
Can lead to septic shock
septic shock
Signs of Sepsis
Hypothermia or hyperthermia
Abdominal distention
Anorexia
Respiratory distress
Vomiting
Cool extremities
Mottling
Lethargy
Management of Lesions
Use cool wet compresses or giving baths in cool or
lukewarm water (Oatmeal bath, e.g., Aveeno)
Keep fingernails short and clean.
Put calamine lotion on itchy areas
Meningococcus
Transmission: respiratory droplets
Highest rates < 5 years of age.
Incubation: 1-10 days
Communicable until 24 hours after start of antibiotics
Clinical manifestations -onset is rapid and life-threatening
Onset - flu-like symptoms with prostration
Neuro signs
Meningococcemia - urticarial, maculopapular
Shock, hypotension, DIC, coma
Meningococcus (cont)
Complications
Loss of limbs d/t necrosis; hearing loss, arthritis, seizures,
pericarditis, hemiparesis
Up to 15% with invasive type die
Prevention
Vaccine for children > 2 years for persons at high-risk
Close contact - prophylaxis treatment
Treatment
Penicillin G (cefotaxime, ceftriaxone - alternatives)
In ICU
DIC treated with plasma, blood, or platelets
Meningococcus
Nursing management
Standard and droplet precautions
Monitor for shock and respiratory compromise
Monitor for fluid overload and ICP -watch fluids
Help identify close contacts that need prophylaxis
Help family identify and connect with supports
Surviving child will likely need rehab
Roseola
Transmission: likely to be respiratory
Incubation : 5-15 days
Clinical manifestations:
Sudden, high fever for 3-8 days; normal behavior and
appetite
Fever followed by pale, pink, discrete, maculopapular rash
Treatment: Supportive
Herpes Zoster (shingles)
Hepatitus B
below the belt,
comes from infected or contaminated blood
vaginal fluids, saliva, urine, semen etc
Hepatitus C
affects the liver
a symptomatic
and causes cirrohsis or hardening of the liver
auto infection
the infection of a primary host with a parasite. Particularly
a helminth
Legionairres disease
produces high fever and pnumonia
out breaks occur in warm moist environments during
summer and winter
uncommon to those 20 years or younger
pennicillin ineffective
Hepatitus A
Treansmited through fecal oral route
ingestation of contaminated food
shellfish from contaminated waterrs
no treatment
Staff
natural inhabitant found in the human body
responsible for boils and other infections
inflammation of the stomach and intestines
source of food intoxication
Poliomyelitus
feared more than aids
fecal oral route
Botulism
Paralytic type illness
recovery takes months or years
paralysis of the breathing muscles
casues respirtory failure
Mumps
contracting it equals life long immunity
inflammed glands
small pox
occurs only in humans
only infectious for a short time
1st communicable disease officially eradicated
not strong enough to survive.
e-Coli
can cause distruction of the kidneys
if excreted con become communicable
found in the lower intestines of warm blooded animals.
fecal oral transmission
Rubella
normally seen in children
communicable for one week
immunity accquired through vaccime or infection
salmonella
2000 different species
communicable for the duration of the infection
ingested of food derived from infected animal
transferred between human and non human
diarhea, feve and abdominal cramps
measles
disease is communicable
spread through respiratory contact
vaccination during second year of life
Histoplasmosis
Plague
spread to humans via fleas
depending on sanitation, van be spread through the air.
can come from contaminated or undercooked foods.
anthrax
used as a biological weapon
spread by spores
anthropod Vector
any tiny organism that can transport infectious pathogens
via bacteria or prion.
mosquitos
flies
mites
ticks
encephalitis
caused by bacterial infections by
rabies
west nile
measles
polio
and herpes simplex
toxic shock
caused by staff and strep
causing problems with several body ogans
can be treated with antibodies
conjunctivitus
eyes become red and inflammed
treated with drops
casued by bacteria rubbed into the eye
caused due to poor handwashing
affects the mucous membrane that lines the eyelid
rhino viruses
commom cold
most common of all communicable diseases
created through rhnoviruses
bacterial exudate is clear
can be transmitted directly or indirectly
Reyes syndrome
causing detrimental harm to many organs such as the brain
and liver
associated with giving children asprin
damages cellular mitochondria
inluenza
communicable 3 to 5 days after inicial symptoms appear
Vaccine is 80 percent effective
Mono
kissing disease
part of the herpes group
smptoms are non specific
carrier has EBV on the throat
affected individuals restricted form contact sport.
meningitis
caused by a bacteria
can be treatd with antibiotics
starts with an upper respiratory infection
Herpes simplex 1
herpes type 1 causes sores around the mouth and lips
(sometimes called fever blisters or cold sores).
Alkalosis
The main cause of respiratory alkalosis is hyperventilation,
resulting in a loss of carbon dioxide having to use a paper
bag
plantar warts
The HPV type 1 causes most plantar warts.
The virus gains access to the skin through direct contact.
endocarditus
inflammation on the inside lining o the heart
hansens disease
effects the skin and perrifrial nerves; leoprosy
necrotising facilitus
bacteria capable of deteriorating the skin and the tissues
covering the muscles due to bacteria entering into the skin.
What is an emergency?
An emergency is a serious event that
requires an immediate response. The
affected population is usually small in
scale. Examples include a house or
neighborhood fire, a car accident, or an
avalanche that traps several people.
What is a disaster?
A disaster affects many people in various
ways. Some examples of disasters include
an earthquake or a hurricane destroying a
city or several cities across a wide area, a
tornado that causes damage and death
over many miles and several cities, or a
man-made disaster such as a nuclear
bomb.
Conventional warfare
Nonconventional warfare (e.g., nuclear,
chemical)
Transportation accidents
Structural collapse
Explosions and bombings
Fires
Hazardous materials incident
Pollution
Civil unrest (e.g., riots)
Terrorism (e.g., chemical, biological,
radiological, nuclear, explosives)
Cyber attacks
Airplane crashes
Radiological incidents
Nuclear power plant incidents
Critical infrastructure failures
Water supply contamination
Pollutants
Medications/drugs
What is toxicity?
The ability to produce a poisonous reaction
what is invasiveness?
the ability to penetrate and spread
throughout a tissue?
What is antigenicity?
the ability to stimulate an immunological
response
What is resistance?
What is infectiousness?
a measure of the potential ability of an
infected host to transmit the infection to
other hosts.
What is an epidemic?
refers to the occurrence of a disease in a
community or region in excess of normal
expectancy.
What is a pandemic?
an epidemic that occurs worldwide and
affects large populations. HIV/AIDS is both
What is a zoonosis?
an infection transmitted from a vertebrate
animal to a human under natural
conditions. The agents that cause
zoonoses do not need humans to maintain
their life cycles; infected humans have
simply somehow managed to get in their
way
infection
A condition that occurs when pathogens enter the body,
multiply, and damage body cells
virus
(virology) ultramicroscopic infectious agent that replicates
itself only within cells of living hosts
toxins
Any of various poisonous substances produced by some
microorganisms
vectors
An organism that transmits disease by conveying
pathogens from one host to another
airborne transmission
Spread of disease-causing microorganisms over long
distances through the air.
respiratory tract
Nasal Cavity, Pharynx, Glottis, Larynx, Trachea, Bronchus,
Bronchioles, Lung, Diaphragm.
mucous membrane
Membrane that lines passages that communicate with air
influenza
Acute, contagious respiratory infection characterized by
sudden onset, fever, chills, headache.
pneumonia
An inflammation of lung tissue, wherer the alveoli in the
affected areas fill w/fluid
strep throat
Bacterial infection of the throat; if left untreated may lead
to high fever and other serious complications
tuberculosis
An infectious disease that may affect almost all tissues of
the body, especially the lungs
jaundice
yellowing of the skin and the whites of the eyes caused by
an accumulation of bile pigment (bilirubin) in the blood
hepatitis A
A virus that is spread by the fecal-oral route through
contaminated food and water or by close and intimate
contact and results in liver inflammation, flu-like
symptoms, nausea, poor appetite, abdominal pain, fatigue,
yellow eyes and skin, and dark urine that can last weeks to
months.
A microorganism that causes disease
pathogen
pandemic
T or F
A disease that is spread from one living organism to
another is called a(n) COMMUNICABLE DISEASE.
True
T or F
Common PATHOGENS include flies, mosquitoes, and ticks.
False vectors
T or F
The common cold and strep throat are both diseases of
the digestive tract.
False respiratory tract
T or F
PNEUMONIA can be caused by either a virus or a bacteria.
True
T or F
The RESPIRATORY SYSTEM is a network of cells, tissues,
organs, and chemicals that fight of pathogens.
False immune system
T or F
A(n) VACCINE is a protein that acts against a specific
antigen.
False
T or F
The body develops ACTIVE IMMUNITY when it is exposed
to antigens from invading pathogens.
True
T or F
LIVE-VIRUS VACCINES use dead pathogens.
False dead-virus vaccines
T or F
T or F
EMERGING INFECTIONS are communicable diseases
whose occurrence in humans has increased within the
past two decades or threatens to increase in the near
future.
True
T or F
Salmonella and E. Coli are VIRUSES that live in animal's
intestinal tracts.
False bacterias
carcinogen
chemicals known to cause cancer
malignant
cancerous
benign
noncancerous. does not spread
Cancer
abnormal, uncontrolled cell growth.
Takes over and destroys normal cells and tissue
Tumor
abnormal growth of tissue
Metastasis
the spread of cancer
Carcinomas
cancers that develop in the skin and linings of organs
Sarcomas
cancers that develop in bones, muscles and tendons
Lymphomas
cancers that develop in the lymphatic system (immune
system)
Diabetes
a chronic disease that affects the way body cells convert
food into energy
Glucose
sugar
Insulin
hormone that helps turn glucose into energy for the cells
Type 1 diabetes
Occurs most often before age 15
The pancreas produces NO insulin
Frequent urination, abnormal thirst and hunger are
symptoms
Must have daily injections
Type 2 diabetes
Usually in adults over 40
The body's cells do no use insulin correctly
Excess weight, drowsiness and blurred vision are symptoms
Must maintain diet and exercise
Usually caused from being overweight
Atherosclerosis
When fat deposits (plaque) build up in the blood vessels it
is called
Stroke
Blood vessels in the brain are blocked or broken
Biopsy
a procedure that removes and examines a group of cells
that may be cancerous.
Virus
The smallest pathogen that multiplies after entering a cell
Bacteria
Single-celled microorganism
Protozoa
Larger, more complex single-celled organism
Fungi
A plant-like organism that causes diseases of the skin
Heart Attack
The death of the cardiac muscle caused by a lack of blood
flow to the heart
Arteriosclerosis
A term used to describe several conditions that cause
hardening or thickening of the arteries
Angina Pectoris
Chest pain from narrowed coronary arteries
Vector
Community-Based Nursing
Focus: Health of individuals, families, and groups within a
community.
Client: Individuals, family, or group of individuals
Activity: Provision of direct primary care in the settings
where individuals and families live, work, and "attend"
(schools, camps, parishes)
Social determinants
Impact whether someone is able to attain/maintain health;
(Income, social status, education, literacy, environment,
support networks, gender, culture, available health care)
Disparities
Gaps in care experienced by one population compared to
another
Florence Nightingale
Studied nursing in Germany then established nursing
schools in England
District Nursing
A mode of service delivery in which a community health
nurse is responsible for addressing all the health needs of a
given population
Lemuel Shattuck
First use of demographic data to look at population health
birth and death records
Dorthea Dix
Established first hospital for the mentally ill in the US
Clara Barton
Civil war nurse: Established the American Red Cross
(providing aid for natural disasters)
Lillian Wald
Found of public health nursing in the US; Founded the
Henry Street Settlement and Visiting Nurse Service which
provided nursing and social services and organized
educational and cultural activities. She is considered the
founder of public health nursing
Mary Breckenridge
Pioneer in nurse-midwifery; established the Frontier Nursing
Service - nurses traveled on horseback to reach mothers in
the hills of Kentucky
Nongovernment Agencies
Agencies that acquire resources from private sources to
assist others
Philanthropic Agencies
Organization that uses endowments or private funding to
address the needs of individuals, families, and populations
Health
A quality, an ability to adapt to change or a resource to
help cope with challenges and processes of daily living
Well Being
A subjective perception of full functional ability as a human
being
Learning Theory
Goal established and reinforced by nurse; Rewards given
for partial accomplishment
Epidemiology
The study of the distribution and determinants of health
and illness
Rate
Primary measurement used to describe either the
occurrance or the existence of a specific state of health or
illness
Outbreaks
Epidemic usually limited to a localized increase in the
incidence of the illness
John Graunt
Father of demographics. recognized importance of
recording birth and death rates and age structure of human
population
William Farr
Set up a system of data collection for causes of death in
difference occupations, gender, and imprisonment.
Importance of definition of illness and population
comparison, groups, and factors such as age, health, and
environment can affect statistics
John Snow
Used mapping and rates as an objective measure to
compare populations
Epidemiological Triad
Model based on the belief that health status is determined
by the interaction of the characteristics of the host, agent,
and environment
Wheel of Causation
Epidemiologic model that deemphasizes the agent as the
sole cause of disease while emphasizing the interplay of
physical, biological, and social environments
Web of Causation
Epidemioligcal model that strongly emphasizes the concept
of multiple causation while deemphasizing the role of
agents in explaining illness
Rate
Primary measure used to describe either the occurrence or
existence of a specific state of health or illness within a
group during a specific time frame
Ratio
Fraction that represents the relationship between two
numbers; Divide one quantity by another quantity
Ex: # boys in class/# girls in class
Proportion
Type of ration
Ex: # boys/ total students
Crude Rate
Adjusted Rate
Controls for differences between populations-used for
comparison
Incidence
Measures probability that people without a condition will
develop the condition over time; measures pace of new
illness
Prevalence
Existence of a condition during a period/interval at a
specific point; Studies number of people diagnosed in the
past and length of illness; Longer length=greater the
prevalence-indicates burned of community
Mortality Rates
Crude mortality: probability of dying from any cause; #
deaths in a year/total population
Incidence Density
Used when unequal periods of observation for study
subjects; Accounts for people who die, drop out of a study,
or acquire an illness
Attributable Risk
The risk of a condition occurring in an exposed group that
is attributable to an exposure, not other factors
Sensitivity
Ability of the test to correctly identify people who have the
health problem
Specificity
Specific incidence and prevalence rates calculated based
on specific characteristics (demographic data), variations
based on location and variations in time (short-outbreak,
periodic- seasonal, long-years)
Incidence Rate
#new cases during time period/population at risk in the
same time period
Causality
Strengths of Association
Consistency
Temporality
Plausibility
Biological Gradient
Case Studies
In-depth analysis of individual or group, often first clue to a
problem
Cohort Studies
(Longitudinal Studies) Monitor over time to find
associations between risk factors and health;
Minimize selection bias;
Relative risk is the ratio of disease incidence in an exposed
population;
Indicates strength of exposure to illness causality
Case Control
Compare group with health problems (cases) to group
without (control)
Key Informants
Persons knowledgeable about specific aspects of a problem
and the communities current and past attempts to address
it
Stakeholders
An individual, organizational, or group that has interest
(stake) in a specific community health issue or the outcome
of a community level intervention
Gantt Chart
Visual of the sequence of steps to achieve objectives;
Developed in planning stages to identify steps, a tool for
scheduling tasks, monitor progress
Community of Interest
People and groups/aggregate that will be affected by
change; Those that will help bring about change
Sustainability
How to maintain change, support system in place
Social Justice
Health care is a risk; Address root cause of illness
Health Equities
Requires elimination of health disparities in living and
working conditions
SMART objectives
S- Specific
M- Measurable
A- Achievable
R- Relevant
T- Time
Coalition Building
Community members participate in planning and
implementing changes at the community level; Need clear
mission, goals, objectives, expectations, leadership,
accountability, and should be heterogenous
Community Readiness
Web of Causation
Identify multiple factors that contribute to chronic disease
Levers of Change
Increase driving/reinforcing forces
Decrease restraining/resisting forces
Geopolitical Population
Has identified designated boundaries with the same
governing structure
Phenomenological Population
Group with common interests or beliefs who have
interpersonal and intrapersonal connection
Community of Solution
Formed by aggregate to address a health problem
In 1988 the Institute of Medicine (IOM) published a report
on the future of public health and its mission that defined
public health:
What society does collectively to ensure the conditons in
which people can be healthy.
Community-oriented care.
T/F
Primary health care is the chief means of delivery of
health care in the United States.
False
External evidence:
Includes research and other evidence
Internal evidence:
Includes the nurse's clinical experiences and client's
preferences.
care workforce.
- Use EBP to evaluate effectiveness, accessibility and
quality of personal and population-based services.
POEM
"Patient oriented evidence that matters." Proposed by
Shaughnessy, Slawson and Bennett (1994), criteria for
evaluating the usefulness of evidence. In general, the
reader should ask "What are the results? Are they
important? Are the results valid? How can the results be
applied to client care?"
Systematic review:
A method of indentifying, apparaising and synthesizing
research evidence. The aim is to evaluate and interpret all
available research that is relevant to a particular research
question. Is usually done by more than one person and
describes the methods used to search for and evaluate the
evidence.
Meta-analysis:
"A specific method of statistical synthesis used in some
systematic reviews, where the results from several studies
are quantitatively combined and summarized.
Integrative review:
A form of a systematic review that does not have the
summary statistic found in the meta-analysis because of
the limitations of the studies that are reviewed (e.g small
sample size of the population)
Narrative review:
A review is done on published papers that support the
reviewer's particular point of view or opinion and is used to
provide a general discussion of the topic reviewed. This
review does not often include an explicit or systematic
review process.
A "paradigm shift"
A change from old ways of knowing to new ways of
knowing and practicing.
4 Ways of Knowing
Empirical knowledge, personal knowledge, aesthetic
knowledge, and ethical knowledge.
Empirical knowledge
The science of nursing
Aesthetic knowledge
The art of nursing
Personal knowledge
interpersonal relationships and caring
Ethical knowledge
Moral and ethical codes of conduct usually established by
professional organizations.
Nightingale's vision
Trained nurses and a model of nursing education
influencing the development of professional nursing, and
indirectly, public health nursing in the United States.
Inspired by the poorly educated, untrained and often
unreliable healthcare workers of the time.
District nursing
The Kaiserwerth Lutheran deaconesses incorporated care
of the sick in the hospital with client care in their homes.
William Rathbone
Nightingale's contemporary and friend, British
philanthropist. Founded the first district nursing
association.
Visiting Nurses:
Became the key to communicating the prevention
campaign, through home visits and well-baby clinics.
Visitng nurses emphasized education of family members in
the care of the sick and in personal and environmental
prevention measures such as hygiene and nutrition.
Settlement Houses
Neighborhood centers that became hubs for health care,
education and social welfare programs.
Lillian Wald
Established leader of public health nursing during it's early
decades. Known as the First Public Health Nurse in the US.
She persuaded the American Red Cross to sponsor rural
health nursing services across the country. Beginning in
1909, Walkd worked with Dr. Lee Frankel of MetLife to
implement the first insurance payment for nursing services.
She convinced business owners that keeping working
people and their families health increased productivity.
Lina Rogers
A Henry Street Settlement resident that became the first
school nurse, worked with children in New York City schools
Frances Root
The first trained nurse in the United States, who was
salaried as a visiting nurse.
Typologies
List of types, which involve classifying communities by
category rather than single definitions.
"Communities of place"
In this type of community, interactions occur within a
specific geographic area. Neighborhood and face-to-face
communities are two examples of this type of community.
Aggregate:
A collection of individuals who have in common one or
more personal or environmental characteristics.
Population-centered practice:
seeks healthful change for the whole community's
benefit.Although the nurse may work with individuals,
families or other interacting groups, aggregates, or
institutions or within a population, the resulting changes
are intended to affect the whole community.
9. Social support
10. Leadership development
Data gathering:
the process of obtaining existing, readily available data.
Data Generation
Informant interviews
i.e focus groups, directed talks with selected members of a
community about community members or groups and
events
Participant observation
The deliberate sharing in the life of a community
Four methods of generating direct data:
Informant Interview, focus groups, participant observation
and windshield studies
Informant interviews
i.e focus groups, directed talks with selected members of a
community about community members or groups and
events
Participant observation
The deliberate sharing in the life of a community
Community
A collection of people who interact with one another and
common interest forms a unity
Geographic community
A group of people usually defined by geographic
boundaries
community of solution
a group of people who come together to solve one problem
- shape and size may vary depending on problem
aggregate
a mass of individuals who are considered as a whole but
are loosely connected
population
all people occupying an area or may also refer to people
who share one or more characteristics
health
a holistic state of well-being including a soundness of mind,
body, spirit
levels of Prevention
Primary example immunization
Secondary example breast screening with mammography
Tertiary example diabetes education after diagnosis
Florence Nightingale
Author of modern day nursing
Lillian Wald
Margaret Sanger
a nurse who openly opposed the Cromstock act, arrested;
her defiance lead to International Planned Parenthood
Federation
cultural sensitivity
recognizing that culturally based values, beliefs, and
practices influence people health's and lifestyles and
should be considered in plans for service
epidemiological triad
host
agent
environment
chain of causation
begins by identifying the reservoir, then portal of exit, then
the agent, then the portal of entry - all set by the
environment
immunity
ability to resist particular infectious disease causing agent active, passive, cross-immunity
herd immunity
risk
the probability that a disease or health problem will occur
census data
data taken from the population - in the US every 10 years
reportable diseases
requirements to report certain diseases to local health
authority
descriptive epidemiology
observe or describe a pattern of disease in a population
rates
statistical measures expressing proportion of people with a
given health problem among a population at risk
prevalence
at a given point of time all the people with a particular
health condition
prevalence rate
number of people with characteristic/total population
incidence
all new cases of disease or health condition within a period
of time
incidence rate
number of new cases of disease or health condition/total
number at risk for developing disease. Note: once a person
has the disease/condition and there is not the possibility of
getting the disease/condition again then the risk is not
there and that number is subjected from the total
population.
mortality rate
sum of deaths in given population at a given time
analytic epidemiology
beyond simple description, seeks to determine associations
DOT
direct observed therapy - client takes the medication in the
presence of health care worker
quarantine
period of forced isolation of a person exposed to
communicable disease during the incubation period to
prevent the spread of the disease
ecological perspective
total relationship or patterns of relationship among people
and environment
built environment
structures built by humans within the environment - can be
used positively or negatively - urban vs rural
epidemic
disease occurring that exceeds the normal or expected
frequency in a community
pandemic
worldwide distribution of disease
endemic
naturally occurring in population
communication
transferring meaning and enhancing understanding
health literacy
the ability to read, write, understand, and act upon health
information
collaboration
purposeful exchange between nurses, clients, health
professionals with shared values, mutual participation, and
joint effort
contracting
negotiating a working agreement between two or more
parties with shared understanding and mutual consent over
a period of time.
health promotion
behavior motivated by a desire to increase well-being and
actualize human potential (Pender, Murdough, & Parsons,
2006)
social marketing
influencing behavior in targeted audiences
social justice
advocacy
pleading a case for another or championing a cause
Community
Group of people sharing something, interacting with one
another. May exhibit commitment with one another and
may share geographic boundary. E.g., a NORC, a school,
NYU students.
Population
Group of people having at least one thing in common and
who may or may not interact with one another. E.g., nightshift workers, children with CF.
Community-focused nursing
Delivery of nursing care to improve health of an entire
community - bigger picture, deals with prevention and
population at systems level.
Population-focused care
Interventions for a defined "at risk" population (e.g. people
with hypertension, weight problems)
Acute Care
Provider control
Predictable routine
Hospital policy
Resources available
Collaboration and consultation
Controlled PT compliance
Standardized care
Health
"extent to which an individual or group is able on the one
hand, to realize aspirations and satisfy needs; and on the
other hand, to change or cope with the environment." WHO
Levels of Care
Individual - downstream
Family
Community
Population - upstream
Levels of Prevention
Primary
Secondary
Tertiary
Primary Prevention
PREVENTION
Stay well and avoid problem
Reduction of risk factors before occurrence of disease
condition/injury
E.g., exercise, brushing teeth, condoms, immunizations,
nutrition.
Secondary Prevention
PREVENTION/MAINTENANCE
SCREENINGS/EARLY DX
Early detection of potential for disease/condition or
existence of such while asymptomatic.
E.g., screening programs - Pap smears, mammograms,
colonoscopy.
Tertiary Prevention
RESTORATIVE
Treatment of existing or symptomatic disease to
prevent/delay progress.
Treatment after Dx, e.g, cardiac/stroke rehab.
Assurance
Ensuring healthy populations
Appropriate and accessible services for all
Healthful physical environment
Stable ecosystem
Strong, supportive, non exploitive membership
Extensive participation in decision making
Members' basic needs provided for.
Access to resources and opportunities for interaction
Sustainable vital economy
Maintain connectedness with cultural and biological
heritages
Provide governance structures that promote health.
ADPIE:
Assessment
Diagnosis (written in different format for the community)
Planning
Implementation
Evaluation
Community Assessment
Population assessment
Primary informants
Gaining entry (Kauffman's 5 phases)
Collecting data
IOSFCW
7 methods
Informant interviews
Observation
Secondary analysis of existing data
Focus groups
Community forums
Windshield surveys
Community Diagnosis
Risk of X
Among X group/population
Implementation Phase
Action phase
Role of community health nurse
Social change, community action
Evaluation
formative - changes made during process
summative - at end, related to outcomes
Health education
"The pedagogy of the oppressed"
Community empowerment (WHO)
Community as partner model (Betty Neuman)
Community as Partner
Community core
8 interacting community subsystems
Community stressors/boundaries
Normal line of defense LOD = status quo
Flexible line of defense - protection vs stressors
Lines of resistance LOR - strengths, resources, coping
mechanisms
Health Education
Planned learning experiences based on sound theories to
provide individuals, groups, communities opportunity to
learn info and skills to make quality health decisions
Marine Hospital
Established by Congress
Facility became the Public Health Service
Florence Nightingale
Established a training school for nurses, Established
sanitary nursing care units. Founder of modern nursing.
began professional education of nursing.
Clara Barton
Established The Red Cross, Launched the American Red
Cross in 1881. An "angel" in the Civil War, she treated the
wounded in the field.
Lillian Wald
Mary Breckinridge
Founder of the Frontier Nursing Service, in Leslie County,
KY; 1st midwifery program in U.S.
Sheppard-Towner Act
U.S. Act of Congress providing federal funding for maternity
and child care, a response to the lack of adequate medical
care for women and children
Community-Oriented Nursing
Client: Community
Focus: Health of community as a "whole"
Community-Based Nursing
Client: Individual, family, or groups
Focus: Individuals, families, and groups within the
community
Epidemiological Triangle
Host - Agent - Environment and (Vector)
Infant Mortality
# infants (< 1 yr.) specific year / # live births in the same
year
Attack Rate
# people developing a certain disease / # people at risk
Better nutrition, water, antibiotics, immunizations. PUBLIC
HEALTH.
Life Expectancy - U.S.
What factors/events resulted in the 21+ additional years of
life from 1900-1950???
What factors/events resulted in the 7 additional years of
life from 1950-1990?
1. Upstream
2. Downstream
There are two views of the health care picture
We need to question the way we have thought of health
and health care...
Should we focus on treatment of illness or prevention of
disease in the first place?
How should we act?
______ or ______
1. Microscopic
2. Medical Model
3. Downstream
_______ approach to solving community health problems
(the _____ or _____):
- Individual (family) response to health and illness
- Emphasizes behavioral responses to illness or lifestyle
patterns
- Nursing interventions aimed at the individual
------Changing lifestyles
------Changing perceptions or belief system
- The individual is the locus of change
- Focuses on the "cure"
1. Macroscopic
2. Public Health
3. Upstream
______ approach to solving community health problems
(______ or _______)
- Interfamily and intercommunity themes
- Emphasizes social, economic, and environmental
precursors of illness
- Nursing interventions may include modifying social or
environmental variables
- May involve social or political action
- society (social system) is the locus of change
- focuses on "prevention"
1.
2.
3.
4.
5.
6. Cues to action
7. Self-efficacy
_________:
- focuses on a person's perceptions of a threat or a health
problems and related appraisal of a recommended
behavior to elicit change
- developed in the 1950s and was one of the first models
using concepts and assumptions from behavioral sciences
to examine health behaviors
------- Addresses attitudes and beliefs of individuals
------- Focus was on increasing the use of preventive health
services
- Primary assumptions of the model are that people fear
disease and that health actions are motivated based on the
extent of the fear and belief in benefits obtained by
preventative action
- Five (Six?) Primary Constructs:
1.
2.
3.
4.
5.
6.
1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
Transtheoretical Model (Stages of Change):
1. _______: No intention to change behavior in the next 6
months
------May be lack of information about consequences or
previous failure.
2. _______: Individual intends to change behavior in the next
6 months.
------Weighs pros and cons
3. _______: Individual intends to act within the next month
and has taken steps toward change
------Has a plan of action
4. _______: Individual has changed behavior for less than 6
months
------Change is sufficient to reduce disease risk.
5. _______: Individual has changed behavior for more than 6
months.
------Tries to prevent relapse
------Phase may last months to years
1. Smoking cessation
2. Injury prevention
3. RNs assisting families obtain health insurance
Examples for applying Transtheoretical Model in nursing:
1.
2.
3.
1. Health Disparities
2. Health and social justice
Examples of applying critical social theory:
1.
2.
1. Purposeful actions
2. Processes
3. Responses
4. Behaviors
Definitions of Health:
Health consists of:
_____, ______, _____, or _____ that leads to: "soundness,"
"wholeness," or "well-being"
1. Physical Environment
2. Social Environment
3. Individual Behavior
4. Biology & Genetics
5. Health Services
6. Policy making
Determinants of Health:
Health Outcomes due to:
1.
2.
3.
4.
5.
6.
Physical Environment
Determinants of Health - Examples of ______ factors:
- Natural environment (ie plants, weather, climate change)
- Worksites, schools and recreational settings
- Housing, homes, neighborhoods
- Exposure to toxic substances
- Physical barriers
- Aesthetic elements (ie good lighting, trees, parks)
Social Factors
Determinants of Health - Examples of ______ factors:
- Availability of resources (ie educational and job
opportunities, living wages, healthful foods)
- Social norms and attitudes
- Exposure to crime and violence
- Social interactions
- Exposure to emerging technology (ie the Internet)
- Transportation options
Individual Behaviors
Determinants of Health - Examples of ______ factors:
- Diet
- Physical activity
- Alcohol, tobacco and other drug use
- Sexual behavior
- Hand washing
Health Service
Determinants of Health - Examples of ______ factors:
- Barriers (lack of availability, high cost, lack of insurance,
language issues)
------- Unmet health needs
------- Delays in receiving care
------- Inability to get preventive services
------- Preventable hospitalizations
Policy Making
1. Life expectancy
2. Health life expectancy
3. Years of potential life lost
4. Physically and mentally unhealthy days
5. Self-assessed health status
6. Limitation of activity
7. Chronic Disease Prevalence
Indicators of General Health Status:
1.
2.
3.
4.
5.
6.
7.
Community
___________:
- It can be a physical place or a geopolitical community.
- Has boundaries
- It can be a relational, interactive group. - A community
with no physical boundaries. A phenomenological
community is abstract. Churches, universities, online
groups are examples
Community
__________:
"A collection of people who interact with one another and
whose common interests or characteristics form the basis
for a sense of unity or belonging." (Nies and McEwen,
2011)
Community
__________:
"A group of people who share something in common and
interact with one another, who may exhibit a commitment
to one another and may share a geographic boundary."
1. People
2. They must interact with each other in some way
3. Something in common: an interest, a geographical
location, a commitment
A community has to have:
1.
2.
3.
1. Primary Prevention
2. Secondary Prevention
3. Tertiary Prevention
Levels of Prevention:
1.
2.
3.
Primary Prevention
_______ level of prevention
- activities preventing a problem before it occurs
- Health promotion
- Specific protection
- Immunizations
Secondary Prevention
________ level of prevention
- Early detection and prompt intervention
- Screening
- Early referral for treatment
- Screening for STDs
Tertiary Prevention
_______ level of prevention
- Focus on limitation of disability and rehabilitation
- Prevention progression of disease
- Reduce the effects of the disease
- Teaching insulin administration
Community-based nursing
___________:
o Nursing of individuals and families to improve their
health
o Goals: Help them manage illness while they move among
health care settings
o Promote self-care and rehabilitation; prevent disease
o Processes: NP; diagnosis and treatment
2.
3.
4.
5.
6.
Clinical Nursing
_________:
o Goal: improve the health of patients
o Clients: Patients of the health care system
o Processes used: nursing process, treatment and patient
care procedures
o Settings: inpatient
1.
2.
3.
4.
5.
6.
Surveillance
Disease and other health event investigation
Outreach
Screening
Case finding
Referral and Follow-up
7. Case management
8. Delegated functions
9. Health Teaching
10. Counseling
11. Consultation
12. Collaboration
13. Coalition Building
14. Community Organizing
15. Advocacy
16. Social Marketing
17. Policy and enforcement
Public Health Interventions:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
12.
13.
14.
15.
16.
17
Surveillance
Describes and monitors health events through ongoing and
systematic collection, analysis and interpretation of health
data for the purpose of planning, implementing and
evaluating public health interventions
Outreach
Locates populations of interest or populations at risk and
provides information about the nature of the concern, what
can be done about it, and how services can be obtained
Screening
Identifies individuals with unrecognized health risk factors
or asymptomatic disease conditions in populations
Case finding
Locates individuals and families with identified risk factors
and connects them with resources
Case Management
Optimizes self-care capabilities of individuals and families
and the capacity of systems and communities to coordinate
and provide services
Delegated Functions
Direct care tasks a registered professional nurse carriers
out under the authority of a health care practitioner as
allowed by law
Health Teaching
Communicates facts, ideas, and skills that change
knowledge, attitudes, values, beliefs, behaviors, and
practices of individuals, families, systems, and/or
communities
Counseling
Establishes an interpersonal relationship intended to
increase or enhance capacity for self-care and coping with
a community, system, and family or individual
Consultation
Seeks information and generates optional solutions to
perceived problems or issues through interactive problem
solving with a community, system, and family or individual
Collaboration
Commits two or more persons or organization to achieve a
common goal through enhancing the capacity of one or
more of the members to promote and protect health
Coalition Building
Promotes and develops alliances among organizations or
constituencies for a common purpose
Community Organizing
Helps community groups to identify common problems or
goals, mobilize resources, and develop and implement
strategies for reaching the goals they collectively have set
Advocacy
Plead someone's cause or act on someone's behalf, with a
focus on developing the community, system, and individual
or family's capacity to plead their own cause or act on their
own behalf
Social Marketing
Utilizes commercial marketing principles and technologies
for programs designed to influence the knowledge,
attitudes, values, beliefs, behaviors, and practices of the
population of interest
John Snow
_______: Father of epidemiology
1. Pasteur
2. Lister
3. Koch
____, _____, _____: On "germs" and disease causation (late
1800s)
1. Edward Jenner
2. Edwick Chadwick
History of Public Health Nursing:
Pre 1850: Home visiting to sick as an act of charity.
- ______ observed people who worked around cattle were
less likely to have smallpox.
1. John Snow
2. Florence Nightingale
3. Pasteur, Lister, Koch
4. Lilian Wald
5. Mary Brewster
History of Public Health Nursing:
1850-1900: Home visiting to sick
- _______ demonstrated that cholera was transmissible
through contaminated water.
-________ - credited with establishing "modern nursing."
- ________: On "germs" and disease causation (late 1800s)
- In 1893, nurses _______ ("mother of community nursing")
and _______ established a district nursing service on the
lower east side of New York City called The House on Henry
Street.
1. 1900-1960s
History of Public Health Nursing:
________:
- Nursing in community centers for the poor
- Communicable disease control
- Communicable disease control/immunization
- Rise in PHN, home visits, school and OH nursing
1. 1960-1980
History of Public Health Nursing:
________: Care provided in public health clinics
1. 1980s-present
History of Public Health Nursing:
_________:
- Health promotion and education
- Health care access improvement
1. Poverty
2. Violence
3. HIV/AIDS
4. TB
5. Bioterrorism
Public/Community Health Nursing Today in U.S.
- Concerned with contemporary problems such as _____,
______, ______, _______, and _______.
- Practice is everywhere in public health agencies, schools,
occupational settings, community-based agencies, etc.
Healthy People
__________:
- provides science-based, 10-year national objectives for
improving the health of all Americans. For 3 decades, this
has established benchmarks and monitored progress over
time in order to:
o Encourage collaborations across communities and
sectors.
o Empower individuals toward making informed health
decisions.
o Measure the impact of prevention activities.
- Vision: A society in which all people live long, healthy lives
Community
Group of people and institutions that share geographic,
civic, and/or social parameters
Community-Based Nursing
Focus of Care (FOC):
Individuals, families
Nursing Activities (NA):
Illness care: Management of acute and chronic conditions
in settings where individuals, families, and groups live,
work, and "attend" (schools, camps, prisons)
Community-Oriented Nursing
FOC:
At-risk individuals, families, and groups
Community
NA:
Health care: Determining health needs of a community,
and intervening at the individual, family, and group level to
improve the collective health of the community
Ethical Considerations
The Public Health Code of Ethics identifies the ethical
practice of public health.
Preventing harm
doing no harm
promoting good,
respecting both the individual and community rights
respecting autonomy and diversity
providing confidentiality
competency
trustworthiness
advocacy
Advocacy
Epidemiology
Study of health-related trends in populations for the
purpose of disease prevention, health maintenance, and
health protection
Relies on statistical evidence to determine the rate of
spread of disease and the proportion of people affected.
Used to evaluate the effectiveness of disease prevention
and health promotion activities and to determine the
extent to which goals have been met.
Provides broad understanding of the spread, transmission,
and incidence of disease and injury. This information is an
important component of community assessment and
program planning.
Involves the study of the relationships among an agent, a
host, and an environment (referred to as the
epidemiological traingle).
Epidemiological triangle
The Agent is the animate or inanimate object that causes
the disease.
Chemical Agents: Drugs, Toxins
Physical Agents: Noise, Temperature
Infectious Agents: Viruses, Bacteria
The host is the living being that is affected by the agent.
Susceptible Host: Age, Gender, Genetics, Ethnicity,
Immunological status, Physiological state, Occupation
The environment is the setting or surrounding that sustains
the host.
Physical Environment: Geography, Water/food supply,
Presence of reservoirs/vectors
Social Environment: Access to health care, High-risk
working conditions, Poverty
Epidemiological Calculations
Incidence: number of new cases in the population at a
specific time/population total X 1,000 = per 1,000
Prevalence: number of existing cases in the population at a
specific time/ population total X 1,000 = per 1,000
Crude Mortality Rate: Number of deaths/population total X
1,000 = per 1,000
Infant Mortality Rate: Number of infant deaths before 1
year of age in a year/numbers of live births in the same
year X 1,000 = per 1,000
Attack Rate: Number of people exposed to a specific agent
who develops the disease/total number of people exposed
Epidemic
When the rate of disease exceeds the usual level of the
condition in a defined population.
Disease Prevention
Levels Of Prevention Focus
Primary Prevention: Prevention of the initial occurrence of
disease injury
Nutrition education
Family planning and sex education
Smoking cessation education
Communicable disease education
Education about health and hygiene issues to specific
groups (day care workers, restaurant workers)
Safety education (seat belt use, helmet use)
Prenatal classes
Providing immunizations
Advocating for access to health care, healthy environments
Disease Prevention
Levels Of Prevention Focus
Secondary Prevention: Early detection and treatment of
disease with the goal of limiting severity and adverse
effects
Community assessments
Disease surveillance (communicable diseases)
Screenings
*Cancer (breast, cervical, testicular, prostate, colorectal)
*Diabetes mellitus
*Hypertension
*Hypercholesterolemia
*Sensory impairments
*Tuberculosis
*Lead exposure
*Genetic disorders/metabolic deficiencies in newborns
Control of outbreaks of communicable diseases
Disease Prevention
Levels Of Prevention Focus
Tertiary Prevention: Maximization of recovery after an
injury or illness (rehabilitation)
Nutrition counseling
Exercise rehabilitation
Case management (chronic illness, mental illness)
Physical and occupational therapy
Support groups
Exercise for hypertensive clients (individual)
Community
Group of people sharing something, interacting with one
another. May exhibit commitment with one another and
may share geographic boundary. E.g., a NORC, a school,
NYU students.
Population
Group of people having at least one thing in common and
who may or may not interact with one another. E.g., nightshift workers, children with CF.
Community-focused nursing
Delivery of nursing care to improve health of an entire
community - bigger picture, deals with prevention and
population at systems level.
Community-based nursing
Nursing care provided outside of acute care setting. Care
for families, individuals within a community. At individual,
"hands on" level. Does not require public health
background.
Population-focused care
Interventions for health promotion, disease prevention to
shape a community's overall health status.
Acute Care
Provider control
Predictable routine
Hospital policy
Resources available
Collaboration and consultation
Controlled PT compliance
Standardized care
Health
"extent to which an individual or group is able on the one
hand, to realize aspirations and satisfy needs; and on the
other hand, to change or cope with the environment." WHO
Eudaimonistic Model
HOLISTIC
UPSTREAM
Greek origins. R/t Maslow's hierarchy of needs.
MOST HOLISTIC
Health = actualization/realization of complete fulfillment
and development. Illness impedes/prevents selfactualization.
Aim to redirect thinking away from mechanistic view
toward holistic view.
HOLISM, UNITY, INDIVIDUALITY
Adaptive Model
ABLE TO ADAPT
Medicine beyond treatment of disease: from writings of
Dubos.
Health means ability to adapt to a changing environment.
Disease is failure to adapt.
How flexible is someone in a changing environment?
Role-performance Model
ABLE TO DO JOB
Medical sociology, work of Parsons.
Person is healthy if they can perform their job.
Shapes health policies of military, industry.
Limited since one person may have many roles.
Clinical Model
MOST LIMITING
DOWNSTREAM
Health extreme = absence of S/S of disease/disability as
IDed by medical science
This model = downstream pattern of thinking rather than
upstream which is holistic.
Levels of Care
Individual - downstream
Family
Community
Population - upstream
Levels of Prevention
Primary
Secondary
Tertiary
Primary Prevention
PREVENTION
Stay well and avoid problem
Reduction of risk factors before occurrence of disease
condition/injury
E.g., exercise, brushing teeth, condoms, immunizations,
nutrition.
Secondary Prevention
PREVENTION/MAINTENANCE
SCREENINGS/EARLY DX
Early detection of potential for disease/condition or
existence of such while asymptomatic.
E.g., screening programs - Pap smears, mammograms,
colonoscopy.
Tertiary Prevention
RESTORATIVE
Treatment of existing or symptomatic disease to
prevent/delay progress.
Treatment after Dx, e.g, cardiac/stroke rehab.
Assurance
Ensuring healthy populations
Appropriate and accessible services for all
Healthful physical environment
Stable ecosystem
Strong, supportive, non exploitive membership
Extensive participation in decision making
Members' basic needs provided for.
Access to resources and opportunities for interaction
Sustainable vital economy
Maintain connectedness with cultural and biological
heritages
Provide governance structures that promote health.
Community Assessment
Population assessment
Primary informants
Gaining entry (Kauffman's 5 phases)
Collecting data
IOSFCW
7 methods
Informant interviews
Observation
Secondary analysis of existing data
Focus groups
Community forums
Windshield surveys
Community Diagnosis
Risk of X
Among X group/population
Implementation Phase
Action phase
Role of community health nurse
Social change, community action
Evaluation
formative - changes made during process
summative - at end, related to outcomes
Health education
"The pedagogy of the oppressed"
Community empowerment (WHO)
Community as partner model (Betty Neuman)
Community as Partner
Community core
8 interacting community subsystems
Community stressors/boundaries
Normal line of defense LOD = status quo
Flexible line of defense - protection vs stressors
Lines of resistance LOR - strengths, resources, coping
mechanisms
Health Education
Planned learning experiences based on sound theories to
provide individuals, groups, communities opportunity to
learn info and skills to make quality health decisions
Facilitate learning
Stimulate senses
Active learning
Comfortable
Learner's readiness?
Relevant information
Repetition
Learning should be positive
Start simple, go to complex
Generalize and pace appropriately
Transtheoretical Model
Most common learning theory
Stages of Change
Precontemplation - resistance; don't see problem
Contemplation - know there's a problem and thinking about
it
Preparation - decision making; prepared for action, e.g.,
cutting down on cigarettes.
Action - modifies behavior/environment to overcome
problem. Takes lots of time and energy. W/D S/S now.
Maintenance - constant work to avoid relapse.
Nature of learning
CAP = B F D
Cognitive Domain
Affective Domain
Psychomotor Domain
Cognitive Domain
BRAIN
memory, recognition, understanding, application, problem
solving.
Affective Domain
FEELINGS
attitudes, values:appreciates, chooses, accepts - role play,
talk to s.o., feelings.
Psychomotor Domain
DEMONSTRATE
Hands on manipulation, "teach back"
performance of skills requiring coordination and motor
skills.
Educational objectives
Cognitive
Affective
Psychomotor
Community Health Nursing:
-Is it broad or specific?
-Wide variety of settings or limited?
-Do they promote health and welfare of pts?
-Specific age groups?
-Diverse populations or specific cultures?
-Nurses working in the community should have an
understanding of what 3 things?
Community Health Nursing:
-broad
-wide variety of settings
-allows nurses to practice in wide variety of settings
-Promote health and welfare of clients
-across the lifespan
-Nurses working in the community should understand the
foundations of CHN, the principles of CHN, and health
promo and disease prevention
-What is a community?
-Do communities vary in their characteristics and health
needs?
-What is a community's health determined by?
-Community- group of people and institutions that share
geographic, civic, and/or social parameters.
-Communities vary in the characteristics and health needs.
Community-oriented nursing:
-Who is the focus of care?
-What are the nursing activities?
-Focus of care: at risk individuals, family, groups as well as
community.
-Nursing activities are r/t health care: determining health
needs of a community, and intervening at the individual,
family, and group level to improve the collective health of
the community.
Autonomy:
-Definition
-Situation
Nonmaleficence:
-Definition
-Situation
-No harm is done with applying standards of care.
-Developing plans of care that include a system for
monitoring and evaluation outcomes.
Beneficence:
-Definition
-Situation
-Maximize possible benefits and minimize possible harms.
-Assessing risks and benefits when planning interventions.
Distributive justice:
-Definition
-Situation
-Fair distribution of the benefits and burden in society is
based on the needs and contributions of its members.
-Determining eligibility for health care services based on
income and fiscal resources.
What is epidemiology?
The study of health-related trends in populations for the
purpose of disease prevention, health maintenance, and
health protection.
Epidemiological triangle:
What are the 3 components?
Agent, host, environment
What is an epidemic?
The rate of disease exceeds the usual level of the condition
in a defined population
learning need.
3) Select aspects of learning theories to use in the
educational program based on the identified learning
need.
4) Identify barriers to learning, and learning styles.
5) Design the education program.
6) Implement the education program. Ensure an
environment that is conducive to learning
7) Evaluate the achievement of learning objectives and the
effectiveness of instruction.
B. Fidelity
C. Respect for autonomy
D. Veracity
Answer: A
A: Correct- distributive justice is fair distribution of benefits
and burden in society
B: Incorrect. Fidelity involves keeping commitments and
following through with promises.
C: Incorrect. Autonomy is supporting the rights of
individuals to determine and pursue personal HC goals.
D: Incorrect. Veracity is the concept of telling the truth.
Boston Dispensary
1796
1st home care program in US
1886
1st visiting nurse service in US
Philadelphia
1893
visiting nurse service
for the poor
NYC
Nurses Settlement House on Henry Street
Licensure by state
gives legal permission to operate w/i state only
Certification by state
Certificate of need
some states grant according to rules and formulas that
state regulator devise
Restorative
return to previous level of function as appropriate/ realistic
Improvement
achieving better health and highter level of function than at
admission
maintenance
preserving functional capacities and independence by
maintaining current level of health
Promotion
teaching healthy lifestyles that keep the effect of illness or
disaibility to a minimum and prevent the recurrence of
illness
1.
2.
3.
4.
5.
technically proficiency
self motivated
independent decision maker
respond prompltly to problems
able to adapt to family/patient/ home enviroment
physical therapy
licensed / qualified physical therapist is required, PT
assistant
goals: restorative and maintanance
rehab plan taught to patient/ family to promote self care
Occupational therapist
Referral
Admission
RN makes the initial eval and admission vist within 24-48
hours of the referreal
1. evaluation
2. enviromental assess.
3. i.d. of impairments
4. i.d. of impact of disease/ disability
5. assess support system
6. determine knowledge/adherence of treatment/ meds
7. involvment of patient/ fam in care plan
8. determin desire for care/ services
9. notify patient of rights
10. explain rights of self determination
11. initial nursing interventions (every 60 days)
Care Plan
from physician
-describes current physical status, meds, treatments,
disciplines, duration, goals, outcomes, time frame
Visits
to serve / meet patients- centered goals
Documentation
concise and complete doc. to provide accurate info of type
and quality of care
linked to legal implications
Discharge planning
done by case manager
begins with admission and ends when
patient goals or other specific criteria are met
Structural Criteria
agencies overall practices
Process criteria
eval of care delivery
Outcome criteria
Measurement of change
Medicare
agency required to be certified
meet federal conditions of :
organization
staffing
training
services covered
agency eval
65 OR OLDER, DISABLED, END STAGE RENAL DISEASE
Medicaid
pays for home care services for LOW INCOME PPL OF ALL
AGES
state administers, federal subsidized
Third Party
pay for limited home care services
payment rates vary
posthospitalization recoveries tied to reimbursment
Private Pay
directly pay for home health services
charges range
HMOs
prefered provider organization
prepaid
based on prevention
PPOs
negotiated contracts with home health agencies
NURSING PROCESS
assessment
analysis/ nursing diagnosis
planning
implementing
evaluation
Take aways
- current trends support growth of home care as an
economic, humane, preferred health delivery system
-medical management and control rather than cure are the
standards of care for illness
-home care provides assessment and eval of chronic
illnesses and is helpful for preventation in future
-aide and homemakers can provide necessary support in
ADLs to enable patient to remain @ home
-skilled nursing and therapy offer rehab and prevention of
deterioration, and methods to cope with physical changes
Long-Term care
defined by ANA as provison of physical, psychological,
spiritual, social, economic services to help ppl attain,
maintain, regain their optimum level of functioning
-range of services:
health maintenance care, to ppl who have lost ability to
function independantly due to chronic illness or condition
Patient-centered approach
achieve/ maintain an individualized plan of carre to assist
patient in preserving meaningful quality of life
quality of life
measure of optimum energy/ force that endows a person
with the power to cope successfully with full range of
challenges he or she encounters in the real world
Hospice
services to patients/families as end of life approaches.
available to any age-group
-maintain comfort as death approaches
pallative care
broader pop. having ability to benefit from comfort care
earlier in their illness or disease process.
provides care for
-basic needs (ADLs)
-ADLs
-pain and symptoms management
-spiritual/ psychosocial support
Adult DayCare
community-based programs to meet needs of functionally
or cognitibely impaired through supervised health and
social/ recreational activities
provide:
-physical care
-mental stimulation
-socialization
-assistance w/ maintanance
-health referrals
(during any part of the day, but for less than 24 hours)
Assisted Living
residential care
rental of small apartment
serveral personal care services:
-bathing, dressing, medications
(choice, autonomy, independance w/ supervision)
-communal dining and various social activities
HOME
least restrictive
INSTITUTIONAL
most restrictive
Institutional settings
1. subacute unit
2. long-term care facility
subacute unit
not limited by reimbursment
less expensive alt. to acute care when patient has high
acuity medical and nursing intervention needs
-bridge between acute care and long-term care
-located in free standing skilled nursing facilities
Medicare
federally funded national health insurance program in US
for ppl older than age 65
Functional Nursing
each has a function adn reports back to head nurse
Team nursing
all work together toward common goal
Utilization Guidelines
wealth of clinical info to assist in assessment and care
planning
nonmaleficience
no harm is done when applying standards of care
beneficience
maximize possible benefits and minimize possible harms
distributive justice
fair distribution of the benefits and burden in society based
on the needs and contributions of its members
epidemiology
investigative study of disease trends in populations for the
purposes of disease prevention and health maintenance,
relies on statistics
agent
animate or inanimate object that causes the disease (virus,
trauma, fumes)
host
the living being that will be affected by the agent
environment
setting or surrounding that sustains the host
incidence
number of new cases
prevalence
existing disease in population at a particular time
attack rate
number of people at risk who develop certain disease
epidemic
the rate of disease exceeds the usual level of the condition
behavioral theory
focus on changing behavior through the use of
reinforcement menthods
cognitive theory
focus on changing thought patters through sensory input
and repetition
critical theory
focus on increasing depth of knowledge through discussion
and inquiry
developmental theory
focus on human developmental stage with methods that
are age-specific and age appropriate with importance given
to "readiness to learn"
humanistic theory
focus on feelings and relationships, principle that learners
will do what is in their best interest
primary prevention
prevent occurrence, immunizations, classes
secondary prevention
early detection and treatment, screenings, treat STD
tertiary prevention
recovery after occurrence, rehab, shelter
airborne illnesses
measles, chickenpox, strep, TB, pneumonia, flu
foodborne illnesses
salmonella, Hep A, trich, E coli
change agent
advocate for needed change at the local, state, or federal
level
lobbyists
persuade or influence legislators
coalitions
facilitation of goal achievement through the collaboration
of two or more groups
public office
serving society and advocating for change by influencing
policy development through public service
culture
beliefs, values, and assumptions about life that are widely
held among a group of people and are transmitted across
generations
environmental health
influence of environmental conditions on the development
of disease or injury
acculturation
process of learning a new culture
cultural awareness
self awareness of one's own cultural background, biases,
and differences
cultural competence
knowing, appreciating, and considering the culture of
someone else in resolving problems
WHO
World health organization, provides daily information
regarding the occurrence of internationally important
diseases, establishes world standards for antibiotics and
vaccines, focus on health care workforce and education,
environment, sanitation, infectious diseases, maternal and
child health, and primary care
informant interviews
direct discussion with community members for the purpose
of obtaining ideas and opinions from key informants
community forum
open public meeting
secondary data
windshield survey
descriptive approach that assesses several community
components by driving through a community
focus groups
directed talk with a representative sample
surveys
specific questions asked in a written format
participant observation
observation of formal or informal community activities
A nurse manager at a community agency is developing
an orientation program for newly hired nurses. When
discussing the differences between community-based and
community-oriented nursing, the nurse should include
which of the following as examples of community-based
nursing? (Select all that apply.)
a. A home health nurse performing wound care for a
client who is immobile
b. An occupational health nurse providing classes on body
mechanics at a local industrial plant
c. A school nurse teaching a student who has asthma
about medications
d. A parish nurse teaching a class on low-sodium cooking
techniques
e. A mental health nurse discussing stress management
techniques with a support group
a, c
d. Biological variations
e. Views about illness
a, b, c, e
c, d, e
a.Assessment
b.Prevention
c.Assurance
d.Policy development
a. Assessment
characteristic
d.Geographical location within a community
c. Collection of individuals who share at least one common
characteristic
a. The mindset that the only role for the nurse is at the
bedside.
b. The structures within which nurses work and the process
of role socialization within those structures.
c. Few nurses receive graduate-level preparation in the
concepts and strategies of the disciplines basic to public
health.
Community-Based Nursing
Focus: Health of individuals, families, and groups within a
community.
Client: Individuals, family, or group of individuals
Activity: Provision of direct primary care in the settings
where individuals and families live, work, and "attend"
(schools, camps, parishes)
Social determinants
Impact whether someone is able to attain/maintain health;
(Income, social status, education, literacy, environment,
support networks, gender, culture, available health care)
Disparities
Gaps in care experienced by one population compared to
another
Florence Nightingale
Studied nursing in Germany then established nursing
schools in England
District Nursing
A mode of service delivery in which a community health
nurse is responsible for addressing all the health needs of a
given population
Lemuel Shattuck
First use of demographic data to look at population health
birth and death records
Dorthea Dix
Established first hospital for the mentally ill in the US
Clara Barton
Civil war nurse: Established the American Red Cross
(providing aid for natural disasters)
Lillian Wald
Found of public health nursing in the US; Founded the
Henry Street Settlement and Visiting Nurse Service which
provided nursing and social services and organized
educational and cultural activities. She is considered the
founder of public health nursing
Mary Breckenridge
Pioneer in nurse-midwifery; established the Frontier Nursing
Service - nurses traveled on horseback to reach mothers in
the hills of Kentucky
Nongovernment Agencies
Agencies that acquire resources from private sources to
assist others
Philanthropic Agencies
Organization that uses endowments or private funding to
address the needs of individuals, families, and populations
Health
A quality, an ability to adapt to change or a resource to
help cope with challenges and processes of daily living
Well Being
A subjective perception of full functional ability as a human
being
Learning Theory
Goal established and reinforced by nurse; Rewards given
for partial accomplishment
Epidemiology
Rate
Primary measurement used to describe either the
occurrance or the existence of a specific state of health or
illness
Outbreaks
Epidemic usually limited to a localized increase in the
incidence of the illness
John Graunt
Father of demographics. recognized importance of
recording birth and death rates and age structure of human
population
William Farr
Set up a system of data collection for causes of death in
difference occupations, gender, and imprisonment.
Importance of definition of illness and population
comparison, groups, and factors such as age, health, and
environment can affect statistics
John Snow
Used mapping and rates as an objective measure to
compare populations
Epidemiological Triad
Model based on the belief that health status is determined
by the interaction of the characteristics of the host, agent,
and environment
Wheel of Causation
Epidemiologic model that deemphasizes the agent as the
sole cause of disease while emphasizing the interplay of
physical, biological, and social environments
Web of Causation
Epidemioligcal model that strongly emphasizes the concept
of multiple causation while deemphasizing the role of
agents in explaining illness
Rate
Primary measure used to describe either the occurrence or
existence of a specific state of health or illness within a
group during a specific time frame
Ratio
Fraction that represents the relationship between two
numbers; Divide one quantity by another quantity
Ex: # boys in class/# girls in class
Proportion
Type of ration
Ex: # boys/ total students
Crude Rate
Measures the occurrence of the condition in the whole
population; May obscure info because it does not consider
factors such as age, race, gender
Numerator: Number of events
Denominator: Total population (not just those at risk)
Adjusted Rate
Controls for differences between populations-used for
comparison
Incidence
Measures probability that people without a condition will
develop the condition over time; measures pace of new
illness
Prevalence
Existence of a condition during a period/interval at a
specific point; Studies number of people diagnosed in the
past and length of illness; Longer length=greater the
prevalence-indicates burned of community
Mortality Rates
Crude mortality: probability of dying from any cause; #
deaths in a year/total population
Incidence Density
Used when unequal periods of observation for study
subjects; Accounts for people who die, drop out of a study,
or acquire an illness
Attributable Risk
The risk of a condition occurring in an exposed group that
is attributable to an exposure, not other factors
Sensitivity
Ability of the test to correctly identify people who have the
health problem
Specificity
Specific incidence and prevalence rates calculated based
on specific characteristics (demographic data), variations
based on location and variations in time (short-outbreak,
periodic- seasonal, long-years)
Incidence Rate
#new cases during time period/population at risk in the
same time period
Causality
Strengths of Association
Consistency
Temporality
Plausibility
Biological Gradient
Case Studies
Cohort Studies
(Longitudinal Studies) Monitor over time to find
associations between risk factors and health;
Minimize selection bias;
Relative risk is the ratio of disease incidence in an exposed
population;
Indicates strength of exposure to illness causality
Case Control
Compare group with health problems (cases) to group
without (control)
Key Informants
Persons knowledgeable about specific aspects of a problem
and the communities current and past attempts to address
it
Stakeholders
An individual, organizational, or group that has interest
(stake) in a specific community health issue or the outcome
of a community level intervention
Gantt Chart
Visual of the sequence of steps to achieve objectives;
Developed in planning stages to identify steps, a tool for
scheduling tasks, monitor progress
Community of Interest
People and groups/aggregate that will be affected by
change; Those that will help bring about change
Sustainability
How to maintain change, support system in place
Social Justice
Health care is a risk; Address root cause of illness
Health Equities
Requires elimination of health disparities in living and
working conditions
SMART objectives
S- Specific
M- Measurable
A- Achievable
R- Relevant
T- Time
Coalition Building
Community members participate in planning and
implementing changes at the community level; Need clear
mission, goals, objectives, expectations, leadership,
accountability, and should be heterogenous
Community Readiness
Assess readiness to undertake change process-issue
specific
Web of Causation
Identify multiple factors that contribute to chronic disease
Levers of Change
Increase driving/reinforcing forces
Decrease restraining/resisting forces
Geopolitical Population
Has identified designated boundaries with the same
governing structure
Phenomenological Population
Group with common interests or beliefs who have
interpersonal and intrapersonal connection
Community of Solution
Formed by aggregate to address a health problem
The factors, exposures, characteristics, and behaviors
that determine patterns of disease are described using:
a. Descriptive epidemiology
b. Analytic epidemiology
c. Distribution
d. Determinants
d. Determinants
b. Risk
c. Epidemiology
d. Epidemic
b. Risk
b. Age
c. Gender
d. Income
b. Age
a. Sensitivity
b. Specificity
c. Positive predictive value
d. Negative predictive value
c. Positive predictive value
geopolitical community
a type of community that is formed by human or natural
boundaries.
a specific area possessing geographic boundaries and
sharing the same governing structure.
*could also include people who work within the community
phenomenological community
a type of community that is formed because its members
have a common interest, experience or a feeling of
belonging.
boundaries are less well defined, members decide what is
meaningful to them
communities of solution
this type of community is formed by an aggregate
specifically to address health concerns within a particular
area. It is composed of persons not only from the area of
need but also members of neighboring communities with a
vested interest.
Community health
is a synthesis of the status (what do they look like),
structure (are there services to deal with the issues),
process (how effective are they- do they require outside
help?)
coalition
a group of consumers, health professionals, policy makers,
and others working together to improve community health
status or to solve a specific community health problem
stakeholder
an individual, organization, or group that has an interest in
a specific community health issue or the outcome of a
community-level intervention
key informant
person knowledgeable about specific aspects of a problem
and the communities current and past attempts to address
it
quantitative
numbers, statistical data
qualitative
perception, beliefs, values, attitudes, health concerns
data sources
statistics, surveys, key informants, libraries, telephone
books, drive-through, churches, school systems,
government offices, public safety depts., maps,
professional, business, voluntary and social organizations
assessment issues
gaining entrance/acceptance
trust
confidentiality
Health planning
problems identified, priorities selected, objectives set for
the development of community health programs based on
findings of community health assessments and health
surveillance data
SMART objectives
Specific
measurable
achievable
relevant
time bound
community-based nursing
-minor acute and chronic care that is comprehensive and
coordinated where people live, work or attend school
-illness care provided outside of acute care setting
-focus on "illness care"
-interacts 1 to 1
-levels of prevention : 2, 3
community-oriented nursing
-focus on "health care"
-Preserve, Promote, Protect
-interacts with groups and 1 to 1
-levels of prevention :1, 2, 3
-uses systematic processes to deliver care
levels of prevention
Primary- prevents disease
Secondary-controls outbreak
Tertiary-limits disability
primary prevention
promotes health
prevents occurrence of disease
(education, vaccinations)
secondary prevention
early diagnosis and interventions
contains/controls outbreak
(mammograms, hearing and vision screening, flu shots)
tertiary prevention
rehabilitation and limiting disability
(cardiac rehab, management of chronic conditions)
Florence Nightingale
formed a team of nurses that assisted soldiers during the
Crimean War and statistically documented her successes
saving lives through prevention of infections and improving
environmental conditions
-also she opened the first school of nursing
Lillian Wald
She was the founder of public health nursing
Founded the Henry street settlement house
Mary Breckinridge
Frontier Nursing- developed a system of rural healthcare in
remote regions.
Traveled on horseback
opened school for frontier nursing and midwifery
Clara Barton
Red Cross
Definition of health
maximal development- physical, social, emotional
positive interaction with physical environment
effective role performance
absence of disease
Primary prevention
maximizing health and wellness through strategies that are
set in place before illness or injury is present
Secondary prevention
maximizing health and wellness through strategies that are
set in place at the early and active chronic stages of
pathogenesis of illness and injury
-interventions designed to diagnose and treat illness early
and restore to health; includes screenings
Tertiary Prevention
maximizing health and wellness through strategies that are
set in place at the palliation and end-stage of disease and
injury trajectories
-rehabilitative/restorative; limites disability
motivational interviewing
client-centered communication style for eliciting behavior
change by helping clients and groups explore and resolve
ambivalence to change
primary prevention
use of seat belts, hand washing, proper preparation of food,
exercise, balanced nutrition, vaccinations
secondary prevention
women diagnosed with HIV/AIDS
student with scoliosis
microsystem influences
relationship between women and the environment
-relationship stage, intimacy, communication patterns
exosystem influences
formal and informal social structures
-socioeconomic and employment status, degree of social
isolation, social networks and supports, poverty
macrocultural influences
values and beliefs of culture
-social norms, attitudes about gender roles, race
theories of learning
behavioral
cognitive
humanistic
developmental
social learning
Domains of learning
-Affective
-Psychomotor
-Cognitive
follower
seeks and follows others direction/authority
gatekeeper
controls/limits outsiders access
ensures all members get an equal voice
leader
guides and directs
peacemaker/conflict manager
facilitate harmony and compromise
task specialists
b. Analytic epidemiology
c. Testicular self-examination
d. Family counseling
a. Rehabilitative job training
b. 100 cases
c. 500 cases
d. Unable to determine
d. Unable to determine
c. Community trial
d. Screening
c. Community trial
C. poverty
D. all above
D
management
b. When demonstrating competencies required for
practicing case management
c. When attempting to achieve a measurable outcome for
a specific client
d. When effectively managing conflict resolution
c. When attempting to achieve a measurable outcome for a
specific client
Transcultural Nursing
comparison of differing cultures to understand their
similarities and their differences across human groups
Culture
set of values, beliefs and traditions that are held by a
specific group of people and that are handed down,
generation to generation
Leininger
1. cultural preservation or maintenance
2. cultural care accommodations or negotiation
3. cultural care re-patterning or restructuring
Nightingale's 10 Canons
1. ventilation and warming
2. light and noise
3. cleanliness of the pt area
4.health of houses
5. bed and bedding
6. personal cleanliness
7. variety
8. offering hope and advice
9. food
10. observation
Primary prevention
patient assessment and intervention to identify and reduce
possible risk factors
Secondary prevention
detection of symptoms that are a reaction to stressors,
appropriately prioritizing interventions, and treatments that
reduce the toxic effects of stressors
Health
seen as a dynamic, positive state and not just absence of
disease
Market justice
people are only entitled to what they can earn; the focus is
on individual responsibility "minimal collective action and
freedom from collective obligations except with respect to
others fundamental rights
Vulnerable populations
low income, less education, homelessness, military
veterans, immigrants, prisoners, migrant and seasonal
farm workers and their families, chronic illness, mental
illness
social determinants
are the circumstances in which people are born; grow up,
live, work, and age as well as the systems put in place to
deal with illness
Health disparities
difference in health outcomes between populations, social,
demographic and geographic
Health inequities
modifiable associate with social inequalities and are
considered unfair
Ethnocentric
tendency to believe others think the same was as "they
do," have the same world view, culture
Altruism
putting others interests before one's own, being present is
an example
Autonomy
PHN independent and responsible for actions - respects
community and individual right to self-determination;
maintain privacy, honesty, and fidelity
Beneficence
seek to do good, not harm
Ethics
standards of behavior that tell us how we ought to act in
various situations we encounter in life
Fairness Perspective
focuses on how fairly or unfairly actions affect a group how benefits and burdens are distributed; requires
consistency in the way people are treated
Non-maleficence
first do no harm - primum non nocere
Advance directive
legal document in which an individual conveys their
decisions about end-of-life care
Health literacy
includes the ability to understand instructions on
prescription drug bottles, appointment slips, medical
Pre-crisis
planning and test messages
Initial
audience wants information NOW
Maintenance
on-going assessment of the situation
Resolution
community will not be ready to conduct risk reduction
immediately after emergency
Evaluation
Crisis and emergency risk communication response
NICs
Nursing interventions classification
NOCs
nursing outcomes classification
Tele-Health
electronic technologies to support clinical health care,
patient and practitioner education, public health and health
administration by long distance
"Right-to-Know" Laws
give people and communities the right to know about
possible chemical exposures where they live and work
Infancy
Adolescence (12-16yrs)
Identity vs. inferiority diffusion
Sensory-motor stage
birth to two
Pre-operational stage
about two to seven
Epidemiology
distribution and determinants of health related
states/events in populations and the use of this study to
control health problems
Prevalence
measures the proportion of the population affected by a
specific condition in a specific time period
Incidence
Mortality rate
also called death rate=an estimation of the proportion of a
population that dies during a specified time period
Epidemic
rates exceed normal or expected frequency in a given
population/community/region
Pandemic
worldwide epidemic (influenza and plague)
Chain of causation
chain of events where every event caused by the previous
event; the sequence of stops that have been identified as
linked to the disease
Web of causation
describes events that have multiple causative factors
Passive Immunity
newborns via maternal antibodies
Active immunity
acquired after exposure to a disease or via immunizations
Cross-immunity
immunity to one pathogen confers immunity to another
such as cowpox providing immunity to smallpox
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
Primary prevention
used before the person gets the disease or condition to
reduce the incidence and prevalence of the disease;
includes health promotion (education) and protection
(immunization)
Secondary prevention
applied after the disease has occurred but before signs are
evident; focuses on early dx (screening) and prompt tx to
limit disability
Tertiary prevention
applied when person already has the disease, focuses on
preventing damage from the condition, slowing the process
of the disease, preventing complications, and returning the
person afflicted to their optimal level of health
(rehabilitation)
Cohort Studies
may be prospective or retrospective, used to establish
causation or evaluate the impact of treatment when
randomized control trials are not possible over time-longitudinal; not good for rare conditions, requires large
study group
meta-analysis
combines data from numerous studies and arrives at
pooled estimates of treatment effectiveness and statistical
significance
Descriptive studies
are observational studies that seek to describe phenomena
Qualitative studies
describe phenomena of interest; include participant
observation, in-depth interviews and focus groups
Quantitative studies
seeks to confirm hypotheses about phenomena; uses more
rigid style eliciting and categorizing responses
sulfur dioxide
product of industry produces acid rain and contributes to
respiratory illness
nitrous oxide
combustion product contributes to illness of lungs, immune
system and asthma
carbon monoxide
car exhaust reduces oxygen delivery at high concentrations
radon
naturally occurring radioactive gas that cannot be detected
by our senses, but is the leading cause of lung cancer in
non-smokers; it is the second cause of lung-cancer behind
smoking
consultation
involves seeking advice or an opinion of an expert; the
consultant does not solve the problems, but assists and
guides the group seeking consultation to solve their own
problems
collaboration
taking an active role in implementing the plan, this requires
understanding of each party's perspectives, on-going
communication and feedback
coalition-building
alliance or group of stakeholders with a common
interest/goal
Advocacy
Cognitive
thinking (comprehension, analysis, synthesis, application,
evaluation); evaluate the level of the learner
affective
feeling (receptive, active participation, valuation,
internalization), includes changes in attitude and values
psychomotor
acting - demonstrates performance skills
natural disasters
due to weather or other natural occurrences
man-made disasters
intentional power outages, chemical spills, acts of bio
terrorism
bacterial agents
anthrax, plague
viral agents
smallpox
Biological toxins-category A
considered high priority and pose national security threathigh morbidity and mortality
smallpox, anthrax, plague, Ebola, Lassa fever, Q fever,
botulism, tularemia, hemorrhagic fever
Biological toxins-category B
moderate to low morbidity and mortality, difficult to detect
Bucellosis, clostridia toxin, staph enterotoxin, salmonella,
shigella, e.coli, cholera
Biological toxins-category C
Health outcomes
health promotion interventions there must be outcomes to
measure analysis of proper structure and constructive
process, operationalizing, outcomes (improved health =
weight loss, lower blood sugars)
Disparities
exist due to poverty, lower educational levels, unequal
access to healthcare, language barriers, environmental
conditions, racism
Motivation
moved from contemplation to action
Self-efficacy
belief about capabilities to produce effects
Self-management
manage independently choices and consequences of life
Compliance
degree to which a plan is followed (passive)
Adherence
agreement to follow a plan of action (active)
pedagogy
literally means the "art and science of teaching children"
andrgogy
intentional and professionally guided activity the aims at a
change in adults
Nurse-managed centers
nurse-managed centers provide a safety net for the poor
and undeserved in rural and urban areas; run by advanced
practice nurses, and may be associated with universities or
may be independent
parish nursing
licensed, registered nurses practicing holistic care in faith
communities
OSHA
sets health and safety work standards, employers are
legally required to protect workers from hazards;
employees have right to know what hazards they are
exposed to
HIPPA
protects the privacy of identifiable, private health
information
EPA
reduce environmental risk and protect the public, maintain
safe air and water, establish pollution regulations, solid
waste and toxic substance disposal, regulate pesticides,
oversee radiation hazards, and noise abatement
CMS
Center for Medicare and Medicaid Services
CDC
monitors and tracts diseases, research injury, infectious
disease, environmental health, genomics, global health,
chronic disease prevention, birth defects and
developmental disorders; publishes the morbidity and
mortality weekly report
NIH
mission is to seek fundamental scientific truth about the
natures and behavior of the living systems and the
application of science to improve health, lengthen life and
reduce the heavy load of illness and disability
SAMHSA
Substance Abuse and Mental Health Administration;
coordinates and funds sustainable substance abuse and
mental health programs in communities or community
health agencies
stakeholders
documentation standards
an agency's standards for how care is
recorded/documented on an individual or program level;
provides a legal record, and should be performed in a
timely manner to ensure accuracy
performance standards
defined standards/expectations for how business is to be
conducted and how performance will be measured
mentoring
expert who establishes a long-term relationship with a
mentee to help them meet professional goals or learn the
role
preceptor
guidance and role modeling are ways to nurture colleagues
or students
professional credibility
clearly demonstrates expertise in an area
expert
perform as an expert maintain standards of behavior and
accountability
health promotion
assessing the health of our community, planning activities
to help our participants to gain some control over their
health to improve their health; emphasis on helping people
change their lifestyles and move toward a state of optimal
health
determinants of health
factors which influence an individual's or population's
health; influences include the availability and access to:
high quality education, nutritious food, decent and safe
housing, affordable, reliable public transportation, culturally
sensitive health care providers, health insurance, and clean
water and non-polluted air
MAPP
Mobilizaing for Action through Planning & Partnerships; this
tool helps communities improve health and quality of life
through community-wide strategic planning; communities
seek to achieve optimal health by identifying and using
their resources wisely, taking into account their unique
circumstances and needs, and forming effective
partnerships for strategic action
Principles of MAPP
systems thinking, dialogue, shared vision, data,
partnerships and collaboration, strategic thinking, and
celebration of successes
incidence
the number of people in a population who develop the
condition during a specified period of time (number of new
cases over a period of time; rate: (# of new cases of
disease/total population at risk)x100,000
prevalence
the total number of people in the population who have the
condition at a particular time; rate: (# of existing cases of
disease/# of in total population)x100,000
relative risk
compares the risk of developing the health condition for
the population exposed to the factor with the risk for the
population not exposed to the factor; indicates the benefit
that might accrue to the person if the risk factor is
removed; rate: incidence among those exposed/incidence
rate among those not exposed
epidemiologic triangle
agent-host-environment model that is a traditional view of
health and disease developed when epidemiology was
concerned chiefly with communicable disease; all 3 can
coexist-disease occurs with interaction of agent, host and
environment
agent
an organism capable of causing disease
host
the population at risk for developing the disease
environment
a combination of physical, biological, and social factors that
surround and influence both the agent and the host
web of causation
views a health condition as the result not of individual
factors but of complex interrelationships of numerous
factors interacting to increase or decrease the risk of
disease; a number of interrelated variables are almost
always involved in the cause of particular outcome
surveillance
passive surveillance
more common form of surveillance used by most local and
state health departments; health care providers report
notifiable conditions
active surveillance
purposeful, ongoing search for new cases of disease by
public health personnel
community analysis
multi-step process used to derive a community nursing
diagnosis; phases used are: categorization, summarization,
comparison, and inference elaboration
demographic characteristics
family size, age, sex, and ethnic and racial groupings
geographic characteristics
area boundaries, number and size of neighborhoods, public
spaces and roads
socioeconomic characteristics
occupation and income categories, educational attainment,
and rental or home ownership patterns
primary prevention
improves the health and well being of the community,
making it less vulnerable to stressors; health promotion
programs, programs that focus on protection from specific
disease; usually nonspecific and directed toward raising the
general healthy of the total community
secondary prevention
begins after a disease or condition is present, although
there may be no symptoms; emphasis on screening, early
diagnosis, and treatment of possible stressors that may
adversely affect the community's health
tertiary prevention
focuses on restoration and rehab; act to return the
community to an optimal level of functioning.
evaluation
must be planned before implementation; measures
progress toward goals and learning objectives; revises
assessment database and community nursing diagnosis
Phases of MAPP
Phase 1: organizing for success, partnership development
Phase 2: visioning
Phase 3: The MAPP assessments
Phase 4: Identifying strategic issues
Phase 5: developing goals and strategies
Phase 6: the action cycle
educational process
1. identify client needs-needs assessment
2. establish educational goals and objectives
3. select appropriate educational strategies
4. develop effective skills as an educator
5. develop effective health education programs
goals
long term group overall learning needs or expected
outcomes after instruction or program activities
objectives
specific, short term, measurable, action oriented behaviors
to be met as steps towards achieving the long term goal
genomics
the study of functions and interactions of all genetic
material in the genome, including interactions with
environmental factors
nursing informatics
specialty that integrates nursing science, computer
science, and information science to manage and
communicate data, information, and knowledge in nursing
practice
information literacy
the ability to recognize when information is needed as well
as the skills to find, evaluate, and use needed information
effectively
public policy
applies to all members of society; includes prescribed
sanctions for failure to comply; formulated by government
bodies; frequently restricts personal choice to improve
public welfare
institutional policy
governs work sites; based on the institution's mission and
goals, and they determine how the institution will function
and relate to employees
organizational policy
formed an applies to groups who have similar interests or
special interests, such as professional associations-state
nurses association or specialty nursing organization that
determines governing rules for membership
medicare
health insurance program; 65 years or older, disabled
people younger than 65, end stage renal disease or Lou
Gehrig disease
medicaid
healthcare, insurance assistance, nursing home coverage;
low-income residents and pregnant women, a parent or
relative caretaker of a dependent child under age 19, the
blind, people with a disability or with a family member in
their household with a disability, or people aged 65 years
or older
health economic
concerned with how scarce resources affect the health care
industry
macroeconomics
microeconomics
the branch of economics that studies the economy of
consumers or households or individual firms; the behavior
of individuals and organizations & how this effects prices,
costs and resources; behaviors that result from tradeoffs in
the use of service and budget limits
efficiency (economics)
refers to producing maximal output, such as a good or
service, using a given set of resources (or inputs), such as
labor, time, and available money; suggests that inputs
used in such a way that there is no better way to produce
the service, or output, and that no other improvements can
be made
effectiveness (economics)
refers to the extent to which a health care service meets a
stated goal or objective, or how well a program or service
achieves what is intended; immunization=herd immunity
environmental health
promotion of safe, healthful living conditions and protection
from environmental factors that may adversely affect
human health or the ecologic balances essential to longterm human health and environmental quality, whether in
the natural or man-made environment
radon (Rn)
a radioactive gas that is formed naturally from the
radioactive decay of uranium in rocks and soil; it can
remain in the soil, move to the soil surface and enter the
air, or enter groundwater; colorless, odorless, and
tasteless, but extremely toxic; when cooled below the
freezing point, it becomes phosphorescent, in yellow and
orange-red tones.
Fracking
common but controversial practice among companies that
drill underground for oil and natural gas; drillers inject
millions of gallons of water, sand, salts and chemicalsall
too often toxic chemicals and human carcinogens such as
benzeneinto shale deposits or other sub-surface rock
formations at extremely high pressure, to fracture the rock
and extract the raw fuel.
dangers of fracking
leaves behind a toxic sludge that companies and
communities must find some way to manage; toxic
chemicals used in the fracking process remain stranded
underground where they can, and often do, contaminate
drinking water, soil and other parts of the environment that
support plant, animal and human life; Methane from
fracture wells can leak into groundwater, creating a serious
risk of explosion and contaminating drinking water supplies
human capital
the knowledge and skills that workers acquire through
education, training, and experience
benefits of MAPP
creates a healthy community; increases visibility of public
health; manages change; stronger public health
infrastructure; builds stronger partnerships; builds public
health leadership; creates advocates
pandemic
steady occurrence of disease over a large geographic area
or worldwide, such as malaria
epidemic
refers to the unexpected increase of an infectious disease
in a geographic are over an extended period of time
endemic
diseases that occur at a consistent, expected level in a
geographic area
outbreak
refers to the unexpected occurrence of an infectious
disease in a limited geographic area during a limited period
of time
infectious agent
an organism (virus, Rickettsia, bacteria, fungus, protozoan,
helminth, or prion) capable of producing infection or
infectious disease
reservoirs
the environment in which a pathogen lives and multiplies
portal of exit
means by which an infectious agent is transported from the
host
mode of transmission
method whereby the infectious agent is transmitted from
one host (or reservoir) to another host
portal of entry
means by which an infectious agent enters a new host
host susceptibility
the presence or lack of sufficient resistance to an infectious
agent to avoid prevent contracting an infection or acquiring
infectious disease
direct transmission
implies the immediate transfer of an infectious agent form
an infected host or reservoir to a portal of entry in the
human host through physical contact such as touching,
biting, kissing, or sexual contact
indirect transmission
the spread of infection through a vehicle of transmission
outside the host
fomites
an inanimate object, material, or substance that acts as a
transport agent for a microbe
vectors
can be animals, insects or artropods, and they can transmit
infection through biologic and mechanical routes
susceptible
at risk for contracting an infection or developing infectious
disease; affected by general health status, personal
behaviors, presence of healthy lines of defense, immune
system and immunization status
natural immunity
an innate resistance to a specific antigen or toxin
acquired immunity
derived from actual exposure to the specific infectious
agent, toxin, or appropriate vaccine
active immunity
when the body produces its own antibodies against an
antigen, either as result of infection with the pathogen or
introduction of the pathogen in a vaccine
passive immunity
the temporary resistance that has been donated to the
host through transfusions of plasma proteins,
immunoglobulins, and antitoxins, or transplacentally from
mother to neonate
herd immunity
refers to a state in which those not immune to an infectious
agent will be safe if a certain proportion of the population
has been vaccinated or is otherwise immune
descriptive epidemiology
focuses on the distribution of frequencies and patterns of
health events with groups in a population; examine disease
analytic epidemiology
seeks to identify associations between a particular disease
or health problem and its etiology; directed toward finding
answers to the "how" and "why" of health disease to
determine casuality
synergism
concept central to the web of causation model, wherein the
whole is more than the sum of its separate parts
Epidemiology is...
the study of the distribution and determinants of health
and disease in human populations
Person-place-time model
Person: "Who" factors, such as demographic
characteristics, health, and disease status
Place: "Where" factors, such as geographic location,
climate and environmental conditions, political and social
environment
Time: "When" factors, such as times of day, week, or
month and secular trends over months and year
Descriptive epidemiology:
-Study of the amount and distribution of disease
-Used by public health professionals
-Identified patterns frequently indicate possible causes of
disease
Analytic Epidemiology
-Examine complex relationships among the many
determinants of disease
-Investigation of the causes of disease, or etiology
Epidemiological Triangle
Host, Agent, Environment
Web of Causation
illustrates the complexity of relationships among causal
variables for heart disease; page 73
Ecosocial approach
-Emphasizes the role of evolving macro-level
socioenvironmental factors along with microbiological
process in understanding health and illness
-challenges the more individually focused risk factor
approach to understanding disease origins
Morbidity rates
rates of illness (page 75)
Risk factor
-Refers to the specific exposure factor
-Often external to the individual
Attributable risk
Primary prevention:
-when interventions occur before disease development
-Includes health promotion and specific prevention
Secondary prevention:
occurs after pathogenesis; screening and physical
examinations that are aimed at early diagnosis
Tertiary prevention:
focuses on limitation of disability and the rehabilitation of
those with irreversible diseases such as diabetes and spinal
cord injury
What is surveillance?
a mechanism for the ongoing collection of community
health information
adolescent son
C) A new mother cuddles and sings to her newborn
D) A father arranges a play date for his 5-year old
daughter
C
Rationale: The affective family function is the family's
ability to meet the psychological needs of its members,
such as bonding with a newborn. The economic function of
the family involves the allocation of adequate resources for
the family members. The providing for health care and
physical necessities function is involved in scheduling
checkups. Arranging a play date is an example of the
socialization function.
and politics
B) Culture plays a minor role in the overall character of
the community
C) Community boundaries cannot limit the services
available to individuals
D) Social systems have little or no impact on a
community's health
A)
Rationale: Social determinants of health are defined as the
circumstances in which people are born, grow up, live,
work, and age, and the systems put in place to deal with
illness. These circumstances are shaped by economics,
social policies, and politics. Social systems have an impact
on a community, and consequently the health of that
community. Culture contributes to the overall character of a
community and, in turn, influences its health needs. A
community is defined by boundaries that often determine
what services are available to individuals.
Upon graduation, a nurse chooses to practice communitybased nursing instead of working in an acute care setting.
Which of the following statements best defines
community-based nursing?
A) It is a "flowing" kind of care that does not necessarily
occur in one setting
B) It does not have a defined philosophy but rather is
defined by the setting itself
C) It is defined by the level of academic preparation
The nurse is caring for a male client with HIV who is living
unmarried with another male and has two adopted
children. How would the nurse document this client's
family structure?
A) Nuclear Family
B) Nuclear Dyad
C) Single-Parent Family
D) Multigenerational Family
A
Rationale: A nuclear family consists of a married couple
with children, or unmarried, heterosexual, or same-sex
couples with children. A nuclear dyad is a couple, married
or unmarried; heterosexual or same sex. A single-parent
family is one adult with children, and a multigenerational
family is any combination of these family structures.
A nurse is designing a physical activity program for a 48year-old male client who has been diagnosed with mild
hypertension. Which of the following is an appropriate
long-term goal for this client?
A) Jog for 15 minutes and weight train for 15 minutes, 3
days a week
B) Walk briskly for 30 minutes most days of the week
C) Bicycle for 1 hour every day of the week
D) Walk briskly for 30 minutes every other day
B
Rationale: Moderate physical activity is recommended for
30 to 45 minutes, 3 to 5 days a week as an initial goal. An
appropriate long-term goal is 30 minutes of moderateintensity physical activity all or most days of the week.
B
Rationale: Older smokers are more likely to stay off
cigarettes once they quit than younger smokers since they
know more about the short-term and long-term benefits of
quitting. It is always good to quit smoking at any age, and
ex-smokers live longer and healthier lives. People who
smoke have a 70% greater heart disease death rate than
do nonsmokers. In some cases, ex-smokers who have had a
heart attack can cut their chance of having another one by
50%.
One of the components of community-based care is selfcare. Which of the following nursing interventions is the
best example of promoting self-care in the community
setting?
A) A nurse arranges for a client who smokes a pack of
A home health care nurse visits the home of an 82-yearold female client who is receiving nursing care and
physical therapy following discharge from the hospital.
The client has right-sided paralysis following a TIA. Upon
assessment, the nurse finds that the client has lost five
pounds since the last visit a week ago. The client is living
alone with daily visits from her two children. Which of the
following would be the most important assessment
question for this client?
A) Are your children still visiting you daily?
B) Who is preparing your meals for you?
C) Are you able to walk to the kitchen to get a snack?
D)How has your physical therapy affected your appetite?
B
Rationale: Assessment is a continuous process designed to
collect information used for an immediate intervention or
as a foundation for additional assessments at a later time.
After assessing this client for weight loss, the nurse would
make further assessments to determine if the client needs
help with grocery shopping, meal planning, and cooking
meals. Tracking the client's eating pattern and intervening
where appropriate are the most important assessments in
this situation.
B
Rationale: Primary prevention is used to prevent the initial
occurrence of a disease, such as preventing obesity or
heart disease through exercise. Screening for hypertension
and recommending a colonoscopy are secondary
preventive measures. Performing range-of-motion exercises
to improve the mobility of a client with arthritis is an
example of tertiary prevention.
helmet), self-esteem (parental praise), and selfactualization (attaining a GED) are higher-level needs that
can be met after physiological needs are met.
The nurse explains to the novice nurse how communitybased nursing differs from nursing care provided in
hospital settings. Which of the following statements
accurately describes one of these differences?
A) In the community setting, the nurse is in charge of all
aspects of client care whereas in the hospital setting the
client directs the care
B) In the community setting, the nurse is the primary
facilitator of self-care as opposed to being solely a care
provider
C) In the hospital setting, a holistic assessment is
facilitated by the collaboration of many professionals,
which is not available in the community setting
D) In the community setting, the client's environment
must be changed to facilitate care, which is not an issue
in the hospital setting
B
Rationale: Because the client and family are involved in
nearly all aspects of care the majority of the time, the
community-based nurse is primarily a facilitator of self-care
as opposed to being the sole care provider. In the
community setting, the delivery of care must be considered
within the family and environment. A holistic assessment
often occurs through the collaboration of many
professionals.
integrity. The nurse should meet the client in a quiet, welllit room with no background noise.
D
Rationale: The first step in providing culturally competent
care is to understand one's own cultural background,
influences, and biases. Only with cultural awareness can
nurses appreciate and be sensitive to values, beliefs, life
practices, and problem-solving methods of a client's
culture. Cultural blindness occurs when the nurse does not
recognize his or her own beliefs or practices, or those of
others. Ethnocentrism is the idea that one's own ideas or
beliefs are the best way to behave, which has a negative
effect on cultural awareness. Preventing stereotyping
(generalizing about others) is important, but is not the first
step in this process.
C
Rationale: The health-illness continuum considers health
rather than illness as the essence of care, which requires a
shift in thinking. Improvement in health is not seen as an
outcome of the amount and type of medical services or the
size of the hospital. Treatment efficacy rather than
technology drives care in this model. Care provided in
acute care facilities is directed at resolving immediate
health problems, whereas in this model the focus is on
maximizing individual potential for self-care.
C
Rationale: An affective learning objective relates to learning
activities that enhance the acceptance of and the
adjustment to illness and subsequent treatment (e.g. the
client expressing a desire to stop smoking). Stating three
healthy snacks to substitute for sweets is a cognitive
objective. Ambulating the length of a hallway and
demonstrating crutch walking are psychomotor learning
objectives.
The nurse working in a culturally diverse communitybased setting knows that a person's cultural belief system
influences his or her health attitudes, beliefs, and
practices. Which of the following clients would be more
likely to look for a supernatural counterforce to get rid of
a health problem?
A) An Asian woman who has breast cancer
B) An Eastern European client who is experiencing
seizures
C) A client of Caribbean culture who is diagnosed with
lung cancer
D) An Arab client who is scheduled for a postatectomy
C
Rationale: The magico-religious view, practiced by people
from Hispanic and Caribbean cultures, sees illness as
having a supernatural force. People with this perspective
will look for a counterforce to rid them of the problem.
People of Arab or Asian descent may ascribe to the hot and
cold theory based on the balance of the four humors.
Assessment
Assurance
- what are activities that make certain that services are
provided?
- you must improve the level of "?" what
Case Management
- what is a systematic process by which a nurse assesses
clients needs, plans for & coordinates services, refers to
other appropriate providers, & monitors and evaluates
progress to ensure that clients multiple service needs are
met in a cost-effective manner?
Clinician
...
Collaborator
- what role of a community nurse involves working jointly
w/ others in a common endeavor, cooperating as partners?
- successful community health practice depends on this
multidisciplinary collegiality & leadership.
Policy Development
- what is enhanced by the synthesis & analysis of
information obtained during assessment?
- the nurse recommends specific training & programs to
meet identified health needs of target populations.
Researcher
- this role of the community nurse involves engaging in a
systematic investigation, collection & analysis of data for
solving problems & enhancing community health practice?
Management Behaviors
- these type of behaviors are grouped into 3 sets of
behaviors:
*Decision Making Behavior
*Transferring of Information Behaviors
*Interpersonal Relationships
Management Skills
- the three basic management skills include:
"Human Skills" which refers to ability to understand,
communicate, motivate, delegate & work well with ppl.
"Conceptual Skills" the mental ability to analyze & interpret
abstract ideas for the purpose of understanding &
diagnosing situations and formulating solutions.
"Technical Skills" the ability to apply special managementrelated knowledge & expertise to a particular situation.
Leadership Role
- this leadership role is separate from the manager role &
focuses on effecting change; thus the nurse becomes an
agent of change.
- as leaders, community health nurses seek to initiate
changes that positively effect ppl's health.
Epidemiology
The study of the distribution and the determinants of states
of health and illness in human populations.
Distribution
Refers to the frequency of occurrences of health and illness
Determinants
Refers to agents or factors that contribute to the cause of
various states of health and illness.
John Snow
Cholera epidemic, linked to the water source in the center
of the city.
Epidemiological triad
Agent (organism like the measles virus), host (human), and
environment
Web of Causation
Based on the belief that health status is multifactorial,
determined by the interaction of many agent, host, and
environment characteristics, and not by any single factor.
Ecological model
Expands epidemiological studies upward into broader
contexts such as neighborhood characteristics and
community and social contexts, and downward to the
genetic molecular level. Model encompasses determinants
at many levels: biological, emotional, behavioral,
socioeconomic, cultural, political, and environmental.
Risk
the probability that a particular event or outcome will occur
within a specified time period.
Genomics
is the study of all the genes in a person, as well as the
interaction of those genes with each other and a person's
environment.
Pre-pathogenesis
factors within individuals and their environments that may
predispose or precipitate the disease. The initial
interactions among agent, host, and environment occur
during this period.
Pathogenesis
begins when the host begins to respond with biological,
psychological, or other changes. Manifested by S&S until
the issue is resolved.
Primary prevention
Activities that prevent a disease from becoming established
and occurs during the pre pathogenesis period.
Secondary prevention
Includes activities designed to detect disease and provide
early treatment.
Tertiary prevention
the treatment, care, and rehabilitation of people with acute
and chronic illness to achieve their maximum potential.
Tertiary prevention is initiated after irreversible changes
have resulted.
Descriptive Epidemiology
Focuses on the frequency and distribution of states of
health within a population. Describe the problem (what
occurs) in terms of person, place , and time.
Risk factors
Factors that are associated primarily with the people who
have the illness.
Ratio
is a fraction that is obtained by dividing one quantity by
another quantity; it represents the relationship between
two numbers.
Proportion
is a type of ratio that include the quantity in the numerator
also as a part of the denominator.
Rate
A measure of frequency of an event or diagnosis in a
defined population within a given time period. (rate is a
proportion that includes the factor of time). best indications
of the probability that a disease, condition, or event will
occur.
Incidence
Measures the occurrence of new illness in a previously
disease-free group of people within a specific time frame.
Measure of the probability that people without a certain
condition will develop the condition over a period of time.
Mortality
Death
Morbidity
illness
Prevalence rates
Measures the amount of morbidity that exists in a
community as a result of the health problem under
investigation.
Period prevalence
indicates the existence of a condition during an interval of
time.
Point prevalence
refers to the existence of a condition at a specific point in
time.
Crude rates
Measure the experience of health problems in populations
of designated geographic areas.
Specific rates
Adjusted rates
Have been standardized, removing differences in
composition of populations, such as age.
Vital statistics
Data collected from the continuous recording of events
such as births, deaths, marriages, divorces, and adoptions,
usually by state agencies.
Person
Characterizes the "Who" develops the health problem.
Place
"Where" the rates of the health problem are the highest or
the lowest can be determined by examining the
characteristics of place.
Time
"When" health problems occur can be describe the
identifying short-term fluctuations measured in hours,
days, weeks, or months; buy periodic changes that are
seasonal or cyclical; or by long-term changes over decades
that reflect gradual changes.
Epidemic curve
Analytic Epidemiology
Focuses on the determinants of health problems, or the
"why". Uses 4 different types of studies: cross-sectional,
retrospective (case-control), prospective, and intervention
(experimental) studies.
What is implied by the web of causation model?
a. Variables interact resulting in higher probability of
illness.
b. One disease causes another, especially in vulnerable
populations.
c. The greater the poverty, the more likely people are to
have diseases.
d. Immunizations are necessary because vulnerable
populations spread disease.
a. Variables interact resulting in higher probability of
illness.
a. Women
a. Poor
b. Near poor
c. Medically indigent
d. Uninsured
c. Medically indigent
partnerships
b. Outreach and case finding
c. Elimination of disparities
d. Culturally and linguistically appropriate care
a. Community-based care and interorganizational
partnerships
b. Outreach and case finding
d. Culturally and linguistically appropriate care
What are the 10 great public health achievements in the
us from 1900-1999?
vaccinations, motor vehicle safety, safer workplaces,
control of infectious diseases, decrease in coronary heart
disease and stroke deaths, safer and healthier foods,
healthier mothers and babies, fluoridation of drinking
water, recognition of tobacco as a health hazard.
behavior models
motivational interviewing. behavior change models.
learning model. health belief model.
ontogenic system
personal factors
microsystem
relationship b/w women and their environment
exosystem
formal and informal social structures
macroculture
values and beliefs of culture
shattuck report
provided the 1st systematic use of birth and death records
and demographic data to describe the health
lemuel shattuck
recommended establishment of state health
dorothea dix
prison and mental health
clara barton
red cross/ civil war
lillian wald
founder of public health nursing. henry st settlement.
mary breckinridge
frontier of nursing service 1925 needs of health in the
mountain region. founded midwifery program
philanthropic organization
an organizations that used endowed funds or private
fundraising to address the needs of individuals, families,
and populations
nongovernmental organizations
agency that acquires resources to help others from
private(vs. public) sources
philanthropic organization
an organization that used endowed funds or private
fundraising to address the needs of individuals, families,
and populations
Definition of health
a state of complete physical, mental and social well-being,
not merely the absence of disease or infirmity
Health
a quality an ability to adapt to change or a resource to help
cope with challenges and processes of daily living
well-being
a subjective perception of full functional ability as human
beings
Primary prevention
maximizing health and wellness through strategies that are
set in place before illness or injury is present
secondary prevention
maximizing health and wellness through strategies that are
set in place at the early and active chronic stages of
parthenogenesis of illness and injury (mass screening,
selective screening)
Tertiary prevention
maximizing health and wellness through strategies that are
set in place at the palliation and end stage of disease and
injury trajectories.
epidemiology
study of the distribution and determinants of states of
health and illness in human populations used both as a
research methodology used to study states of health and
illness and as a body of knowledge that results from the
study of a specific state of health for or illness
epidemic
an outbreak that occurs when there is an increased
incidence of a diseases beyond that which is normally
found in the population
rates
the primary measurement used to describe either the
occurrence or or the existence of a specific state of health
or illness
epidemiological triad
host, agent, and environment
wheel of causation
emphasizing the interplay of physical biological and social
environments
when was the first state board of health formed in the us?
1869-north carolina
edward jenner
smallpox 1790
louis paster
1822-1895 pasteurization started as a wine experiment
joseph lister
antiseptic solution
robert koch
anthrax and cholera
john snow
first epidemiologist linked cholera rates with water street
pump golden square in london
isabel hampton
1890s helped found ANA
Margaret Sanger
1910s birth control
Lillian Wald
Clara Barton
civil war nurse leader, US red cross founder
population
group of people who have at least one thing in common
and who may or may not interact w/ one another
culture
the beliefs, values, and behavior that are shared by
members of a society and provide a design or "roadmap"
for a living
cultural diversity/plurality
a variety of cultural patterns coexist within a designated
geographic area
race
refers to biologically designated groups of people whose
distinguishing features, such as skin color, are inherited
ethnic group
a collection of people who have common origins and a
shared culture and identity; they may share a common
geographic origin, race, language, religion, traditions,
values, and food preferences
ethnicity
the group of qualities that mark one's association with a
particular ethnic group
subcultures
large aggregates of people w/in a society who share
separate distinguishing characteristics, such as ethnicity,
occupation, religion, geographic area, age, gender, or
sexual preferences
microcultures
systems of cultural knowledge characteristic of subgroups
within larger societies
ethnocentrism
the belief or feeling that one's own culture is best and
reflects our tendency to judge other people's beliefs and
behavior using values of our own native culture
ethnorelativism
seeing all behavior in a cultural context
Characteristics of culture
Culture is: learned, integrated, shared, mostly tacit,
dynamic
enculturation
learning about culture through socialization with the family
or significant group
biomedical view
relies on scientific principle and sees diseases/injuries as
life events controlled by physical and biochem processes
that can be manipulated through meds, surgery, and other
treatments
magicoreligious view
focus on the control of health and illness by supernatural
forces; illness - punishment of god, health - gift from god
holistic view
viewing the world in terms of harmonious balance - if
principles guiding natural laws to maintain order are
disturbed, an imbalance in the forces of nature is created,
resulting in chaos and disease
folk medicine
home remedies
individualized caregiving practices that are passed down
w/in families
complementary therapies
practices used to complement contemporary Western
medical and nursing care and are designed to promote
comfort, health, and wellbeing
primary prevention
a type of prevention that seeks to promote heath and
prevent disease from the beginning
secondary prevention
an intervention that seeks to detect disease early in its
progression (early pathogenesis) before clinical signs and
symptoms become apparent in order to make an early
diagnosis and begin treatment
tertiary prevention
intervention that begins once the disease is obvious; the
aim is to interrupt the course of the disease, reduce the
amount of disability that might occur, and begin
rehabilitation
medicaid
a jointly sponsored state and federal program that pays for
medical services for the aged, poor, blind, disabled, and
families with dependent children
medicare
a federally funded health insurance program for the elderly
and disabled and persons with end-stage renal disease
legal immigrant
not citizens, but they are by law allowed to both live and
work in the US, often because they have useful job skills or
family ties;
must live in US for 10 years to be eligible for all
entitlements, such as Aid to Families of Dependent
Children, food stamps, Medicaid, and unemployment
insurance
refugees
refugees are admitted outside the usual quota restrictions
based on fear of perseution due to their race, religion,
nationality, social group, or political views;
may receive Temporary Assistance for Needy Families,
Supplemental Securty Inome, and Medicaid
nonimmigrants
admitted to the US for a limited duration of time and for a
specific purpose
unauthorized immigrant
undocumented or illegal aliens;
eligible only for emergency medical services,
immunizations, treatment for the symptoms of
communicable diseases, and access to school lunches
assessment
systematic data collection on the population, monitoring
the populations health status, and making information
available about the health of the community
policy development
efforts to develop policies that support the health of the
population, including a scientific knowledge base to make
policy decisions
assurance
making sure that essential community-oriented health
services are available;
includes providing essential personal health services or
individuals, as well as a competent PH workforce
cultural shock
the feeling of helplessness, discomfort, and disorientation
experienced by an individual attempting to understand or
effectively adapt to another cultural group that differs in
practices, values, and beliefs. it results from the anxiety
caused by losing familiar sights, sounds, and behaviors
cultural repatterning
working with clients to make changes in health practices
when the clients cultural behaviors are harmful or decrease
their well-being
cultural preservation
the use by clients of those aspects of their culture that
promote healthy behaviors
cultural knowledge
the information necessary to provide nurses with an
understanding of the organizational elements of cultures
and to provide effective nursing care
cultural imposition
the process of imposing one's values on others
cultural encounter
interaction with a client related to all aspects of his or her
life
cultural blindness
when differences between cultures are ignored and persons
act as though these differences don't exist
quarantine
period of enforced isolation of persons exposed to a
communicable disease during the incubation period of the
disease to prevent its spread should infection occur
sanitation
promotion of hygiene and prevention of disease by
maintenance of health-enhancing (sanitary) conditions
Shattuck Report
advocate the establishment of state and local boards of
health, enviro sanitation, collection and use of vital
statistics, systematic study of diseases, control of food and
drugs, urban planning, est of nurses' training schools, and
preventive medicine
antigen
A live or inactivated substance (e.g., protein,
polysaccharide) capable of producing an immune response
antibody
Protein molecules (immunoglobulin) produced by B
lymphocytes to help eliminate an antigen
active immunity
Protection produced by the person's own immune system;
usually permanent
passive immunity
Protection transferred from another person or animal;
temporary protection
LAIV
Rotavirus
Herpes Zoster
inactivated vaccines
Toxoids (DTaP, Td, Tdap)
Whole (Hepatitis A, IPV)
Split (Influenza - TIV)
Recombinant vaccines (Hepatitis B, HPV4, HPV2)
Polysaccharide vaccines (PPSV23, MPSV4)
Conjugated vaccines (Hib, PCV13, MCV4)
retrospective payment
Fee established in advance
Reimburse after service rendered
Abused through the requesting and ordering of
unnecessary tests
Encouraged sickness rather than wellness
prospective payment
External authority sets rates
Rates derived from predictions set in advance
Fixed rates rather than cost coverage
Imposes constraints on spending
Providers at risk for losses or surpluses
Which statement about disasters is true?
a. They can be natural or human-made.
b. They can be relieved without assistance.
c. There is always injury and death when a disaster
occurs.
d. The timing of a disaster does not influence the types of
injuries that will occur.
a. They can be natural or human-made.
casualties because:
a. They cause the most widespread destruction.
b. Victims have little time to make evacuation
preparations.
c. Those with chronic conditions cannot escape in time.
d. The early warning systems are not effective.
b. Victims have little time to make evacuation preparations.
b. Communicable disease
c. Chronic illness
d. Injuries requiring first aid
a. Stress
c. Surveillance
d. Health teaching
a. Screening
immunizations
c. Should be aware of the laws in the state regarding
acceptable reasons for immunization exemption
d. Should allow the student to attend school without the
immunizations
c. Should be aware of the laws in the state regarding
acceptable reasons for immunization exemption
b. Educational services
c. Day care
d. Orthodontics
b. Educational services
The nurse caring for children when they need health care
is providing which of the following levels of prevention?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Health promotion
b. Secondary prevention
c. Vandalism
d. Victimizing
a. Venting
b. Vocalizing
c. Vandalism
d. Victimizing
Carrier
A person who harbors an infectious organism and transmits
the organism to others although having no symptoms of
the disease
colonization
The presence and multiplication of infectious organism
without invading damage to tissuse
Contagious
Able to be passed easily from one person to another.
endemic
The constant or ususal prevalence of a specific disease or
infectious agent within a population or geographic area
Epidemic
A widespread outbreak of an infectious disease.
Healthcare-associated infection
An infection that was not present on admission to the
hospital and develops during the course of treatment for
other conditions (nosocomial)
Incubation period
The period between infection and the appearance of
symptoms of the disease.
Infectious disease
A disease that is caused by a pathogen and that can be
spread from one individual to another.
propagated outbreak
an outbreak that spreads from person to person rather than
from a common source
pathogenicity
The ability to cause disease
Reservoir
A place where microorganisms survive, multiply, and await
transfer to a susceptible host
Secondary infection
caused by an opportunistic pathogen after the primary
infection has weakened the body's defense
Surveillance
- collecting, analyzing, & reporting data on rates of
occurrence, mortality, morbidity, and transmission of
infections
transmission
An incident in which an infectious disease is transmitted to
another person/people.
Antigenic drift
Slow and progressive genetic changes that take place in
DNA and RNA as organisms replicate in multiple hosts
Antigentic shift
dramatic change,
Convergence model
Model illustrating the interaction of 13 factors that
contribute to the emergence of infectious disease.
Ecosystem
A community of interdependent organisms and the physical
environment they inhabit.
Herd immunity
The resistance of a group to invasion and spread of an
infectious agent, based on the resistance to infection of a
high proportion of individual members of a group; the
resistance is a product of the number susceptible and the
probability that those who are susceptible will come into
contact with an infected person
Microbial adaption
Process by which organisms adjust and change to their
enviroment
Pandemic
A worldwide epidemic.
Femicide
A term used to refer to a homicide that occurs in the
context of intimate partner violence (IPV).
Gender-based violence
any act of gender violence that results in or is likely to
result in physical, sexual or psychological harm and
suffering to women, including theats of such acts, coercion,
or arbitrary deprivations of liberty, whether occuring in
public or private life.
Human rights
The basic rights to which all people are entitled as human
beings.
Incidence
Disease is the number of new cases occurring in a specific
period
Lethality assessment
Perpetrate
To commit, as a crime or other antisocial act
Prevalence
'The number or proportion of cases of a particular disease
or condition present in a population at a given time.'"snap
shot" (AIHW, 2008)
Violence
1. Violence is a broad concept that ranges from homicide to
physical assault or intentional use of force against another
person, community, or even against oneself (suicide)
Abstinence
Act of refraining from for 12 months or more
Addiction
habitual use of a drug, a disease in itself. Caused by taking
a chemically dependent drug "prescribed or illegally used
compulsively psycological and physiologicaL dependency
Craving
an intense desire for some particular thing
Intoxication
An altered state of consciousness as a result of drinking
alcohol or ingesting other substances
Substance abuse
A) Substance abuse differs from dependence in that
withdrawal or tolerance have never been present, but use
of the substance has caused significant impairment or
distress - e.g., missing work, school failure, DUI, legal
problems
Substance dependence
Substance use
This is the use of a substance that alters physical or mental
functions: It can be legal or illegal, therapeutic or
recreational and can be done by sniffing, snorting, inhaling,
swallowing, drinking, smoking, or injecting the substance or
absorbing it throught the skin.
Tolerance
A process in which your body needs more and more of a
drug to get the same effect
Withdrawal
Physical signs of discomfort associated with the
discontinuation of an abused substance.
Inmate
a person serving a sentence in a jail or prison
Trimorbidity
Three common chronic illnesses of homeless people
(mental illness, chronic physical illness, substance
addiction)
Underserved population
A subgroup of the population that has a higher risk of
developing health problems because of a greater exposure
to health risks because of marginalization in sociocultural
status, access to economic resources, age or gender
Bioavailabilty
The amount of a contaiminant that actually ends up inthe
systemic circulation
Biomonitoring
Analysis of blood, urine, tissues, and so forth to measure
chemical exposure in humans
Environmental epidemiology
field of public health science that focuses on the incidence
& prevalence of disease or illness in a population from
exposures in their enviroments
Environmental health
Environmental factors that influence human health and
ecological systems
Environmental justice
A legal strategy based on claims that racial minorities are
subjected disproportionately to environmental hazards
Exposure
A situation in which a person has had contact with blood,
body fluids, tissues, or airborne particles in a manner that
suggests disease transmission may occur.
Exposure estimate
Factors that determine a persons level of exposure to a
contaminant.
Exposure pathway
The pathway linking the environmental source of a
contaminant to the point of exposure
Exposure history
process to help determine whether an individual has been
exposed to environmental contaminants
Precautionary principle
States that when there is a threat of serious or irreversible
environmental damage, we shouldn't wait for scientific
proof before taking action.
Healthy communities
communities that optimize the physcial, social, and
economic environment of the community
Risk assessment
Assessing each risk involves determining likelihood that the
risk event will occur and the degree of impact the event
will have on the project objective.
Toxicology
study of poisonous substances and their effects upon body
parts
After-action report
Retrospective analysis used to evaluate emergency
response drills.
Decontamination
A process in which recently used and soiled medical
devices, including instruments, are rendered safe for
personnel to handle.
Evacation
Moving people from a dangerous place to safety
Invacuation
Moving people from one area to another, within the same
facility.
Point of distribution
centralized location where the public picks up emergency
supplies following a disaster
Real time
Means that the people who are conversing on a computer
are online at the same time.
Scenario
A sequence of events that is imagined, assumed, or
suggested
Shelter-in-place
Taking refuge inside an interior room with few or no
windows, in the event of the release of chemical biological,
or radiological contaminants:
Simulation
A representation of a situation or problem with a similar but
simpler model or a more easily manipulated model in order
to determine experimental results.
Terrorism
Is the use or threatened use of violence to gain a political
objective
Deinstitutionaliztion
a focus on reducing costly and neglectful institutional care
and on providing more humane services in the community
First-generation antipsychotics
improve positive symptoms of schizophrenia more
effectively than negative symptoms or cognitive
dysfunction.
Nonadherence
an informed decision on the part of the patient not to
adhere to or follow a therapeutic plan or suggestion. Same
thing as noncompliance.
Prodromal stage
This is the Initial stage of disease, characterized by
common general complaints of illness malasia and fever ?
Second-generation antipsychotics
drugs that alleviate schizophrenia without serious risk of
producing movement disorders
tardive dyskinesia
A side effect of long-term use of traditional antipsychotic
drugs causing the person to have uncontrollable facial tics,
grimaces, and other involuntary movements of the lips,
jaw, and tongue.
congregation
A gathering of people, especially for religious services
congregration-based model
faith based nurse serving a particular faith community by
virtue of a contract or job description
Institution-based model
the parish nurse serves as a liasion and helps plan and
coordinate care
Parish nursing
a model of care for members of a faith community that can
include wellness care through home visiting
Spiritual care
Recognition of spiritual needs and the assistance given
toward meeting those needs.
Adjuvant drugs
relieve pain either alone or in combination with analgesics.
These drugs can potentiate or enhance the effectiveness of
the analgesic.
Advance directives
Documents that indicate a patient's wishes in the event
that the patient becomes incapacitated and unable to
make decisions regarding medical care
Bereavement
Feeling of grief or desolation, especially at the death or loss
of a loved one.
Breakthrough pain
Pain that occurs between doses of pain medication. (p.
157)
Grief
Extreme sadness after someone dies or goes away.
Healthcare proxy
an individual who has been appointed to make health
decisions by the maker in the event of their incapacitation
Mourning
Outward, social expressions of grief and the behavior
associated with loss.
Pallative care
care designed not to treat an illness but to provide physical
and emotional comfort to the patient and support and
guidance to his or her family
Postmortem care
Care given immediately after death before the body is
moved to the mortuary usually by nurses
Biological hazards
Any living organisms or its properties that can cause an
adverse response in humans
Chemical hazards
Toxicity and the use of the chemicals. Excessive airborne
concentrations of mists, vapors, gases, or solids in the form
of dusts or fumes
Ergonomics
Physical hazards
Hazards that result from the transfer of physical energy to
workers
Psychosocial hazards
- all organizational factors and interpersonal relationships
in the workplace that may affect the health of the workers
How is TB transmitted?
Exposure to bacilli in airborne droplets form infected person
during coughing, sneezing, or talking
A patient with diabetes has her TB skin test read and the
nurse discovers 11 mm induration. Further testing reveals
no symptoms and a negative chess x-ray. What does the
nurse suspect?
A. Active TB infection
B. No TB infection
C. Latent TB infection
D. Further testing is required
C. Latent TB infection
Cheaper
More efficient - success rate 67%
2000 samples/day vs. technicians that can only process 20
samples/day
Bleeding problems
Flu-like symptoms
Rash
Turns urine, saliva, tears orange (discolors contact lens)
Photosensitivity
Birth control pills/implants less effective
Hepatic enzyme elevation
Peripheral neuropathy
Mild CNS effects
Joint aches
Hyperericemia (uric acid in blood)
Optic neuritis
Ototoxicity & nephrotoxicity
A. Agent-host-environment interaction.
C. Specificity.
D. Variability.
B. Sensitivity.
Quarantine is
- incubation (define)
ISOLATION during a communicable disease (especially
during incubation ) to prevent spread.
incubation: The development of an infection from the time
the pathogen enters the body until signs or symptoms first
appear.
Assessment
- define
- it is a continuous process of ____ (2) information about
__
- function?
- morbidity?
measuring and monitoring the health status and needs of a
designated community or population.
-a continuous process of collecting data and disseminating
information about health,diseases, injuries, air and water
quality, food safety, and
available resources.
This function helps to identify morbidity, mortality, and
causative factors.
- rate of incident
Assurance is
- 2 MORE FUNCTIONS?
the process of translating established policies into
services.
1. ensures that population based services are provided,
whether by public health agencies or private sources.
2. monitors the quality of and access to those services.
medically indigent
(those who are unable to pay for and totally lack medical
services)
DHHS
Department of Health and Human Services
Economics
science of making decisions regarding scarce resources.
(Study of how societies decide what to produce, how to
produce it, and how to distribute what they produce)
Economics permeates our social structureit affects and is
affected by policies.,
Microeconomic theory is
concerned with supply and demand.
Macroeconomic theory is
concerned with the broad variables that affect the status of
the economy as a whole.
Supply is
the quantity of goods or services that providers are willing
to sell at a particular price.
Demand
Consumer willingness and ability to buy products
adverse selection
-define
-ex
the tendency for people with the greatest probability of loss
to be the ones most likely to purchase insurance.
(ex: when high-risk patients are denied insurance or care)
deductible
( yearly health insurance bill)
A certain amount of money that the patient must pay each
year toward his or her medical expenses before health
insurance benefits begin.
cost sharing
a situation where insured individuals pay a portion of the
healthcare costs, such as deductibles, coinsurance or copayments.
( ex: auxilio mutuo private health insurance)
Medicare
A federal program of health insurance for persons 65 years
of age and older
Medicaid
A public assistance program designed to provide healthcare
to poor, disabled and disadvatanged americans
capitation rates
(fixed amounts of money paid per person by the health
plan to the provider for covered services)
retrospective payment
rendered
Provided, given
reimbursement
paying back
fee-for-service
A system under which doctors and hospitals receive a
separate payment for each service that they provide
Prospective payment
payment method based on rates derived from predictions
of
annual service costs that are set in advance of service
delivery.
-the payment amount or reimbursement with a set rate for
certain procedures is known in advance
cost shifting.
- read
- define
This practice of charging different prices to different
consumers most often affects those without health
insurance who are paying out-ofpocket for care.
- Lack of insurance, uninsured populations, and
uncompensated care are covered by charging more to
those who can pay. This practice is referred to as
managed care
It refers to systems that coordinate medical care for
specific
groups to promote provider efficiency and control costs.
Medical home
seeing the same health care provider for regular care
Competition means
a contest between rival health care organizations for
resources and clients
Regulation refers to
mandated procedures and practices affecting health
services delivery that are enforced by law
Managed competition,
- what does it combine?
combine with market competition to achieve cost
savings with government regulation to achieve expanded
coverage.
single-payer system
- this lead to?
When the government collects taxes for healthcare from all
citizens and then uses the collected money to pay for the
citizens healthcare services.
- universal coverage
universal coverage
(everyone would have health insurance of some type,
assuring better access to care).
SUMMARY
SUMMARY
history
Primitive practices of early centuries were replaced with
more advanced sanitary measures by the Greeks and
Romans. The Middle Ages saw a
serious health decline in Europe, with raging epidemics
leading to extensive 19th-century reform efforts in England
and, later, in the United States.
Private health services are the unofficial arm of the community health system. They include (2) agencies
voluntary nonprofit agencies
privately owned (proprietary) and for-profit
agencies.
OSHA
sets health and safety work standards employees are in
legally required to protect workers from hazards and
employees have a right to know what hazards they are
exposed to
passive immunity
newborns through maternal antibodies
.risk assessment
qualitative and quantitative evaluation of the risk posed to
human health for the environment by the actual or
potential presence or use of specific pollutants
needs assessment
needs assessment systemic appraisal of type depth and
scope of problems as perceived by clients health providers
or both
natural immunity
species determinate resistance to an infectious agent
WIC
woman and children Supplemental Nutrition Program
provides federal grants to states for supplemental food
health care referral and nutrition education for low-income
pregnant breastfeeding and non-breastfeeding postpartum
women infants and children up to five years of age who are
found to be at a nutritional risk
primary prevention
type of intervention that seeks to promote health and
prevent disease from the beginning involves health
promotion and education
secondary prevention
secondary prevention intervention that seeks to detect
disease by screening and providing healthcare early in the
progression before clinical signs and symptoms become a
apparent in order to make an early diagnosis and begin
treatment
tertiary prevention
SARS
severe acute respiratory syndrome spread via airborne
droplets indirect.contact and by close contact with an
infected person there is no cure as a person is suspected of
having sars they should be admitted to the hospital
immediately and kept under Isolation if in an outpatient
setting the person must be rapidly divertid to a separate
area to minimize transmission to others
palliative care
care to alleviate symptoms by meeting the special needs of
and providing comfort for the dying client and their families
by the nurse
color
food preferences include blue cornmeal fruits Game and
Fish.nutritional excess of carbohydrates and calories
risk factors are diabetes malnutrition tuberculosis infant
and maternal mortality
Good luck
...
3 shared commonalities
geographic, common interest, community of solution
community of solution
group of people who come together to solve problems that
affects all of them, ex: guidance counselors, counties
working for water pollution
common interest
collection of people with interest or goal that bind them
together, ex: MADD, disabled community, church groups,
gay community
population
all the people occupying an area, or all those who share
one more characteristic, may not necessarily interact
aggregates
a mass or grouping of distinct individuals who are
considered as a whole and are loosely associated with each
other, broader term then population
aggregates
communities and populations are types of
promotion of health
health education, preventative care services, healthy
people 2010, raise levels of wellness for individuals,
families, populations and communities
primary prevention
to keep illness from occurring, hand rails, immunizations
secondary prevention
efforts to detect and treat existing health problems.
Screenings: htn, drug abuse, breast exam, DM test; to
intervene to control or eradicate the problem
tertiary prevention
attempts to reduce the extent and severity of health
problems so as to minimize disability and restore or reserve
function: rehab after CVA.
tertiary prevention
someone that has an eating disorder, following up with
counseling
treatment of disorders
focuses on illness by: direct service, indirect service,
development of programs to correct unhealthy conditions
indirect service
referring to someone, calling another professional to help
solve problem for client
rehab
evaluation
process by which the practice is analysis, judged, and
improved according to established goals and standards
research
investigation to discover facts affecting community health
and community health practice, solve problems, and
explore improved methods of health science
determinant of health
biology
determinant of health
behavior
determinant of health
social & physical environment
determinant of health
polices and interventions
clinician
most familiar role, ensures health services are provided
educator / teacher
client is not acutely ill, so can absorb information better,
wide audience can be reached
advocate
2 goals: help clients gain greater independence or self
determination; make the system more responsible and
relevant to the needs of clients. Every client has the right
to receive just, equal and humane treatment
collaborator
work jointly with others, need communication skills
leader
focuses on change, nurse becomes an agent of change,
influence people to think and behave differently about their
health
researcher
evidence based practice, systematic investigation,
collection, and analysis of data for solving problems and
enhancing community heath practice
case manager
has become the standard method of managing health care
in delivery systems in US. Evaluates progress to ensure
that clients' multiple service needs are met in a costeffective manner.
Florence Nightingale
early 19th century, crimean war, record keeping and
statistics, organized nursing care, kitchens, laundries,
"notes on nursing"
Federal agencies
DHHS, EPA, Homeland security, D of Agriculture, Dept of
Ed, VA
State agencies
Medicare, Medicaid, SCHIPS
medicare
medicaid
a federally aided, state operated program that provides
medical benefits for low-income persons in need of medical
care
OASIS
outcome, assessment information set: very detailed form
supplies
thrown away after each use
multiplicity of problems
finding more then one problem
maintaining balance
hospice
medicare is the main payment, even if you're under 65
hospice
you have 6 months or less to live
hospice
pain medication or no aggressive chemo or procedures
compounding pharmacist
combining drugs in a unique way in a hospice setting
I-Prepare
prevent, resident, environment, past work, activities,
resources, education
web of causation
the combination of factors that lead to a problem
contaminant
organic or inorganic that enters medium that renders it
impure
toxic agent
poisonous substance in the environment
overpopulation
exceeds ability of it's ecosystem to either support needs; 4
factors (starvation, disease, wars, aide from other
countries)
air pollution
high in industrial areas
radon
odorless, colorless, causes cancer
lead poisoning
affects CNS, old paint,
psychological hazards
noise, overcrowding, lack of natural beauty
traditional nursing
work as part of team, acute setting, with other
professionals
hospice
concept of palliative care for terminally ill patients,
referral sources
hospitals (MD, MSW, Case Mgr), Clinics (RN or MD), Families
(self)
vectors
carry diseases such as mosquitoes, flies, ticks, roaches,
fleas, rats, mice, and squirrels
Public health
a system and social enterprise; a profession; a collection of
methods, knowledge, and techniques; governmental health
services, especially medical care for the poor and
underserved; and the health status of the public
Epidemiology
the study of the occurrence and distribution of healthrelated states or events in specified populations, including
the study of the determinants influencing such states, and
the application of this knowledge to control the health
problems
Descriptive epidemiology
seeks to describe the occurrence of a disease in terms of
person, place, and time.
Analytic epidemiology
focuses on investigation of causes and associations.
Distribution
determine who has the disease and where and when the
disease occurs
The RN will
Demonstrate an understanding of the relationship of
genetics and genomics to health, prevention, screening,
diagnostics, prognostics, selection of treatment, and
monitoring of treatment effectiveness. Demonstrate ability
to elicit a minimum of a three-generation family health
history information. Construct a pedigree from collected
family history information using standardized symbols and
terminology. Collect personal, health, and developmental
histories that consider genetic, environmental, and
genomic influences and risk factors. Critically analyze the
history and physical assessment findings for genetic,
environmental, and genomic influences and risk factors.
Assess patients' knowledge, perceptions, and responses to
genetic and genomic information. Develop a plan of care
that incorporates genetic and genomic assessment
information.
Genomics will
enable medicine to be tailored to each person's needs
Genetic screening
Evaluate >1600 genetic disorders, First used in the late
1970s
Genomics
the study of individual genes in order to understand the
structure of the genome, including the mapping of genes
and sequencing the DNA.
Genomics examines
the molecular mechanisms and the interplay of genetic and
environmental, cultural, and psychosocial factors in disease
Genes
the DNA segments that carry the genetic information
Chromosomes
long structures that organize DNA
DNA replication
chromosomes are duplicated before cells divide
Mutations
DNA Repair
process in which mutations are corrected; estimates
indicate repair mechanisms correct at least 99.9% of initial
errors
I
Investigate Potential Exposures Investigate potential
exposures by asking: Have you ever felt sick after coming
in contact with a chemical, such as a pesticide or other
substances? Do you have any symptoms that improve
when you are away from your home or work?
P
Present WorkAt your present work: Are you exposed to
solvents, dusts, fumes, radiation, loud noise, pesticides, or
other chemicals? Do you know where to find material
safety data sheets for chemicals with which you work? Do
you wear personal protective equipment? Are work clothes
worn home? Do co-workers have similar health problems?
R
Residence When was your residence built? What type of
heating do you have? Have you recently remodeled your
home? What chemicals are stored on your property? Where
is the source of your drinking water
E
Environmental Concerns Are there environmental concerns
in your neighborhood (e.g., air, water, soil)? What types of
industries or farms are near your home? Do you live near a
hazardous waste site or landfill?
P
Past Work What are your past work experiences? What job
did you have for the longest period of time? Have you ever
been in the military, worked on a farm, or done volunteer
or seasonal work?
A
Activities What activities and hobbies do you and your
family pursue? Do you burn, solder, or melt any products?
Do you garden, fish, or hunt? Do you eat what you catch or
R
Referrals and Resources Use these key referrals and
resources: Environmental Protection Agency
(http://www.epa.gov) National Library of MedicineToxnet
Programs (http://www.nlm.nih.gov) Agency for Toxic
Substances and Disease Registry
(http://www.atsdr.cdc.gov) Association of Occupational and
Environmental Clinics (http://www.aoec.org) Occupational
Safety and Health Administration (http://www.osha.gov)
EnviRN website (http://www.enviRN.umaryland.edu) Local
Health Department, Environmental Agency, Poison Control
Center
E
Educate (A Checklist) Are materials available to educate
the client? Are alternatives available to minimize the risk of
exposure? Have prevention strategies been discussed?
What is the plan for follow-up?
Epidemiology
The science that helps us understand the strength of the
association between exposures and health effects
Epidemiologic triangle
Agent, host, and environment, a simple model that belies
the often complex relationships between agent, which may
include chemical mixtures (i.e., more than one agent); host,
which may refer to a community with people of multiple
ages, genders, ethnicities, cultures, and disease states; and
environment, which may include dynamic factors, such as
air, water, soil, and food, as well as temperature, humidity,
and wind.
Agent
Chemical or disease
Host
Community, patient,
Environment
water, air, cleanliness, plumbing, sewer systems, soil,
temperatures, climates, habits and customs
Health departments
conduct assessments of community health status, a core
function of public health, on an ongoing basis
Executive branch
Suggests, administers, and regulates policy. President,
cabinet, various administrative and regulatory
departments, and agencies. U.S. Department of Health and
Human Services.
Legislative branch
Identifies problems and proposes, debates, passes, and
modifies laws to address those problems. Identifies
problems and proposes, debates, passes, and modifies laws
to address those problems. Senate and House of
Representatives.
Judicial branch
Interprets laws and their meaning. System of federal, state,
and local courts guided by opinions of the Supreme Court.
Machine Co. v. Davis.
Culture
A set of beliefs, values, and assumptions about life that are
widely held among a group of people and that are
transmitted intergenerationally. Develops over time and is
resistant to change. Each culture has its own unique
Race
A social classification that relies on physical markers, such
as skin color, to identify group membership. Individuals
may be the same race but of different cultures
Ethnicity
The shared feeling of peoplehood among a group of
individuals. Reflects membership in a cultural group and is
based on individuals sharing similar cultural patterns.
Represents the identifying characteristics of culture, such
as race, religion, or national origin, and affects beliefs,
behaviors, and access to resources. Members of an ethnic
group are likely to give up aspects of their identity and
society when they adopt characteristics of another group's
identity. However, when there is a strong ethnic identity,
the individual maintains the values, beliefs, behaviors,
practices, and ways of thinking of their group.
Legal immigrants
Make up 80% of immigrant population. Are not citizens but
are legally allowed to work and live in the United States.
Nonimmigrants
are admitted to the United States for a limited duration and
for a specified purpose. include students, tourists,
temporary workers, business executives, career diplomats
and their spouses and children, artists, entertainers, and
reporters.
Advocacy
Advocacy
Act in accordance with the patient's wishes and
instructions. Keep the patient properly informed. Carry out
instructions with diligence and competence. Act impartially
and offer frank, independent advice. Maintain patient
confidentiality.
Feminist ethics
encompasses the tenets that women's thinking and moral
experiences are important and should be taken into
account in any fully developed moral theory, and that the
oppression of women is morally wrong. Entails knowledge
about the social, cultural, political, legal, economic,
environmental, and professional contexts that insidiously
and overtly oppress women as individuals, or within a
family, group, community or society. Demand results.
Nurses were reluctant to embrace feminism and it's ethics
for many years.
competencies of PH
In the spring of 2010 this Council, funded by the Centers
for Disease Control and Prevention, Health and Human
Services (HHS), adopted an updated set of Core
Competencies ("a set of skills desirable for the broad
practice of public health")
(http://www.phf.org/link/corecompetencies.htm) for all
public health professionals, including nurses.
Shattuck Report
was published in 1850 by the Massachusetts Sanitary
Commission with an emphasis on the public's health. The
report called for major innovations: the establishment of a
state health department and local health boards in every
town; sanitary surveys and collection of vital statistics;
environmental sanitation; food, drug, and communicable
disease control; well-child care; health education; tobacco
and alcohol control; town planning; and the teaching of
preventive medicine in medical schools. However, these
recommendations were not implemented in Massachusetts
for 19 years, and in other states much later.
Crimean War
Disparities
Racial or ethnic differences in the quality of health care, not
based on access, clinical needs, preferences, or
appropriateness of an intervention
-Indicators that continue to cause disparities in the United
States' health care system:
Cost
Access
Quality
Primary care
Efficiency
Suggests that inputs are combined and used in such a way
that there is no better way to produce the service, or
output, and that no other improvements can be made
refers to producing maximal output, such as a good or
service, using a given set of resources (or inputs), such as
labor, time, and available money.
Effectiveness
For example, effectiveness of a mass immunization
program is related to the level of "herd immunity"
developed.
refers to the extent to which a health care service meets a
stated goal or objective, or how well a program or service
achieves what is intended.
macroeconomics
Focuses on the "big picture"the total, or aggregate, of all
individuals and organizations
Aggregate is usually a country or nation
Ethics
is concerned with a body of knowledge that addresses such
questions as the following: How should I behave? What
actions should I perform? What kind of person should I be?
What are my obligations to myself and to fellow humans?
There are general obligations that humans have as
members of society.
Ethical judgments
are concerned with values. The goal of an ethical judgment
is to choose that action or state of affairs that is good or
right in the circumstances.
Consequentialism
The decision is based on outcomes or consequences. That
approach to ethical decision making maintains that the
right action is the one that produces the greatest amount
of good or the least amount of harm in a given situation.
Utilitarianism
is a well-known consequentialist theory that appeals
exclusively to outcomes or consequences in determining
which choice to make.
Deontology
may conclude that the action is right or wrong in itself,
regardless of the amount of good that might come from it.
Non-maleficence
requires that we do no harm. It is impossible to avoid harm
entirely, but this principle requires that health care
professionals act according to the standards of due care,
always seeking to produce the least amount of harm
possible.
Beneficence
This principle is complementary to nonmaleficence and
requires that we do good. We are limited by time, place,
and talents in the amount of good we can do. We have
general obligations to perform those actions that maintain
or enhance the dignity of other persons whenever those
actions do not place an undue burden on health care
providers.
Distributive justice
Distributive justice requires that there be a fair distribution
of the benefits and burdens in society based on the needs
and contributions of its members. This principle requires
that, consistent with the dignity and worth of its members
and within the limits imposed by its resources, a society
must determine a minimal level of goods and services to be
available to its members.
Egalitarianism
is the view that everyone is entitled to equal rights and
equal treatment in society.
Libertarian
view of justice holds that the right to private property is the
most important right.
lillian wald
- first public health nurse--started public health nursing
- known fo establishmen of henry street settlements in new
york
- national organization of public health established in 1912was the president
Lina Rogers
-first school nurse
- focused on investigating the cause of absenteeism
- did not treat illness- physicians job at the time
segregation
- lasted until 1960s
- made it difficult for african american nurses to get
certification and graduate education
mary breckenridge
- developed health programs to improve healthcare in rural
and hard to reach populations in the applachians of
southern kentucky
ruth freeman
leading healh educator, author, consultant and leader of
national health organization of the 20th century
- offeren many professional oppurtunities
- saw nursing as intellectually challenging and was about
caring for people
WHO conference
- @ Alma Ata in 1978
- main focus of the conference was
worldwideimplementation of primary health
population health
holistic approach that considers the total health system
and focuses on the broad range of factors and conditions
that have a strong influenceon the health of population
- determinants social factors, social support netweorks,
education,m employmentm, and healthy child development
mulitlatral organizations
organizations that recieve fundings from mulple
governmental and non-governmental sources
bio terrorism
intentiaonal use of a pathogen or biological product to
cause harm to living organisms to influence or intimidatt eh
conduct of a government and cause harm to other
people. :
- role of PHN and healh officieals is to detect pathogen ,
manage services, and communicate during threat
- anthrax, plague, and smallpox biological agens highest
concern
environmental health
chemical exposure
nurses have made discoveries based on assessing people
presenting with signs and symptoms related to known
chemical toxicity
epidemiology
studies the incidence and prevalence of disease, in
POPULATIONS
- helps us to understand the strength of the association
between exposure and health effects
- monitors health of populations , understands
determinants of health and disease in communities, and
investigates and evaluates interventions to prevent disease
and maintain health
- father of epidemiology is JOHN SNOW_ because of his
work with cholera
toxicology
study of health effects associated with chemical exposures
rule of seven
native american concept, what will be the effect of this
decision in 7 years. .
- native americans believe humans are stewards, not
propieters of the land
attack rate
-a measure of morbididity often used in infectious disease
investigations
- often specific to an exposure such as food specific attack
rates
-rate that best indicates the proportion of people exposed
to an agent who deelop the disease.
mortality rates
reflect serious health problems and changing patterns of
disease
- do not give direct info about level of existing disease or
the risk of getting a disease
-informative only for fatal diseases
descriptive epidemiology
seeks to describe a desiease entitiy according to person,
place, and time
analytical epidemiology
directed toward understanding the etiology of the disease
and attempts to dienitfy the determinants of disease in
individuals
- determinants may be indvidiual, social , communal, or
environmental
- Examples- cohort studies (prospective and retrospective);
case control studies, cross sectional studies, ecological
studies
rate
measure of frequency of a health event in a "definied
population in a specified period of time
- not a proportion because the denominator is a function of
both the population size and the dimension of time while
the numberator is the number of events
- one cannot tell the degree of seriousness or if it is an
epidemic if you do not have a deonomiator which
represents the total population
risk
the probability an even will occur within a specified time
incidence rate
the number of new cases developing in a population at risk
during a sepcified period
formula= # of new cases (divided by) total population at
risk x 1,000
incidence
quantifies the rate of development of new cases in a
population at risk
epidemic
when the rate of disease injury or other condition exceeds
the usual level of that position
- Examples- an isolatedcase of smallpox in Africa because
there is no smallpox; nursing shortage in US, adult obesity
in the US,
primary prevention
secondary prevention
focuses on ealy detection and prompt treatment of disease
injury or disability. things before symptoms occur . ie
screening for hearig defects, mammograms
tertiary prevention
interventions aimed at disability limitation, and
rehabilitation from disease, injury and disability
- EXAMPLES- rehbilitative job training, vocational training
specificity
a screening test has high specificity - meaning that the test
accuately identifies those without the trait
-the test accuractely identigying those without the trait
point epidemic
- temporal and spatial pattern of disease distribution
- illustrated with freuqncy of disease plotted against time
0 shapr peak indicates concentration of cases in some
short interval of time
- example- outbreak of GI illness from a food borne
pathogen
cohort study
describes a group of persons enroled in a study that share
the same characteristic of interest for a period of time
community trial
as opposed to clinical trials * treatment of existing disease)
is focused on health promotion and disease prevention
Example: Residents of a city have recently voted to add
fluoride to the H20. Epidemiologists wanting to study the
effect on dental caries would be conducting a....
systemetic review
- one of the two ways nurses can read research in
condenced format
- method of identifying, appraising and synthesizing
research evidence to evaluate all available research to a
particular question
- usually done by more than one person and describes the
methods used to search for the evidence
population
a collection of individuals who share at least one common
characteristic
aggregate
definied poplation made up of individuals in communities fo
a specific geographic regions
assurance
making sure that community oriented helath servies are
avaiable .
a core function
core functions
assurance, policy development, assessment, and ascietific
based care
CDC
- implement quality performance standards in public
health. which are used to guid e improvents in the public
health system.
- 1998
assessment
policy development
one of the core functions of public health needed to provide
leadership in deveoping policies.
determinants
- factors, exposures, characteristics and behaviors that
determine patterns of disease.
- may be individual , relational or social, communal, or
environmental
prevalence
the measure of existing disease in a population at a
particular time
Ex: a screening for HTN revleaed 20 previously diagnosed
hypertensive individuals and 10 probable new cases ,
which were later confirmed for a total of 30 cases.
total # of cases divided by total population at risk times
100,000
predictive value
Positive predictor value refers to the proportion of persons
with a positive test who actually have the disease,
interpreted as the probability that an individual with a
positive test has the disease.
nursing model
a tangible schematic and often visual representation of
relationships between and among key concepts that
explain how something works
core
people and their demographics, vital statistics, values,
beliefs, community perception, and history; center which
represents things necessary for life
8 subsystems
physical environment, education, safety and transportation,
politics and government, health and social services,
communication, economics, and recreation
lines of resistance
internal mechanisms that act to defend against stressors;
community strength; an evening recreational program for
young people implemented to decrease vandalism
stressor
tension-producing stimuli that have the potential of causing
disequilibrium in the system; may originate outside the
community or inside the community--inadequate,
inaccessible, or unaffordable services
degree of reaction
stressors and lines of resistance become a part of
community and nursing diagnosis; amount of
disequilibrium or disruption that results
vulnerability
social groups who have an increased relative risk or
susceptibility to adverse health outcomes; increased
morbidity, premature mortality, and diminished quality of
life
CareLink
financial assistance program for medical services received
within University Health System and our providers;
payment plan and payer of last resort; not health insurance
and not free
cultural competence
the ability to express an awareness of one's own culture, to
recognize differences between oneself and others, to adapt
behaviors to appreciate and accommodate those
differences; recognize that people with cultural
backgrounds different from our own have unique values,
life ways, health practices, and interpersonal styles.
population
could include a race, ethnic group, religious group,
profession, a company, people with a certain sexual
preference, or gender; even from the area of the country
that one resides
cultural proficiency
having a vision that you can create an environment for
social change and social justice in your interactions with
colleagues, families and communities to effectively serve
the needs of all cultural groups
family
cultural encounter
process which encourages the healthcare professional to
directly engage in face-to-face cultural interactions and
other types of encounters with clients from culturally
diverse backgrounds in order to modify existing beliefs
about a cultural group and to prevent possible
stereotyping; exposure and practice
cultural knowledge
process in which the healthcare professional seeks and
obtains a sound educational base about culturally diverse
groups; healthcare professionals must focus on the
integration of three specific issues: health-related beliefs
practices and cultural values; disease incidence and
prevalence; cultural views, theoretical and conceptual
framework
cultural awareness
conducting self examination; acknowledgment and
awareness of one's own culture and willingness to explore
one's own feelings and biases; awareness of how culture
influences own ways of thinking and making decisions;
acknowledgement of how day-to-day behaviors reflect
cultural norms and values perpetuated by our families and
larger social networks
cultural assessment
use client's preferred language; be aware of client's
priorities; check client's understanding of diagnoses, and
treatment plan; ask whether client is using alternative
treatments; what or who is the support system; ask what
they think about the problem; ask what treatment they
think will help; what do they hope to receive from your
care; what do they fear most about the problem or
treatment; keep in mind background and individual and
biological differences
education
Religion-does the patient/family have beliefs that you need
to respect and accommodate for to enable you to care for
them
family forms and meaning of family
ethnocentrism
the belief that your cultural values, beliefs, and life ways
are superior to all others; the standard by which one judges
all other cultural patterns; one must be self aware of
perceptions and subsequent judgments are not
ethnocentric
health disparities
differences in the incidence, prevalence, mortality, and
burden of diseases and other health conditions among
specific population groups.
Health Leads
national nonprofit organization that connects low-income
patients with the basic resources they need to be healthy
upstream determinants
features of the social environment, such as socioeconomic
status and discrimination, that influence individual
behavior, disease, and health status.-preventive, health
promotion
downstream preventions/interventions
short-term, problem-specific, individual-based
interventions; after the fact--after disease process has
started.
community assessment
act of becoming acquainted with a community; assessing a
community to identify factors (both positive and negative)
that impinge on the health of the people to develop
strategies for health promotion
Lillian Wald
recognized the intertwining of health status, environmental
sanitation, and social and political forces; mother of public
health nursing; contributions include establishing nursing
schools, advocating for better housing, working to change
child labor laws, teaching preventive practices, advocating
occupational health nursing, and improving the education
of public health nurses
windshield survey
crucial to community assessment because it serves as a
model, or map, to direct and guide that assessment
process; it guides the community assessment; learning
about the community of foot/drive by
CAP Assessment
CAP will guide assessment process; assess core and 8
subsystems (relationships); many methods used to assess
data-observation, interviews, data collection
CAP Planning
goals derived from stressors (weaknesses): aim to mitigate,
alleviate, eliminate the stressor; strengthen the
community's lines of defense; plan interventions to
strengthen lines of resistance
CAP Interventions
all are preventive in nature; Primary-aims at strengthening
the lines of defense, secondary-applied after stressor has
penetrated the community, and tertiary-applied after
stressor pentrates and the degree of reaction has taken
place resulting in system disequilibrium
CAP Evaluation
based on feedback from the community: involves
community in all phases of the nursing process to ensure
success
outcomes: may use same parameters as used in
assessment
bioterrorism
intentional release of pathogens or biologic agents to cause
harm--biological disaster
pandemic
steady occurrence of disease over a large geographic area
or worldwide, such as malaria in Africa
epidemic
unexpected increase of an infectious disease in a
geographic area over an extended period of time; defined
relative to the infectious agent and the history of the
disease in the area
endemic
occur at a consistent, expected level in a geographic areaSTI, tuberculosis
outbreak
unexpected occurrence of an infectious disease in a limited
geographic area during limited period of time
unable to move
Sort: categorize victims based on urgency of care
Send: transport injured persons away from the scene
triage in disaster
emphasis may shift from meeting the most urgent
individual need to meeting the needs of the largest
numbers of victims to maximize the number of lives saved;
should be an ongoing activity. Assess, Assess, Assess-move
move move.
SARS
severe acute respiratory syndrome, outbreak in 2003
disaster
occurs as the result of an event where "normal conditions
of existence are disrupted and the level of suffering
exceeds the capacity of the hazard-affected community to
respond to it"
emergency
occurs as the result of an event where "normal procedures
are suspended and extraordinary measures are taken in
order to avert the impact of a hazard on the community"-can become a disaster
hazard
occurs when an event "has the potential to cause
disruption or damage to the community; earthquake, flood,
typhoon and cyclone--some may become emergencies but
not all become disasters
early colonial PH
efforts
Principles of Nursing
William Rathborne
founded first district nursing association in liverpool,
england
rathbone and nightingale recommended steps to provide
nursing in the home, and district nursing was organized
thorughout england
1870s
first nightingale model nursing schools started
1877
women's board of the new york city mission hired frances
root
1878
ethical culture society of new york hired four nurses to
work in dispensaries
1885-1886
visiting nurses association were established
lina rodges
first united states school nurse
worked with children in NYC schools
She and her other school nurses found illness was often not
the reason for absence
late in 1800s
local health departments formed
1918
Economic depression
agenecies and communities not prepared to address the
increased needs and numbers of impoverished (decreased
funding)
Agencies that helped to support nurse employment
(Federal Emergency relief administration, works progress
administration, relief nursing service, civil works
administratin)
1932 survery
found only 7% of nurses working in PH were adequtely
prepared
world war II
accelerated need for nurses, both for war effort and home
nursing council on national defense
many nurses joined the army, and navy nurse corps.
bolton act of 1943 established cadet nurses corps
some expansion of PHN scope of practice
Emergency maternity and infant care act of 1943
Job opportunities
1960s
medicare and medicad
did not include coverage for preventive services
home health care only reimbursed if ordered by a physician
increase in for-profit home health agencies
reduction in health promotion and disease prevention by
local and state departmetns
1970s
Nurse made significant contribution to:
the hospital movement
the development of birthing centers
1980s
concern about high health costs
fundign shifted away from health promotion and disease
prevention to acute care
national center for nursing research (NCNR) established in
1985 (gained offical status within NIH in 1993, beocming
NINR
IOM's report the future of public health 1988
Healthy people initaitve began
1990s
health care debate focused on cost, quality, and access to
direct care services
nursing organizations joined to support health care reform
2000s
health care reform finally passed in 2010 with the federal
patient protection and affordable care act
PHN organizations develop position papers on:
graduate education for advance practice PHN
faculty qualifactions for community/public health nursing
educators
importance of PHN within PH systems
Better nutrition, water, antibiotics, immunizations. PUBLIC
HEALTH.
Life Expectancy - U.S.
What factors/events resulted in the 21+ additional years of
life from 1900-1950???
What factors/events resulted in the 7 additional years of
life from 1950-1990?
1. Upstream
2. Downstream
There are two views of the health care picture
We need to question the way we have thought of health
and health care...
Should we focus on treatment of illness or prevention of
disease in the first place?
1. Microscopic
2. Medical Model
3. Downstream
_______ approach to solving community health problems
(the _____ or _____):
- Individual (family) response to health and illness
- Emphasizes behavioral responses to illness or lifestyle
patterns
- Nursing interventions aimed at the individual
------Changing lifestyles
------Changing perceptions or belief system
- The individual is the locus of change
- Focuses on the "cure"
1. Macroscopic
2. Public Health
3. Upstream
______ approach to solving community health problems
(______ or _______)
- Interfamily and intercommunity themes
- Emphasizes social, economic, and environmental
precursors of illness
- Nursing interventions may include modifying social or
environmental variables
- May involve social or political action
- society (social system) is the locus of change
- focuses on "prevention"
1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
Transtheoretical Model (Stages of Change):
1. _______: No intention to change behavior in the next 6
months
------May be lack of information about consequences or
previous failure.
2. _______: Individual intends to change behavior in the next
6 months.
------Weighs pros and cons
3. _______: Individual intends to act within the next month
and has taken steps toward change
------Has a plan of action
4. _______: Individual has changed behavior for less than 6
months
------Change is sufficient to reduce disease risk.
5. _______: Individual has changed behavior for more than 6
months.
------Tries to prevent relapse
------Phase may last months to years
1. Smoking cessation
2. Injury prevention
3. RNs assisting families obtain health insurance
1. Health Disparities
2. Health and social justice
Examples of applying critical social theory:
1.
2.
1. Purposeful actions
2. Processes
3. Responses
4. Behaviors
Definitions of Health:
Health consists of:
_____, ______, _____, or _____ that leads to: "soundness,"
"wholeness," or "well-being"
1. Physical Environment
2. Social Environment
3. Individual Behavior
4. Biology & Genetics
5. Health Services
6. Policy making
Determinants of Health:
Health Outcomes due to:
1.
2.
3.
4.
5.
6.
Physical Environment
Determinants of Health - Examples of ______ factors:
- Natural environment (ie plants, weather, climate change)
- Worksites, schools and recreational settings
- Housing, homes, neighborhoods
- Exposure to toxic substances
- Physical barriers
- Aesthetic elements (ie good lighting, trees, parks)
Social Factors
Determinants of Health - Examples of ______ factors:
- Availability of resources (ie educational and job
opportunities, living wages, healthful foods)
- Social norms and attitudes
- Exposure to crime and violence
- Social interactions
- Exposure to emerging technology (ie the Internet)
- Transportation options
Individual Behaviors
Determinants of Health - Examples of ______ factors:
- Diet
- Physical activity
- Alcohol, tobacco and other drug use
- Sexual behavior
- Hand washing
Health Service
Determinants of Health - Examples of ______ factors:
- Barriers (lack of availability, high cost, lack of insurance,
language issues)
------- Unmet health needs
Policy Making
Determinants of Health - Examples of ______ factors:
- Health curricula requirements
- Increased taxes on tobacco
- Prohibitions on smoking
- Drinking age restrictions
- Seat belt laws and child restraints
1. Life expectancy
2. Health life expectancy
3. Years of potential life lost
4. Physically and mentally unhealthy days
5. Self-assessed health status
6. Limitation of activity
7. Chronic Disease Prevalence
Indicators of General Health Status:
1.
2.
3.
4.
5.
6.
7.
Community
___________:
- It can be a physical place or a geopolitical community.
- Has boundaries
- It can be a relational, interactive group. - A community
with no physical boundaries. A phenomenological
community is abstract. Churches, universities, online
groups are examples
Community
__________:
"A collection of people who interact with one another and
whose common interests or characteristics form the basis
for a sense of unity or belonging." (Nies and McEwen,
2011)
Community
__________:
"A group of people who share something in common and
interact with one another, who may exhibit a commitment
to one another and may share a geographic boundary."
1. People
2. They must interact with each other in some way
3. Something in common: an interest, a geographical
location, a commitment
A community has to have:
1.
2.
3.
1. Primary Prevention
2. Secondary Prevention
3. Tertiary Prevention
Levels of Prevention:
1.
2.
3.
Primary Prevention
_______ level of prevention
- activities preventing a problem before it occurs
- Health promotion
- Specific protection
- Immunizations
Secondary Prevention
________ level of prevention
- Early detection and prompt intervention
- Screening
- Early referral for treatment
- Screening for STDs
Tertiary Prevention
_______ level of prevention
- Focus on limitation of disability and rehabilitation
- Prevention progression of disease
- Reduce the effects of the disease
- Teaching insulin administration
---------------------------------
Community-based nursing
___________:
o Nursing of individuals and families to improve their
health
o Goals: Help them manage illness while they move among
health care settings
o Promote self-care and rehabilitation; prevent disease
o Processes: NP; diagnosis and treatment
Community clinics
School clinics
Workplace clinics
Rehabilitation centers
Settings for Community-based nursing:
1.
2.
3.
4.
5.
6.
Clinical Nursing
_________:
o Goal: improve the health of patients
o Clients: Patients of the health care system
o Processes used: nursing process, treatment and patient
care procedures
o Settings: inpatient
1. Surveillance
2. Disease and other health event investigation
3. Outreach
4. Screening
5. Case finding
6. Referral and Follow-up
7. Case management
8. Delegated functions
9. Health Teaching
10. Counseling
11. Consultation
12. Collaboration
13. Coalition Building
14. Community Organizing
15. Advocacy
16. Social Marketing
17. Policy and enforcement
Public Health Interventions:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
12.
13.
14.
15.
16.
17
Surveillance
Describes and monitors health events through ongoing and
systematic collection, analysis and interpretation of health
data for the purpose of planning, implementing and
evaluating public health interventions
Outreach
Locates populations of interest or populations at risk and
provides information about the nature of the concern, what
can be done about it, and how services can be obtained
Screening
Identifies individuals with unrecognized health risk factors
or asymptomatic disease conditions in populations
Case finding
Locates individuals and families with identified risk factors
and connects them with resources
Case Management
Optimizes self-care capabilities of individuals and families
and the capacity of systems and communities to coordinate
and provide services
Delegated Functions
Direct care tasks a registered professional nurse carriers
out under the authority of a health care practitioner as
allowed by law
Health Teaching
Communicates facts, ideas, and skills that change
knowledge, attitudes, values, beliefs, behaviors, and
practices of individuals, families, systems, and/or
communities
Counseling
Establishes an interpersonal relationship intended to
increase or enhance capacity for self-care and coping with
a community, system, and family or individual
Consultation
Collaboration
Commits two or more persons or organization to achieve a
common goal through enhancing the capacity of one or
more of the members to promote and protect health
Coalition Building
Promotes and develops alliances among organizations or
constituencies for a common purpose
Community Organizing
Helps community groups to identify common problems or
goals, mobilize resources, and develop and implement
strategies for reaching the goals they collectively have set
Advocacy
Plead someone's cause or act on someone's behalf, with a
focus on developing the community, system, and individual
or family's capacity to plead their own cause or act on their
own behalf
Social Marketing
Utilizes commercial marketing principles and technologies
for programs designed to influence the knowledge,
attitudes, values, beliefs, behaviors, and practices of the
population of interest
John Snow
_______: Father of epidemiology
1. Pasteur
2. Lister
3. Koch
____, _____, _____: On "germs" and disease causation (late
1800s)
1. Edward Jenner
2. Edwick Chadwick
History of Public Health Nursing:
Pre 1850: Home visiting to sick as an act of charity.
- ______ observed people who worked around cattle were
less likely to have smallpox.
- _______ called attention to the consequences of unsanitary
conditions that resulted in health disparities that shortened
the life span of the laboring class in particular.
1. John Snow
2. Florence Nightingale
3. Pasteur, Lister, Koch
4. Lilian Wald
5. Mary Brewster
History of Public Health Nursing:
1850-1900: Home visiting to sick
- _______ demonstrated that cholera was transmissible
through contaminated water.
-________ - credited with establishing "modern nursing."
- ________: On "germs" and disease causation (late 1800s)
- In 1893, nurses _______ ("mother of community nursing")
and _______ established a district nursing service on the
lower east side of New York City called The House on Henry
Street.
1. 1900-1960s
History of Public Health Nursing:
________:
- Nursing in community centers for the poor
- Communicable disease control
- Communicable disease control/immunization
- Rise in PHN, home visits, school and OH nursing
1. 1960-1980
History of Public Health Nursing:
________: Care provided in public health clinics
1. 1980s-present
History of Public Health Nursing:
_________:
- Health promotion and education
- Health care access improvement
1. Poverty
2. Violence
3. HIV/AIDS
4. TB
5. Bioterrorism
Public/Community Health Nursing Today in U.S.
- Concerned with contemporary problems such as _____,
______, ______, _______, and _______.
- Practice is everywhere in public health agencies, schools,
occupational settings, community-based agencies, etc.
Healthy People
__________:
- provides science-based, 10-year national objectives for
improving the health of all Americans. For 3 decades, this
has established benchmarks and monitored progress over
time in order to:
o Encourage collaborations across communities and
sectors.
o Empower individuals toward making informed health
decisions.
o Measure the impact of prevention activities.
- Vision: A society in which all people live long, healthy lives
E.
F.
G.
Community organizing
Nursing process
Community diagnosis
Epidemiologic process
4. R.A. 1054 is also known as the Occupational Health Act. Aside from
number of employees, what other factor must be considered in determining
the occupational health privileges to which the workers will be entitled?
Type of occupation: agricultural, commercial, industrial
Location of the workplace in relation to health facilities
Classification of the business enterprise based on net profit
H.
E.
F.
G.
H.
21
101
201
301
6. When the occupational health nurse employs ergonomic principles, she is
performing which of her roles?
E.
F.
G.
H.
E.
F.
G.
H.
E.
For
For
For
For
10. We say that a Filipino has attained longevity when he is able to reach the
average lifespan of Filipinos. What other statistic may be used to determine
attainment of longevity?
E.
F.
G.
H.
E.
E.
F.
G.
H.
Primary
Secondary
Intermediate
Tertiary
15. Which is true of primary facilities?
E.
F.
G.
H.
E.
Effectiveness
Efficiency
Adequacy
Appropriateness
18. You are a new B.S.N. graduate. You want to become a Public Health
Nurse. Where will you apply?
E.
F.
G.
H.
Department of Health
Provincial Health Office
Regional Health Office
Rural Health Unit
19. R.A. 7160 mandates devolution of basic services from the national
government to local government units. Which of the following is the major goal
of devolution?
E.
F.
G.
H.
E.
F.
G.
H.
Mayor
Municipal Health Officer
Public Health Nurse
Any qualified physician
21. Which level of health facility is the usual point of entry of a client into the
health care delivery system?
E.
F.
G.
H.
Primary
Secondary
Intermediate
Tertiary
22. The public health nurse is the supervisor of rural health midwives. Which
of the following is a supervisory function of the public health nurse?
E.
F.
G.
H.
E.
F.
G.
H.
E.
F.
G.
H.
1
2
3
The RHU does not need any more midwife item.
25. If the RHU needs additional midwife items, you will submit the request for
additional midwife items for approval to the
E.
F.
G.
H.
E.
F.
Act 3573
R.A. 3753
G.
H.
R.A. 1054
R.A. 1082
27. According to Freeman and Heinrich, community health nursing is a
developmental service. Which of the following best illustrates this statement?
E.
Poliomyelitis
Measles
Rabies
Neonatal tetanus
29. The public health nurse is responsible for presenting the municipal health
statistics using graphs and tables. To compare the frequency of the leading
causes of mortality in the municipality, which graph will you prepare?
E.
F.
G.
H.
Line
Bar
Pie
Scatter diagram
30. Which step in community organizing involves training of potential leaders
in the community?
E.
F.
G.
H.
Integration
Community organization
Community study
Core group formation
10. We say that a Filipino has attained longevity when he is able to reach the average
life span of Filipinos. What other statistic may be used to determine attainment of
longevity?
A. Age-specific mortality rate
B. Proportionate mortality rate
C. Swaroops index
D. Case fatality rate
11. Which of the following is the most prominent feature of public health nursing?
A. It involves providing home care to sick people who are not confined in the hospital
B. Services are provided free of charge to people within the catchment area
C. The public health nurse functions as part of a team providing a public health nursing
service
D. Public health nursing focuses on preventive, not curative services
12. According to Margaret Shetland, the philosophy of public health nursing is based
on which of the following?
A. Health and longevity as birthrights
B. The mandate of the state to protect the birthrights of its citizens
C. Public health nursing as a specialized field of nursing
D. The worth and dignity of man
13. Which of the following is the mission of the Department of Health?
A. Health for all Filipinos
B. Ensure the accessibility and quality of health
C. Improve the general health status of the population
D. Health in the hands of the Filipino people by the year 2020
14. Region IV Hospital is classified as what level of facility?
A. Primary
B. Secondary
C. Intermediate
D. Tertiary
15. What is true of primary facilities?
30. Which step in community organizing involves training of potential leaders in the
community?
A. Integration
B. Community organization
C. Community study
D. Core group formation
31. In which step are plans formulated for solving community problems?
A. Mobilization
B. Community organization
C. Follow-up/extension
D. Core group formation
32. The public health nurse takes an active role in community participation. What is
the primary goal of community organizing?
A. To educate the people regarding community health problems
B. To mobilize the people to resolve community health problems
C. To maximize the communitys resources in dealing with health problems
33. An indicator of success in community organizing is when people are able to:
A. Participate in community activities for the solution of a community problem
B. Implement activities for the solution of the community problem
C. Plan activities for the solution of the community problem
D. Identify the health problem as a common concern
34. Tertiary prevention is needed in which stage of the natural history of disease?
A. Pre-pathogenesis
B. Pathogenesis
C. Predromal
D. Terminal
35. Isolation of a child with measles belongs to what level of prevention?
A. Primary
B. Secondary
C. Intermediate
D. Tertiary
36. On the other hand, Operation Timbang is_____ prevention?
A. Primary
B. Secondary
C. Intermediate
D. Tertiary
37. Which type of family-nurse contact will provide you with the best opportunity to
observe family dynamics?
A. Clinic consultation
B. Group conferences
C. Home visit
D. Written communication
38. The typology of family nursing problems is used in the statement of nursing
diagnosis in the care of families. The youngest child of the delos Reyes family has
been diagnosed as mentally retarded. This is classified as:
A. Health threat
B. Health deficit
C. Foreseeable crisis
D. Stress point
39. The delos Reyes couple have 6-year old child entering school for the first time.
The delos Reyes family has a:
A. Health threat
B. Health deficit
C. Foreseeable crisis
D. Stress point
40. Which of the following is an advantage of a home visit?
A. It allows the nurse to provide nursing care to a greater number of people
B. It provides an opportunity to do first hand appraisal of the home situation
A. Epidemic occurrence
B. Cyclical variation
C. Sporadic occurrence
D. Secular occurrence
51. In the year 1980, the World Health Organization declared the Philippines, together
with some other countries in the Western Pacific Region, free of which disease?
A. Pneumonic plaque
B. Poliomyelitis
C. Small pox
D. Anthrax
52. In the census of the Philippines in 1995, there were about 35,299,000 males and
about 34,968,000 females. What is the sex ratio?
A. 99.06:100
B. 100.94:100
C. 50.23%
D. 49.76%
53. Primary health care is a total approach to community development. Which of the
following is an indicator of success in the use of the primary health care approach?
A. Health services are provided free of charge to individuals and families
B. Local officials are empowered as the major decision makers in matters of health
C. Health workers are able too provide care based on identified health needs of the people
D. Health programs are sustained according to the level of development of the community
54. Sputum examination is the major screening tool for pulmonary tuberculosis.
Clients would sometimes get false negative results in this exam. This means that the
test is not perfect in terms of which characteristic of a diagnostic examination?
A. Effectiveness
B. Efficacy
C. Specificity
D. Sensitivity
55. Use of appropriate technology requires knowledge of indigenous technology.
Which medical herb is given for fever, headache and cough?
A. Sambong
B. Tsaang gubat
C. Akapulko
D. Lagundi
56. What law created the Philippine institute of Traditional and Alternative Health
Care?
A. RA 8483
B. RA4823
C. RA 2483
D. RA 3482
57. In traditional Chinese medicine, the yielding, negative and feminine force is
termed:
A. Yin
B. Yang
C. Qi
D. Chai
58. What is the legal basis of Primary Health Care approach in the Philippines?
A. Alma Ata Declaration of PHC
B. Letter of Instruction No 949
C. Presidential Decree No. 147
D. Presidential Decree 996
59. Which of the following demonstrates inter-sectoral linkages?
A. Two-way referral system
B. Team approach
C. Endorsement done by a midwife to another midwife
D. Cooperation between PHN and public school teacher
60. The municipality assigned to you has a population of about 20/000. Estimate the
number of 1-4 year old children who be given Retinol capsule 200.000 every 6
months.
A. 1,500
B. 1,800
C. 2,000
D. 2,300
61. Estimate the number of pregnant women who will be given tetanus toxoid during
an immunization outreach activity in a barangay with a population of about 1,500.
A. 265
B. 300
C. 375
D. 400
62. To describe the sex composition of the population, which demographic tool may
be used?
A. Sex ratio
B. Sex proportion
C. Population pyramid
D. Any of these maybe used
63. Which of the following is a natality rate?
A. Crude birth rate
B. Neonatal mortality rate
C. Infant mortality rate
D. General fertility rate
64. You are computing the crude rate of your municipality, with a total population o
about 18,000 for last year. There were 94 deaths. Among those who died, 20 died
because of diseases of the heart and 32 were aged 50 years or older. What is the
crude death rate?
A. 4.1/1000
B. 5.2/1000
C. 6.3/1000
D. 7.3/1000
65. Knowing that malnutrition is a frequent community health problem, you decided
to conduct nutritional assessment. What population is particularly susceptible to
protein energy malnutrition (PEM)?
A. Pregnant women and the elderly
B. Under 5 year old children
C. 1-4 year old children
D. School age children
66. Which statistic can give the most accurate reflection of the health status of a
community?
A. 1-4 year old age-specific mortality rate
B. Infant mortality rate
C. Swaroops index
D. Crude death rate
67. In the past year, Barangay A had an average population of 1655. 46 babies were
born in that year, 2 of whom died less than 4 weeks after they were born. They were 4
recorded stillbirths. What is the neonatal mortality rate?
A. 27.8/1000
B. 43.5/1000
C. 86.9/1000
D. 130.4/1000
68. Which statistic best reflects the nutritional status of a population?
A. 1-4 year old age-specific mortality rate
B. Proportionate mortality rate
C. Infant mortality rate
D. Swaroops index
69. What numerator is used in computing general fertility rate?
A. Estimated midyear population
B. Number of registered live births
C. Number of pregnancies in the year
D. Number of females of reproductive age
70. You will gather data for nutritional assessment of a purok. You will gather
information only from families with members who belong to the target population for
PEM. What method of delta gathering is best for this purpose?
A. Census
B. Survey
C. Record Review
D. Review of civil registry
71. In the conduct of a census, the method of population assignment based on the
actual physical location of the people is termed;
A. De jure
B. De locus
C. De facto
D. De novo
72. The Field Health Services and information System (FHSIS) is the recording and
reporting system in public health) care in the Philippines. The monthly field health
service activity report is a form used in which of the components of the FHSIS?
A. Tally report
B. Output report
C. Target/client list
D. Individual health record
73. To monitor clients registered in long-term regimens, such as the Multi-Drug
Therapy, which component will be most useful?
A. Tally report
B. Output report
C. Target/client list
D. Individual health record
74. Civil registries are important sources of data. Which law requires registration of
births within 30 days from the occurrence of the birth?
A. PD 651
B. Act 3573
C. RA 3753
D. RA 3375
75. Which of the following professionals can sign the birth certificate?
A. Public health nurse
B. Rural health midwife
C. Municipal health officer
D. Any of these health professionals
76. Which criterion in priority setting of health problems is used only in community
health care?
A. Modifiability of the problem
B. Nature of the problem presented
C. Magnitude of the health problem
D. Preventive potential of the health problem
77. The Sentrong Sigla Movement has been launched to improve health service
delivery. Which of the following is/are true of this movement?
A. This is a project spearheaded by local government units
B. It is a basis for increasing funding from local government units
C. It encourages health centers to focus on disease prevention and control
D. Its main strategy is certification of health centers able to comply with standards
78. Which of the following women should be considered as special targets for family
planning?
A. Those who have two children or more
B. Those with medical conditions such as anemia
C. Those younger than 20 years and older than 35 years
D. Those who just had a delivery within the past 15 months
79. Freedom of choice in one of the policies of the Family Planning Program of the
Philippines. Which of the following illustrates this principle?
A. Information dissemination about the need for family planning
B. Support of research and development in family planning methods
C. Adequate information for couples regarding the different methods
D. Encouragement of couples to take family planning as a joint responsibility
80. A woman, 6 months pregnant, came to the center for consultation. Which of the
following substances is contraindicated?
A. Tetanus toxoid
B. Retinol 200,000 IU
C. Ferrous sulfate 200mg
D. Potassium iodate 200 mg, capsule
81. During prenatal consultation, a client asked you if she can have her delivery at
home. After history taking and physical examination, you advised her against a home
delivery. Which of the following findings disqualifies her for a home delivery?
A. Her OB score is G5P3
B. She has some palmar pallor
C. Her blood pressure is 130/80
D. Her baby is in cephalic presentation
82. Inadequate intake by the pregnant woman of which vitamin may cause neural
tube defects?
A. Niacin
B. Riboflavin
C. Folic Acid
D. Thiamine
83. You are in a clients home to attend to a delivery. Which of the following will you
do first?
A. Set up a sterile area
B. Put on a clean gown and apron
C. Cleanse the clients vulva with soap and water
D. Note the interval, duration and intensity of labor and contractions
84. In preparing a primigravida for breastfeeding, which of the following will you do?
A. Tell her that lactation begins within a day after delivery
B. Teach her nipple stretching exercises if her nipples are everted
C. Instruct her to wash her nipples before and after each breastfeeding
D. Explain to her that putting the baby to breast will lessen blood loss after delivery
85. A primigravida is instructed to offer her breast to the baby for the first time within
30 minutes after delivery. What is the purpose of offering the breast this early?
A. To initiate the occurrence of milk letdown
B. To stimulate milk production by the mammary acini
C. To make sure that the baby is able to get the colustrum
D. To allow the woman to practice breastfeeding in the presence of the health worker
86. In a mothers class, you discuss proper breastfeeding technique. Which of these
is a sign that the baby has lactated on the breast property?
A. The baby takes shallow, rapid sucks
B. The mother does not feel nipple pain
C. The babys mouth is only partly open
D. Only the mothers nipple is inside the babys mouth
87. You explain to a breastfeeding mother that breastmilk is sufficient for all of the
babys nutrient needs only up to:
A. 3 months
B. 6 months
C. 1 year
D. 2 years
88. What is given to a woman within a month after the delivery of a baby?
A. Malunggay capsule
B. Ferrous sutfate l00mg O.D.
C. Retinol 200.000 IU 1 capsule
D. Potassium Iodate 200 mg, 1 capsule
89. Which biological used in EPI is stored in the freezer?
A. DPT
B. Tetanus toxoid
C. Measles vaccine
D. Hepatitis B vaccine
90. Unused BCG should be discarded how many hours after reconstitution?
A. 2
B. 4
C. 6
D. At the end of the day
91. In immunity school entrants with BCG, you not obliged to secure parental
consent. This is because of which legal document?
A. PD 996
B. RA 7864
C. Presidential Proclamation No. 6
D. Presidential Proclamation No. 46
92. Which immunization produces a permanent scar?
A. DPT
B. BCG
C. Measles vaccination
D. Hepatitis B vaccination
93. A 4 week old baby was brought to the health center for his first immunization.
Which can be given to him?
A. DPT1
B. OPV1
C. Infant BCG
D. Hepatitis B Vaccin
94. You will not give DPT 2 if the mother says that the infant had?
A. Seizures a day after DPT1
B. Fever for 3 days after DPT1
C. Abscess formation after DPT1
D. Local tenderness for 3 days after DPT1
95. A 2-month old infant was brought to the health center for immunization. During
assessment, the infants temperature registered at 38.1 C. Which is the best course
of action that you will take?
and his eyes are sunken. Using the IMCI guidelines, you will classify this infant in
which category?
A. No signs of dehydration
B. Some dehydration
C. Severe dehydration
D. The data is insufficient
101. Based on the assessment, you classified a 3-month old infant with the chief
complaint of diarrhea in the category of SOME DEHYDRATION. Based on the IMCI
management guidelines, which of the following will you do?
A. Bring the infant to the nearest facility where IV fluids can be given
B. Supervise the mother in giving 200 to 400 ml of Oresol in 4 hours
C. Give the infants mother instructions on home management
D. Keep the infant in your health center for close observation
102. A mother is using Oresol in the management of diarrhea of her 3-year old child.
She asked you what to do if her child vomits. You will tell her to:
A. Bring the child to the nearest hospital for further assessment
B. Bring the child to the health center for IV therapy
C. Bring the child to the health center for assessment by the physician
D. Let the child rest for 10 minutes then continue giving Oresol more slowly
103. A 1 1/2 year old child was classified as having 3rd degree of protein energy
malnutrition, kwashjorkor. Which of the following signs will be most apparent in this
child?
A. Voracious appetite
B. Wasting
C. Apathy
D. Edema
104. Assessment of a 2-year old child revealed baggy pants. Using the IMCI
guidelines, how will you manage this child?
A. Refer the child urgently to a hospital for confinement
B. Coordinate with the social worker to enroll the child in a feeding program
C. Make a teaching plan for the mother, focusing on the menu planning for her child
D. Assess and treat the child for health problems like infections and intestinal parasitism
105. During the physical examination of a young child, what is the earliest sign of
xerophthalmia that may observe?
A. Keratomalacia
B. Corneal opacity
C. Night blindness
D. Conjunctival xerosis
106. To prevent xerophthalmia, young children are given Retinol capsule every 6
months. What is the dose given to preschoolers?
A. 10, 000 IU
B. 20, 000 IU
C. 100, 000 IU
D. 200, 000 IU
107. The major sign of iron deficiency anemia is pallor. What part is best examined
for pallor?
A. Palms
B. Nailbeds
C. Around the lips
D. Lower conjunctival sac
108. Food fortification is one of the strategies to prevent micronutrient deficiency
conditions. RA 8976 mandates fortification of certain food items. Which of the
following is among these food items?
A. Sugar
B. Bread
C. Margarine
D. Filled milk
109. What is the best course of action when there is a measles epidemic in a nearby
municipality?
A. Give measles vaccine to babies aged 6 to 3 months
B. Give babies aged 6 to 11 months one dose of 100,000 IU of Retinol
C. Instruct mother to keep their babies at home to prevent disease transmission
D. Instruct mothers to feed their babies adequately to enhance their babies resistance
110. A mother brought her daughter, 4 years old, to the RHU because of cough and
colds. Following the IMCI assessment guide, which of the following is a danger sign
that indicates the need for urgent referral to a hospital?
A. Inability to drink
B. High grade fever
C. Signs of severe dehydration
D. Cough for more than 30 days
111. Management of a child with measles includes the administration of which of the
following?
A. Gentian violet on mouth lesions
B. Antibiotic to prevent pneumonia
C. Tetracycline eye ointment for corneal opacity
D. Retinol capsule regardless of when the last dose was given
112. A mother brought her 10 month old infant for consultation because of fever
which started 4 days prior to consultation. To determine malaria risk, what will you
do?
A. Do a tourniquet test
B. Ask where the family resides
C. Get a specimen for blood smear
D. Ask if the fever is present everyday
113. The following are strategies implemented by the DOH to prevent mosquito-borne
diseases. Which of these is most effective in the control of Dengue fever?
A. Stream seeding with larva-eating fish
B. Destroying breeding places of mosquitoes
C. Chemoprophylaxis of non-immune persons going to endemic areas
D. Teaching people in endemic areas to use chemically treated mosquito nets
114. Secondary prevention for malaria includes?
A. Planting of neem or eucalyptus trees
B. Residual spraying of insecticides at night
C. Determining whether a place is endemic or not
D. Growing larva-eating fish in mosquito breeding places
115. Scotch tape swab is done to check for which intestinal parasite?
A. Ascaris
B. Pinworm
C. Hookworm
D. Schistosoma
116. Which of the following signs indicates the need for sputum examination for
AFB?
A. Hematemesis
B. Fever for 1 week
C. Cough for 3 weeks
D. Chest pain for 1 week
117. Which clients are considered targets for DOTS category?
A. Sputum negative cavitary cases
B. Clients returning after default
C. Relapses and failures of previous PTB treatment regimens
D. Clients diagnosed for the first time through a positive sputum exam
118. To improve compliance to treatment, what innovation is being implemented in
DOTS?
A. Having the health worker follow up the client at home
B. Having the health worker or a responsible family member monitor drug intake
C. Having the patient come to the health center every month to get his medications
D. Having a target list to check on whether the patient has collected his monthly supply of
drugs
119. Diagnosis of leprosy is highly dependent on recognition of symptoms. Which of
the following is an early sign of leprosy?
A. Macular lesions
B. Inability to close eyelids
C. Thickened painful nerves
D. Sinking of the nose bridge
125. Which biological used in EPI should not be stored in the freezer?
A. DPT
B. OPV
C. Measles vaccine
D. MMR
126. You will conduct outreach immunization in a barangay with a population of
about 1500. Estimate the number of infants in the barangay.
A. 45
B. 50
C. 55
D. 60
127. In IMCI, severe conditions generally require urgent referral to a hospital. Which
of the following severe conditions Does not always require urgent referral to
hospital?
A. Mastoiditis
B. Severe dehydration
C. Severe pneumonia
D. Severe febrile disease.
128. A client was diagnosed as having Dengue Fever. You will say that there is slow
capillary refill when the color of the nailbed that you pressed does not return within
how many seconds?
A. 3
B. 5
C. 8
D. 10
129. A 3-year old child was brought by his mother to the health center because of
fever of 4-day duration. The child had a positive tourniquet test result. In the absence
of other signs, which of the most appropriate measure that the PHN may carry out to
prevent Dengue shock syndrome?
A. Insert an NGT and give fluids per NGT
B. Instruct the mother to give the child Oresol
A. I
B. II
C. III
D. IV
140. You are the PHN in the city health center. A client underwent screening for AIDS
using ELISA. His result was positive. What is the best course of action that you may
take?
A. Get a thorough history of the client, focusing on the practice of high risk behavior
B. Ask the client to be accompanied by a significant person before revealing the result.
C. Refer the client to the physician since he is the best person to reveal the result to the
client
D. Refer the client for a supplementary test, such as Western blot, since the ELISA result
maybe false
141. Which is the BEST control measure for AIDS?
A. Being faithful to a single sexual partner
B. Using a condom during each sexual contact
C. Avoiding sexual contact with commercial sex workers
D. Making sure that ones sexual partner does not have signs of AIDS
142. The most frequent causes of death among clients with AIDS are opportunistic
diseases. Which of the following opportunistic infections is characterized by
tonsilllopharyngitis?
A. Respiratory candidiasis
B. Infectious mononucleosis
C. Cytomegalovirus disease
D. Pneumocystis carinii pneumonia
143. To determine the possible sources of sexually transmitted infections, which is
the BEST method that may be undertaken by the public health nurse?
A. Contact tracing
B. Community survey
C. Mass screening tests
D. Interview suspects
144. Antiretroviral agents, such as AZT are used in the management of AIDS. Which
of the following is not an action expected of these drugs?
A. They prolong the life of the client with AIDS
B. They reduce the risk of opportunistic infections
C. They shorten the period of communicability of the disease
D. They are able to bring about a cure of the disease condition
145. A barangay had an outbreak of German measles. To prevent congenital rubella,
what is the BEST advice that you can give to women in the first trimester of
pregnancy in the barangay?
a. Advice them on the sign of German Measles
b. Avoid crowded places, such as markets and moviehouses
c. Consult at the health center where rubella vaccine may be given
d. Consult a physician who may give them rubella immunoglobulin
The community health nurse develops the health capability of people through health
education and community organizing activities.
28. Answer: (B) Measles
Presidential Proclamation No. 4 is on the Ligtas Tigdas Program.
29. Answer: (B) Bar
A bar graph is used to present comparison of values, a line graph for trends over time or
age, a pie graph for population composition or distribution, and a scatter diagram for
correlation of two variables.
30. Answer: (D) Core group formation
In core group formation, the nurse is able to transfer the technology of community
organizing to the potential or informal community leaders through a training program.
31. Answer: (B) Community organization
Community organization is the step when community assemblies take place. During the
community assembly, the people may opt to formalize the community organization and
make plans for community action to resolve a community health problem.
32. Answer: (D) To maximize the communitys resources in dealing with health problems
Community organizing is a developmental service, with the goal of developing the peoples
self-reliance in dealing with community health problems. A, B and C are objectives of
contributory objectives to this goal.
33. Answer: (A) Participate in community activities for the solution of a community problem
Participation in community activities in resolving a community problem may be in any of the
processes mentioned in the other choices.
34. Answer: (D) Terminal
Tertiary prevention involves rehabilitation, prevention of permanent disability and disability
limitation appropriate for convalescents, the disabled, complicated cases and the terminally
ill (those in the terminal stage of a disease)
35. Answer: (A) Primary
The purpose of isolating a client with a communicable disease is to protect those who are
not sick (specific disease prevention).
test is 100% sensitive, all the cases tested will have a positive result, i.e., there will be no
false negative results.
55. Answer: (D) Lagundi
Sambong is used as a diuretic. Tsaang gubat is used to relieve diarrhea. Akapulko is used
for its antifungal property.
56. Answer: (A) R.A. 8423 or AN ACT CREATING THE PHILIPPINE INSTITUTE OF
TRADITIONAL AND ALTERNATIVE HEALTH CARE (PITAHC) TO ACCELERATE THE
DEVELOPMENT OF TRADITIONAL AND ALTERNATIVE HEALTH CARE IN THE
PHILIPPINES, PROVIDING FOR A TRADITIONAL AND ALTERNATIVE HEALTH CARE
DEVELOPMENT FUND AND FOR OTHER PURPOSES signed to a law on December 9,
1997.
57. Answer: (A) Yin
Yang is the male dominating, positive and masculine force.
58. Answer: (B) Letter of Instruction No. 949
Letter of Instruction 949 was issued by then President Ferdinand Marcos, directing the
formerly called Ministry of Health, now the Department of Health, to utilize Primary Health
Care approach in planning and implementing health programs.
59. Answer: (D) Cooperation between the PHN and public school teacher
Intersectoral linkages refer to working relationships between the health sector and other
sectors involved in community development.
60. Answer: (D) 2,300
Based on the Philippine population composition, to estimate the number of 1-4 year old
children, multiply total population by 11.5%.
61. Answer: (A) 265
To estimate the number of pregnant women, multiply the total population by 3.5%.
62. Answer: (D) Any of these may be used.
Sex ratio and sex proportion are used to determine the sex composition of a population. A
population pyramid is used to present the composition of a population by age and sex.
63. Answer: (A) Crude birth rate
Natality means birth. A natality rate is a birth rate.
only BCG is discarded 4 hours after reconstitution. This is why BCG immunization is
scheduled only in the morning.
91. Answer: (A) P.D. 996
Presidential Decree 996, enacted in 1976, made immunization in the EPI compulsory for
children under 8 years of age. Hepatitis B vaccination was made compulsory for the same
age group by R.A. 7846.
92. Answer: (B) BCG
BCG causes the formation of a superficial abscess, which begins 2 weeks after
immunization. The abscess heals without treatment, with the formation of a permanent scar.
93. Answer: (C) Infant BCG
Infant BCG may be given at birth. All the other immunizations mentioned can be given at 6
weeks of age.
94. Answer: (A) Seizures a day after DPT 1.
Seizures within 3 days after administration of DPT is an indication of hypersensitivity to
pertussis vaccine, a component of DPT. This is considered a specific contraindication to
subsequent doses of DPT.
95. Answer: (A) Go on with the infants immunizations.
In the EPI, fever up to 38.5C is not a contraindication to immunization. Mild acute
respiratory tract infection, simple diarrhea and malnutrition are not contraindications either.
96. Answer: (A) 1 year
The baby will have passive natural immunity by placental transfer of antibodies. The mother
will have active artificial immunity lasting for about 10 years. 5 doses will give the mother
lifetime protection.
97. Answer: (C) Normal
In IMCI, a respiratory rate of 50/minute or more is fast breathing for an infant aged 2 to 12
months.
98. Answer: (D) Chest indrawing
In IMCI, chest indrawing is used as the positive sign of dyspnea, indicating severe
pneumonia.
Mobilization
Community organization
Follow-up/extension
Core group formation
2. The public health nurse takes an active role in community participation.
What is the primary goal of community organizing?
E.
F.
G.
E.
F.
G.
H.
Pre-pathogenesis
Pathogenesis
Prodromal
Terminal
5. Isolation of a child with measles belongs to what level of prevention?
E.
F.
G.
H.
Primary
Secondary
Intermediate
Tertiary
6. On the other hand, Operation Timbang is _____ prevention.
E.
F.
G.
H.
Primary
Secondary
Intermediate
Tertiary
7. Which type of family-nurse contact will provide you with the best opportunity
to observe family dynamics?
E.
F.
G.
H.
Clinic consultation
Group conference
Home visit
Written communication
8. The typology of family nursing problems is used in the statement of nursing
diagnosis in the care of families. The youngest child of the de los Reyes family
has been diagnosed as mentally retarded. This is classified as a:
E.
F.
G.
H.
Health threat
Health deficit
Foreseeable crisis
Stress point
9. The de los Reyes couple have a 6-year old child entering school for the first
time. The de los Reyes family has a:
E.
F.
G.
H.
Health threat
Health deficit
Foreseeable crisis
Stress point
10. Which of the following is an advantage of a home visit?
E.
F.
E.
Descriptive
Analytical
Therapeutic
Evaluation
15. Which of the following is a function of epidemiology?
E.
E.
F.
G.
20. The number of cases of Dengue fever usually increases towards the end
of the rainy season. This pattern of occurrence of Dengue fever is best
described as
E.
F.
G.
H.
Epidemic occurrence
Cyclical variation
Sporadic occurrence
Secular variation
21. In the year 1980, the World Health Organization declared the Philippines,
together with some other countries in the Western Pacific Region, free of
which disease?
E.
F.
G.
H.
Pneumonic plague
Poliomyelitis
Small pox
Anthrax
22. In the census of the Philippines in 1995, there were about 35,299,000
males and about 34,968,000 females. What is the sex ratio?
E.
F.
G.
H.
99.06:100
100.94:100
50.23%
49.76%
23. Primary health care is a total approach to community development. Which
of the following is an indicator of success in the use of the primary health care
approach?
E.
Effectiveness
Efficacy
G.
H.
Specificity
Sensitivity
25. Use of appropriate technology requires knowledge of indigenous
technology. Which medicinal herb is given for fever, headache and cough?
E.
F.
G.
H.
Sambong
Tsaang gubat
Akapulko
Lagundi
26. What law created the Philippine Institute of Traditional and Alternative
Health Care?
E.
F.
G.
H.
R.A. 8423
R.A. 4823
R.A. 2483
R.A. 3482
27. In traditional Chinese medicine, the yielding, negative and feminine force
is termed
E.
F.
G.
H.
Yin
Yang
Qi
Chai
28. What is the legal basis for Primary Health Care approach in the
Philippines?
E.
F.
G.
H.
E.
F.
G.
H.
E.
F.
G.
1,500
1,800
2,000
H.
2,300
41.
Answer: (C) A home visit should be conducted in the
manner prescribed by the RHU.The home visit plan should be
flexible and practical, depending on factors, such as the familys
needs and the resources available to the nurse and the family.
42.
Answer: (B) Should minimize if not totally prevent the
spread of infection. Bag technique is performed before and after
handling a client in the home to prevent transmission of infection to
and from the client.
43.
Answer: (A) Wash his/her hands before and after
providing nursing care to the family members. Choice B goes
against the idea of utilizing the familys resources, which is
encouraged in CHN. Choices C and D goes against the principle of
asepsis of confining the contaminated surface of objects.
44.
Answer: (B) Analytical. Analytical epidemiology is the study
of factors or determinants affecting the patterns of occurrence and
distribution of disease in a community.
45.
Answer: (D) Evaluating the effectiveness of the
implementation of the Integrated Management of Childhood
Illness. Epidemiology is used in the assessment of a community or
evaluation of interventions in community health practice.
46.
Answer: (C) Participating in the investigation to
determine the source of the epidemic. Epidemiology is the
study of patterns of occurrence and distribution of disease in the
community, as well as the factors that affect disease patterns. The
purpose of an epidemiologic investigation is to identify the source of
an epidemic, i.e., what brought about the epidemic.
47.
Answer: (A) Delineate the etiology of the
epidemic. Delineating the etiology of an epidemic is identifying its
source.
48.
Answer: (D) There is a gradual build up of cases before
the epidemic becomes easily noticeable. A gradual or insidious
onset of the epidemic is usually observable in person-to-person
propagated epidemics.
49.
Answer: (A) Establishing the epidemic. Establishing the
epidemic is determining whether there is an epidemic or not. This is
done by comparing the present number of cases with the usual
number of cases of the disease at the same time of the year, as well
as establishing the relatedness of the cases of the disease.
50.
Answer: (B) Cyclical variation. A cyclical variation is a
periodic fluctuation in the number of cases of a disease in the
community.
51.
Answer: (C) Small pox. The last documented case of Small
pox was in 1977 at Somalia.
52.
Answer: (B) 100.94:100. Sex ratio is the number of males
for every 100 females in the population.
53.
Answer: (D) Health programs are sustained according to
the level of development of the community. Primary health
care is essential health care that can be sustained in all stages of
development of the community.
54.
Answer: (D) Sensitivity. Sensitivity is the capacity of a
diagnostic examination to detect cases of the disease. If a test is
100% sensitive, all the cases tested will have a positive result, i.e.,
there will be no false negative results.
55.
Answer: (D) Lagundi. Sambong is used as a diuretic. Tsaang
gubat is used to relieve diarrhea. Akapulko is used for its antifungal
property.
56.
Answer: (A) R.A. 8423
57.
Answer: (A) Yin. Yang is the male dominating, positive and
masculine force.
58.
Answer: (B) Letter of Instruction No. 949. Letter of
Instruction 949 was issued by then President Ferdinand Marcos,
directing the formerly called Ministry of Health, now the Department
of Health, to utilize Primary Health Care approach in planning and
implementing health programs.
59.
Answer: (D) Cooperation between the PHN and public
school teacher. Intersectoral linkages refer to working
relationships between the health sector and other sectors involved
in community development.
60.
Answer: (D) 2,300. Based on the Philippine population
composition, to estimate the number of 1-4 year old children,
multiply total population by 11.5%.
1. Estimate the number of pregnant women who will be given tetanus toxoid
during an immunization outreach activity in a barangay with a population of
about 1,500.
E.
F.
G.
H.
265
300
375
400
2. To describe the sex composition of the population, which demographic tool
may be used?
E.
F.
G.
H.
Sex ratio
Sex proportion
Population pyramid
Any of these may be used.
3. Which of the following is a natality rate?
E.
F.
G.
H.
E.
F.
G.
H.
4.2/1,000
5.2/1,000
6.3/1,000
7.3/1,000
5. Knowing that malnutrition is a frequent community health problem, you
decided to conduct nutritional assessment. What population is particularly
susceptible to protein energy malnutrition (PEM)?
E.
F.
G.
H.
E.
F.
G.
H.
E.
F.
G.
H.
27.8/1,000
43.5/1,000
86.9/1,000
130.4/1,000
E.
F.
G.
H.
E.
F.
G.
H.
Census
Survey
Record review
Review of civil registry
11. In the conduct of a census, the method of population assignment based on
the actual physical location of the people is termed
E.
F.
G.
H.
De jure
De locus
De facto
De novo
12. The Field Health Services and Information System (FHSIS) is the
recording and reporting system in public health care in the Philippines. The
Monthly Field Health Service Activity Report is a form used in which of the
components of the FHSIS?
E.
F.
G.
H.
Tally report
Output report
Target/client list
Individual health record
13. To monitor clients registered in long-term regimens, such as the Multi-Drug
Therapy, which component will be most useful?
E.
F.
G.
H.
Tally report
Output report
Target/client list
Individual health record
14. Civil registries are important sources of data. Which law requires
registration of births within 30 days from the occurrence of the birth?
E.
F.
G.
H.
P.D. 651
Act 3573
R.A. 3753
R.A. 3375
15. Which of the following professionals can sign the birth certificate?
E.
F.
G.
H.
E.
F.
G.
H.
E.
F.
G.
E.
F.
G.
Tetanus toxoid
Retinol 200,000 IU
Ferrous sulfate 200 mg
Potassium iodate 200 mg. capsule
21. During prenatal consultation, a client asked you if she can have her
delivery at home. After history taking and physical examination, you advised
her against a home delivery. Which of the following findings disqualifies her for
a home delivery?
E.
F.
G.
H.
E.
F.
G.
H.
Niacin
Riboflavin
Folic acid
Thiamine
23. You are in a clients home to attend to a delivery. Which of the following
will you do first?
E.
F.
G.
H.
E.
F.
G.
H.
Explain to her that putting the baby to breast will lessen blood
loss after delivery.
25. A primigravida is instructed to offer her breast to the baby for the first time
within 30 minutes after delivery. What is the purpose of offering the breast this
early?
E.
F.
G.
H.
E.
F.
G.
H.
E.
F.
G.
H.
3 months
6 months
1 year
2 years
28. What is given to a woman within a month after the delivery of a baby?
E.
F.
G.
H.
Malunggay capsule
Ferrous sulfate 100 mg. OD
Retinol 200,000 I.U., 1 capsule
Potassium iodate 200 mg, 1 capsule
29. Which biological used in Expanded Program on Immunization (EPI) is
stored in the freezer?
E.
F.
G.
H.
DPT
Tetanus toxoid
Measles vaccine
Hepatitis B vaccine
30. Unused BCG should be discarded how many hours after reconstitution?
E.
F.
2
4
G.
H.
6
At the end of the day
42.
Answer: (A) Tally report. A tally report is prepared monthly
or quarterly by the RHU personnel and transmitted to the Provincial
Health Office.
43.
Answer: (C) Target/client list. The MDT Client List is a
record of clients enrolled in MDT and other relevant data, such as
dates when clients collected their monthly supply of drugs.
44.
Answer: (A) P.D. 651. P.D. 651 amended R.A. 3753, requiring
the registry of births within 30 days from their occurrence.
45.
Answer: (D) Any of these health professionals. D. R.A.
3753 states that any birth attendant may sign the certificate of live
birth.
46.
Answer: (C) Magnitude of the health problem. Magnitude
of the problem refers to the percentage of the population affected
by a health problem. The other choices are criteria considered in
both family and community health care.
47.
Answer: (D) Its main strategy is certification of health
centers able to comply with standards. Sentrong Sigla
Movement is a joint project of the DOH and local government units.
Its main strategy is certification of health centers that are able to
comply with standards set by the DOH.
48.
Answer: (D) Those who just had a delivery within the
past 15 months. The ideal birth spacing is at least two years. 15
months plus 9 months of pregnancy = 2 years.
49.
Answer: (C) Adequate information for couples regarding
the different methods. To enable the couple to choose freely
among different methods of family planning, they must be given full
information regarding the different methods that are available to
them, considering the availability of quality services that can
support their choice.
50.
Answer: (B) Retinol 200,000 IU. Retinol 200,000 IU is a
form of megadose Vitamin A. This may have a teratogenic effect.
51.
Answer: (A) Her OB score is G5P3. Only women with less
than 5 pregnancies are qualified for a home delivery. It is also
advisable for a primigravida to have delivery at a childbirth facility.
52.
Answer: (C) Folic acid. It is estimated that the incidence of
neural tube defects can be reduced drastically if pregnant women
have an adequate intake of folic acid.
53.
Answer: (D) Note the interval, duration and intensity of
labor contractions.. Assessment of the woman should be done
first to determine whether she is having true labor and, if so, what
stage of labor she is in.
54.
Answer: (D) Explain to her that putting the baby to
breast will lessen blood loss after delivery. Suckling of the
nipple stimulates the release of oxytocin by the posterior pituitary
gland, which causes uterine contraction. Lactation begins 1 to 3
days after delivery. Nipple stretching exercises are done when the
nipples are flat or inverted. Frequent washing dries up the nipples,
making them prone to the formation of fissures.
55.
Answer: (B) To stimulate milk production by the
mammary acini. Suckling of the nipple stimulates prolactin reflex
(the release of prolactin by the anterior pituitary gland), which
initiates lactation.
56.
Answer: (B) The mother does not feel nipple pain.. When
the baby has properly latched on to the breast, he takes deep, slow
sucks; his mouth is wide open; and much of the areola is inside his
mouth. And, youre right! The mother does not feel nipple pain.
57.
Answer: (B) 6 months. After 6 months, the babys nutrient
needs, especially the babys iron requirement, can no longer be
provided by mothers milk alone.
58.
Answer: (C) Retinol 200,000 I.U., 1 capsule. A capsule of
Retinol 200,000 IU is given within 1 month after delivery. Potassium
iodate is given during pregnancy; malunggay capsule is not
routinely administered after delivery; and ferrous sulfate is taken for
two months after delivery.
59.
Answer: (C) Measles vaccine. Among the biologicals used in
the Expanded Program on Immunization, measles vaccine and OPV
are highly sensitive to heat, requiring storage in the freezer.
60.
Answer: (B) 4. While the unused portion of other biologicals
in EPI may be given until the end of the day, only BCG is discarded 4
hours after reconstitution. This is why BCG immunization is
scheduled only in the morning.
1. In immunizing school entrants with BCG, you are not obliged to secure
parental consent. This is because of which legal document?
E.
F.
G.
H.
E.
P.D. 996
R.A. 7846
Presidential Proclamation No. 6
Presidential Proclamation No. 46
2. Which immunization produces a permanent scar?
DPT
F.
G.
H.
BCG
Measles vaccination
Hepatitis B vaccination
3. A 4-week old baby was brought to the health center for his first
immunization. Which can be given to him?
E.
F.
G.
H.
DPT1
OPV1
Infant BCG
Hepatitis B vaccine 1
4. You will not give DPT 2 if the mother says that the infant had
E.
F.
G.
H.
E.
F.
G.
H.
E.
F.
G.
H.
1 year
3 years
10 years
Lifetime
7. A 4-month old infant was brought to the health center because of cough.
Her respiratory rate is 42/minute. Using the Integrated Management of Child
Illness (IMCI) guidelines of assessment, her breathing is considered
E.
F.
G.
H.
Fast
Slow
Normal
Insignificant
8. Which of the following signs will indicate that a young child is suffering from
severe pneumonia?
E.
F.
G.
H.
Dyspnea
Wheezing
Fast breathing
Chest indrawing
9. Using IMCI guidelines, you classify a child as having severe pneumonia.
What is the best management for the child?
E.
F.
G.
H.
Prescribe an antibiotic.
Refer him urgently to the hospital.
Instruct the mother to increase fluid intake.
Instruct the mother to continue breastfeeding.
10. A 5-month old infant was brought by his mother to the health center
because of diarrhea occurring 4 to 5 times a day. His skin goes back slowly
after a skin pinch and his eyes are sunken. Using the IMCI guidelines, you will
classify this infant in which category?
E.
F.
G.
H.
No signs of dehydration
Some dehydration
Severe dehydration
The data is insufficient.
11. Based on assessment, you classified a 3-month old infant with the chief
complaint of diarrhea in the category of SOME DEHYDRATION. Based on
IMCI management guidelines, which of the following will you do?
E.
13. A 1 year old child was classified as having 3rd degree protein energy
malnutrition, kwashiorkor. Which of the following signs will be most apparent
in this child?
E.
F.
G.
H.
Voracious appetite
Wasting
Apathy
Edema
14. Assessment of a 2-year old child revealed baggy pants. Using the IMCI
guidelines, how will you manage this child?
E.
F.
Keratomalacia
Corneal opacity
Night blindness
Conjunctival xerosis
16. To prevent xerophthalmia, young children are given Retinol capsule every
6 months. What is the dose given to preschoolers?
E.
F.
G.
H.
10,000 IU
20,000 IU
100,000 IU
200,000 IU
17. The major sign of iron deficiency anemia is pallor. What part is best
examined for pallor?
E.
F.
G.
H.
Palms
Nailbeds
Around the lips
Lower conjunctival sac
18. Food fortification is one of the strategies to prevent micronutrient
deficiency conditions. R.A. 8976 mandates fortification of certain food items.
Which of the following is among these food items?
E.
F.
G.
H.
Sugar
Bread
Margarine
Filled milk
19. What is the best course of action when there is a measles epidemic in a
nearby municipality?
E.
F.
Inability to drink
High grade fever
Signs of severe dehydration
Cough for more than 30 days
21. Management of a child with measles includes the administration of which
of the following?
E.
F.
G.
H.
E.
F.
G.
H.
Do a tourniquet test.
Ask where the family resides.
Get a specimen for blood smear.
Ask if the fever is present everyday.
23. The following are strategies implemented by the Department of Health to
prevent mosquito-borne diseases. Which of these is most effective in the
control of Dengue fever?
E.
F.
G.
E.
F.
G.
H.
Ascaris
Pinworm
Hookworm
Schistosoma
26. Which of the following signs indicates the need for sputum examination for
AFB?
E.
F.
G.
H.
Hematemesis
Fever for 1 week
Cough for 3 weeks
Chest pain for 1 week
27. Which clients are considered targets for DOTS Category I?
E.
F.
G.
H.
E.
F.
E.
F.
G.
H.
Macular lesions
Inability to close eyelids
Thickened painful nerves
Sinking of the nosebridge
30. Which of the following clients should be classified as a case of
multibacillary leprosy?
3
3
5
5
skin
skin
skin
skin
lesions,
lesions,
lesions,
lesions,
39.
Answer: (B) Refer him urgently to the hospital. Severe
pneumonia requires urgent referral to a hospital. Answers A, C and D
are done for a client classified as having pneumonia.
40.
Answer: (B) Some dehydration. Using the assessment
guidelines of IMCI, a child (2 months to 5 years old) with diarrhea is
classified as having SOME DEHYDRATION if he shows 2 or more of
the following signs: restless or irritable, sunken eyes, the skin goes
back slow after a skin pinch.
41.
Answer: (B) Supervise the mother in giving 200 to 400
ml. of Oresol in 4 hours. In the IMCI management guidelines,
SOME DEHYDRATION is treated with the administration of Oresol
within a period of 4 hours. The amount of Oresol is best computed
on the basis of the childs weight (75 ml/kg body weight). If the
weight is unknown, the amount of Oresol is based on the childs age.
42.
Answer: (D) Let the child rest for 10 minutes then
continue giving Oresol more slowly. If the child vomits
persistently, that is, he vomits everything that he takes in, he has to
be referred urgently to a hospital. Otherwise, vomiting is managed
by letting the child rest for 10 minutes and then continuing with
Oresol administration. Teach the mother to give Oresol more slowly.
43.
Answer: (D) Edema. Edema, a major sign of kwashiorkor, is
caused by decreased colloidal osmotic pressure of the blood brought
about by hypoalbuminemia. Decreased blood albumin level is due a
protein-deficient diet.
44.
Answer: (A) Refer the child urgently to a hospital for
confinement. Baggy pants is a sign of severe marasmus. The
best management is urgent referral to a hospital.
45.
Answer: (D) Conjunctival xerosis. The earliest sign of
Vitamin A deficiency (xerophthalmia) is night blindness. However,
this is a functional change, which is not observable during physical
examination.The earliest visible lesion is conjunctival xerosis or
dullness of the conjunctiva due to inadequate tear production.
46.
Answer: (D) 200,000 IU. Preschoolers are given Retinol
200,000 IU every 6 months. 100,000 IU is given once to infants aged
6 to 12 months. The dose for pregnant women is 10,000 IU.
47.
Answer: (A) Palms. The anatomic characteristics of the
palms allow a reliable and convenient basis for examination for
pallor.
48.
Answer: (A) Sugar. R.A. 8976 mandates fortification of rice,
wheat flour, sugar and cooking oil with Vitamin A, iron and/or iodine.
49.
Answer: (A) Give measles vaccine to babies aged 6 to 8
months. Ordinarily, measles vaccine is given at 9 months of age.
During an impending epidemic, however, one dose may be given to
babies aged 6 to 8 months. The mother is instructed that the baby
needs another dose when the baby is 9 months old.
50.
Answer: (A) Inability to drink. A sick child aged 2 months to
5 years must be referred urgently to a hospital if he/she has one or
more of the following signs: not able to feed or drink, vomits
everything, convulsions, abnormally sleepy or difficult to awaken.
51.
Answer: (D) Retinol capsule regardless of when the last
dose was given. An infant 6 to 12 months classified as a case of
measles is given Retinol 100,000 IU; a child is given 200,000 IU
regardless of when the last dose was given.
52.
Answer: (B) Ask where the family resides. Because
malaria is endemic, the first question to determine malaria risk is
where the clients family resides. If the area of residence is not a
known endemic area, ask if the child had traveled within the past 6
months, where he/she was brought and whether he/she stayed
overnight in that area.
53.
Answer: (B) Destroying breeding places of
mosquitoes. Aedes aegypti, the vector of Dengue fever, breeds in
stagnant, clear water. Its feeding time is usually during the daytime.
It has a cyclical pattern of occurrence, unlike malaria which is
endemic in certain parts of the country.
54.
Answer: (C) Determining whether a place is endemic or
not. This is diagnostic and therefore secondary level prevention.
The other choices are for primary prevention.
55.
Answer: (B) Pinworm. Pinworm ova are deposited around the
anal orifice.
56.
Answer: (C) Cough for 3 weeks. A client is considered a PTB
suspect when he has cough for 2 weeks or more, plus one or more
of the following signs: fever for 1 month or more; chest pain lasting
for 2 weeks or more not attributed to other conditions; progressive,
unexplained weight loss; night sweats; and hemoptysis.
57.
Answer: (D) Clients diagnosed for the first time through
a positive sputum exam. Category I is for new clients diagnosed
by sputum examination and clients diagnosed to have a serious
form of extrapulmonary tuberculosis, such as TB osteomyelitis.
58.
Answer: (B) Having the health worker or a responsible
family member monitor drug intake. Directly Observed
Treatment Short Course is so-called because a treatment partner,
Liver cancer
Liver cirrhosis
Bladder cancer
Intestinal perforation
2. What is the most effective way of controlling schistosomiasis in an endemic
area?
E.
F.
G.
H.
Use of molluscicides
Building of foot bridges
Proper use of sanitary toilets
Use of protective footwear, such as rubber boots
3. When residents obtain water from an artesian well in the neighborhood, the
level of this approved type of water facility is
E.
F.
G.
H.
I
II
III
IV
4. For prevention of hepatitis A, you decided to conduct health education
activities. Which of the following is IRRELEVANT?
E.
F.
G.
H.
E.
F.
G.
H.
DPT
Oral polio vaccine
Measles vaccine
MMR
6. You will conduct outreach immunization in a barangay with a population of
about 1500. Estimate the number of infants in the barangay.
E.
F.
G.
H.
45
50
55
60
7. In Integrated Management of Childhood Illness, severe conditions generally
require urgent referral to a hospital. Which of the following severe conditions
DOES NOT always require urgent referral to a hospital?
E.
F.
G.
H.
Mastoiditis
Severe dehydration
Severe pneumonia
Severe febrile disease
8. A client was diagnosed as having Dengue fever. You will say that there is
slow capillary refill when the color of the nailbed that you pressed does not
return within how many seconds?
E.
F.
G.
H.
3
5
8
10
9. A 3-year old child was brought by his mother to the health center because
of fever of 4-day duration. The child had a positive tourniquet test result. In the
absence of other signs, which is the most appropriate measure that the PHN
may carry out to prevent Dengue shock syndrome?
E.
F.
G.
H.
E.
F.
G.
Nasal mucosa
Buccal mucosa
Skin on the abdomen
H.
E.
F.
G.
H.
Viral conjunctivitis
Acute poliomyelitis
Diphtheria
Measles
12. Among children aged 2 months to 3 years, the most prevalent form of
meningitis is caused by which microorganism?
E.
F.
G.
H.
Hemophilus influenzae
Morbillivirus
Steptococcus pneumoniae
Neisseria meningitidis
13. Human beings are the major reservoir of malaria. Which of the following
strategies in malaria control is based on this fact?
E.
F.
G.
H.
Stream seeding
Stream clearing
Destruction of breeding places
Zooprophylaxis
14. The use of larvivorous fish in malaria control is the basis for which strategy
of malaria control?
E.
F.
G.
H.
Stream seeding
Stream clearing
Destruction of breeding places
Zooprophylaxis
15. Mosquito-borne diseases are prevented mostly with the use of mosquito
control measures. Which of the following is NOT appropriate for malaria
control?
E.
F.
G.
H.
E.
F.
Giardiasis
Cholera
G.
H.
Amebiasis
Dysentery
17. In the Philippines, which specie of schistosoma is endemic in certain
regions?
E.
F.
G.
H.
S. mansoni
S. japonicum
S. malayensis
S. haematobium
18. A 32-year old client came for consultation at the health center with the
chief complaint of fever for a week. Accompanying symptoms were muscle
pains and body malaise. A week after the start of fever, the client noted
yellowish discoloration of his sclera. History showed that he waded in flood
waters about 2 weeks before the onset of symptoms. Based on his history,
which disease condition will you suspect?
E.
F.
G.
H.
Hepatitis A
Hepatitis B
Tetanus
Leptospirosis
19. MWSS provides water to Manila and other cities in Metro Manila. This is
an example of which level of water facility?
E.
F.
G.
H.
I
II
III
IV
20. You are the PHN in the city health center. A client underwent screening for
AIDS using ELISA. His result was positive. What is the best course of action
that you may take?
E.
F.
G.
H.
AIDS
22. The most frequent causes of death among clients with AIDS are
opportunistic diseases. Which of the following opportunistic infections is
characterized by tonsillopharyngitis?
E.
F.
G.
H.
Respiratory candidiasis
Infectious mononucleosis
Cytomegalovirus disease
Pneumocystis carinii pneumonia
23. To determine possible sources of sexually transmitted infections, which is
the BEST method that may be undertaken by the public health nurse?
E.
F.
G.
H.
Contact tracing
Community survey
Mass screening tests
Interview of suspects
24. Antiretroviral agents, such as AZT, are used in the management of AIDS.
Which of the following is NOT an action expected of these drugs.
E.
F.
G.
H.
E.
F.
G.
F.
Pregnant women
Elderly clients
Young adult males
Young infants
44.
Answer: (B) Cholera. Passage of profuse watery stools is the
major symptom of cholera. Both amebic and bacillary dysentery are
characterized by the presence of blood and/or mucus in the stools.
Giardiasis is characterized by fat malabsorption and, therefore,
steatorrhea.
45.
Answer: (B) S. japonicum. S. mansoni is found mostly in
Africa and South America; S. haematobium in Africa and the Middle
East; and S. malayensis only in peninsular Malaysia.
46.
Answer: (D) Leptospirosis. Leptospirosis is transmitted
through contact with the skin or mucous membrane with water or
moist soil contaminated with urine of infected animals, like rats.
47.
Answer: (C) III. Waterworks systems, such as MWSS, are
classified as level III.
48.
Answer: (D) Refer the client for a supplementary test,
such as Western blot, since the ELISA result may be false. A
client having a reactive ELISA result must undergo a more specific
test, such as Western blot. A negative supplementary test result
means that the ELISA result was false and that, most probably, the
client is not infected.
49.
Answer: (A) Being faithful to a single sexual
partner. Sexual fidelity rules out the possibility of getting the
disease by sexual contact with another infected person.
Transmission occurs mostly through sexual intercourse and exposure
to blood or tissues.
50.
Answer: (B) Infectious mononucleosis. Cytomegalovirus
disease is an acute viral disease characterized by fever, sore throat
and lymphadenopathy.
51.
Answer: (A) Contact tracing. Contact tracing is the most
practical and reliable method of finding possible sources of personto-person transmitted infections, such as sexually transmitted
diseases.
52.
Answer: (D) They are able to bring about a cure of the
disease condition. There is no known treatment for AIDS.
Antiretroviral agents reduce the risk of opportunistic infections and
prolong life, but does not cure the underlying immunodeficiency.
53.
Answer: (D) Consult a physician who may give them
rubella immunoglobulin. Rubella vaccine is made up of
attenuated German measles viruses. This is contraindicated in
pregnancy. Immune globulin, a specific prophylactic against German
measles, may be given to pregnant women.
54.
Answer: (D) Proper handwashing during food
preparation is the best way of preventing the
condition. Symptoms of this food poisoning are due to
staphylococcal enterotoxin, not the microorganisms themselves.
Contamination is by food handling by persons with staphylococcal
skin or eye infections.
55.
Answer: (A) The older one gets, the more susceptible he
becomes to the complications of chicken pox. Chicken pox is
usually more severe in adults than in children. Complications, such
as pneumonia, are higher in incidence in adults.
56.
Answer: (C) Young adult males. Epididymitis and orchitis
are possible complications of mumps. In post-adolescent males,
bilateral inflammation of the testes and epididymis may cause
sterility.
1. May arrives at the health care clinic and tells the nurse that her last
menstrual period was 9 weeks ago. She also tells the nurse that a home
pregnancy test was positive but she began to have mild cramps and is now
having moderate vaginal bleeding. During the physical examination of the
client, the nurse notes that May has a dilated cervix. The nurse determines
that May is experiencing which type of abortion?
E.
Inevitable
F.
Incomplete
G.
Threatened
H.
Septic
2. Nurse Reese is reviewing the record of a pregnant client for her first
prenatal visit. Which of the following data, if noted on the clients record, would
alert the nurse that the client is at risk for a spontaneous abortion?
E.
Age 36 years
F.
History of syphilis
G.
History of genital herpes
H.
History of diabetes mellitus
3. Nurse Hazel is preparing to care for a client who is newly admitted to the
hospital with a possible diagnosis of ectopic pregnancy. Nurse Hazel develops
a plan of care for the client and determines that which of the following nursing
actions is the priority?
E.
Monitoring weight
F.
Assessing for edema
G.
Monitoring apical pulse
H.
Monitoring temperature
H.
Continuous CPR
10. A trial for vaginal delivery after an earlier caesareans, would likely to be
given to a gravida, who had:
E.
First low transverse cesarean was for active herpes type 2
infections; vaginal culture at 39 weeks pregnancy was positive.
F.
First and second caesareans were for cephalopelvic
disproportion.
G.
First caesarean through a classic incision as a result of severe
fetal distress.
H.
First low transverse caesarean was for breech position. Fetus in
this pregnancy is in a vertex presentation.
11.Nurse Ryan is aware that the best initial approach when trying to take a
crying toddlers temperature is:
E.
Talk to the mother first and then to the toddler.
F.
Bring extra help so it can be done quickly.
G.
Encourage the mother to hold the child.
H.
Ignore the crying and screaming.
12.Baby Tina a 3 month old infant just had a cleft lip and palate repair. What
should the nurse do to prevent trauma to operative site?
E.
Avoid touching the suture line, even when cleaning.
F.
Place the baby in prone position.
G.
Give the baby a pacifier.
H.
Place the infants arms in soft elbow restraints.
13. Which action should nurse Marian include in the care plan for a 2 month
old with heart failure?
E.
Feed the infant when he cries.
F.
Allow the infant to rest before feeding.
G.
Bathe the infant and administer medications before feeding.
H.
Weigh and bathe the infant before feeding.
14.Nurse Hazel is teaching a mother who plans to discontinue breast feeding
after 5 months. The nurse should advise her to include which foods in her
infants diet?
E.
Skim milk and baby food.
F.
Whole milk and baby food.
G.
Iron-rich formula only.
H.
Iron-rich formula and baby food.
15.Mommy Linda is playing with her infant, who is sitting securely alone on
the floor of the clinic. The mother hides a toy behind her back and the infant
looks for it. The nurse is aware that estimated age of the infant would be:
E.
6 months
F.
4 months
G.
H.
8 months
10 months
16.Which of the following is the most prominent feature of public health
nursing?
E.
It involves providing home care to sick people who are not
confined in the hospital.
F.
Services are provided free of charge to people within the
catchments area.
G.
The public health nurse functions as part of a team providing a
public health nursing services.
H.
Public health nursing focuses on preventive, not curative,
services.
17.When the nurse determines whether resources were maximized in
implementing Ligtas Tigdas, she is evaluating
E.
Effectiveness
F.
Efficiency
G.
Adequacy
H.
Appropriateness
18.Vangie is a new B.S.N. graduate. She wants to become a Public Health
Nurse. Where should she apply?
E.
Department of Health
F.
Provincial Health Office
G.
Regional Health Office
H.
Rural Health Unit
19.Tony is aware the Chairman of the Municipal Health Board is:
E.
Mayor
F.
Municipal Health Officer
G.
Public Health Nurse
H.
Any qualified physician
20.Myra is the public health nurse in a municipality with a total population of
about 20,000. There are 3 rural health midwives among the RHU personnel.
How many more midwife items will the RHU need?
E.
1
F.
2
G.
3
H.
The RHU does not need any more midwife item.
21.According to Freeman and Heinrich, community health nursing is a
developmental service. Which of the following best illustrates this statement?
E.
The community health nurse continuously develops himself
personally and professionally.
F.
E.
F.
G.
H.
80 to 100 beats/minute
100 to 120 beats/minute
120 to 160 beats/minute
160 to 180 beats/minute
28.The skin in the diaper area of a 7 month old infant is excoriated and red.
Nurse Hazel should instruct the mother to:
E.
Change the diaper more often.
F.
Apply talc powder with diaper changes.
G.
Wash the area vigorously with each diaper change.
H.
Decrease the infants fluid intake to decrease saturating
diapers.
29.Nurse Carla knows that the common cardiac anomalies in children with
Down Syndrome (tri-somy 21) is:
E.
Atrial septal defect
F.
Pulmonic stenosis
G.
Ventricular septal defect
H.
Endocardial cushion defect
30.Malou was diagnosed with severe preeclampsia is now receiving I.V.
magnesium sulfate. The adverse effects associated with magnesium sulfate
is:
E.
Anemia
F.
Decreased urine output
G.
Hyperreflexia
H.
Increased respiratory rate
31.A 23 year old client is having her menstrual period every 2 weeks that last
for 1 week. This type of menstrual pattern is bets defined by:
E.
Menorrhagia
F.
Metrorrhagia
G.
Dyspareunia
H.
Amenorrhea
32. Jannah is admitted to the labor and delivery unit. The critical laboratory
result for this client would be:
E.
Oxygen saturation
F.
Iron binding capacity
G.
Blood typing
H.
Serum Calcium
33.Nurse Gina is aware that the most common condition found during the
second-trimester of pregnancy is:
E.
Metabolic alkalosis
F.
Respiratory acidosis
G.
Mastitis
H.
Physiologic anemia
34.Nurse Lynette is working in the triage area of an emergency department.
She sees that several pediatric clients arrive simultaneously. The client who
needs to be treated first is:
E.
A crying 5 year old child with a laceration on his scalp.
F.
A 4 year old child with a barking coughs and flushed
appearance.
G.
A 3 year old child with Down syndrome who is pale and asleep
in his mothers arms.
H.
A 2 year old infant with stridorous breath sounds, sitting up in
his mothers arms and drooling.
35.Maureen in her third trimester arrives at the emergency room with painless
vaginal bleeding. Which of the following conditions is suspected?
E.
Placenta previa
F.
Abruptio placentae
G.
Premature labor
H.
Sexually transmitted disease
36.A young child named Richard is suspected of having pinworms. The
community nurse collects a stool specimen to confirm the diagnosis. The
nurse should schedule the collection of this specimen for:
E.
Just before bedtime
F.
After the child has been bathe
G.
Any time during the day
H.
Early in the morning
37.In doing a childs admission assessment, Nurse Betty should be alert to
note which signs or symptoms of chronic lead poisoning?
E.
Irritability and seizures
F.
Dehydration and diarrhea
G.
Bradycardia and hypotension
H.
Petechiae and hematuria
38.To evaluate a womans understanding about the use of diaphragm for
family planning, Nurse Trish asks her to explain how she will use the
appliance. Which response indicates a need for further health teaching?
E.
I should check the diaphragm carefully for holes every time I
use it
F.
I may need a different size of diaphragm if I gain or lose
weight more than 20 pounds
G.
The diaphragm must be left in place for atleast 6 hours after
intercourse
H.
I really need to use the diaphragm and jelly most during the
middle of my menstrual cycle.
F.
G.
H.
12 inches
18 inches
24 inches
46. In a mothers class, Nurse Lhynnete discussed childhood diseases such
as chicken pox. Which of the following statements about chicken pox is
correct?
E.
The older one gets, the more susceptible he becomes to the
complications of chicken pox.
F.
A single attack of chicken pox will prevent future episodes,
including conditions such as shingles.
G.
To prevent an outbreak in the community, quarantine may be
imposed by health authorities.
H.
Chicken pox vaccine is best given when there is an impending
outbreak in the community.
47.Barangay Pinoy had an outbreak of German measles. To prevent
congenital rubella, what is the BEST advice that you can give to women in the
first trimester of pregnancy in the barangay Pinoy?
E.
Advice them on the signs of German measles.
F.
Avoid crowded places, such as markets and movie houses.
G.
Consult at the health center where rubella vaccine may be
given.
H.
Consult a physician who may give them rubella
immunoglobulin.
48.Myrna a public health nurse knows that to determine possible sources of
sexually transmitted infections, the BEST method that may be undertaken is:
E.
Contact tracing
F.
Community survey
G.
Mass screening tests
H.
Interview of suspects
49.A 33-year old female client came for consultation at the health center with
the chief complaint of fever for a week. Accompanying symptoms were muscle
pains and body malaise. A week after the start of fever, the client noted
yellowish discoloration of his sclera. History showed that he waded in flood
waters about 2 weeks before the onset of symptoms. Based on her history,
which disease condition will you suspect?
E.
Hepatitis A
F.
Hepatitis B
G.
Tetanus
H.
Leptospirosis
50.Mickey a 3-year old client was brought to the health center with the chief
complaint of severe diarrhea and the passage of rice water stools. The client
is most probably suffering from which condition?
E.
Giardiasis
F.
Cholera
G.
Amebiasis
H.
Dysentery
51.The most prevalent form of meningitis among children aged 2 months to 3
years is caused by which microorganism?
E.
Hemophilus influenzae
F.
Morbillivirus
G.
Steptococcus pneumoniae
H.
Neisseria meningitidis
52.The student nurse is aware that the pathognomonic sign of measles is
Kopliks spot and you may see Kopliks spot by inspecting the:
E.
Nasal mucosa
F.
Buccal mucosa
G.
Skin on the abdomen
H.
Skin on neck
53.Angel was diagnosed as having Dengue fever. You will say that there is
slow capillary refill when the color of the nailbed that you pressed does not
return within how many seconds?
E.
3 seconds
F.
6 seconds
G.
9 seconds
H.
10 seconds
54.In Integrated Management of Childhood Illness, the nurse is aware that the
severe conditions generally require urgent referral to a hospital. Which of the
following severe conditions DOES NOT always require urgent referral to a
hospital?
E.
Mastoiditis
F.
Severe dehydration
G.
Severe pneumonia
H.
Severe febrile disease
55.Myrna a public health nurse will conduct outreach immunization in a
barangay Masay with a population of about 1500. The estimated number of
infants in the barangay would be:
E.
45 infants
F.
50 infants
G.
55 infants
H.
65 infants
F.
G.
H.
8 hours
At the end of the day
68.The nurse explains to a breastfeeding mother that breast milk is sufficient
for all of the babys nutrient needs only up to:
E.
5 months
F.
6 months
G.
1 year
H.
2 years
69.Nurse Ron is aware that the gestational age of a conceptus that is
considered viable (able to live outside the womb) is:
E.
8 weeks
F.
12 weeks
G.
24 weeks
H.
32 weeks
70.When teaching parents of a neonate the proper position for the neonates
sleep, the nurse Patricia stresses the importance of placing the neonate on
his back to reduce the risk of which of the following?
E.
Aspiration
F.
Sudden infant death syndrome (SIDS)
G.
Suffocation
H.
Gastroesophageal reflux (GER)
71.Which finding might be seen in baby James a neonate suspected of having
an infection?
E.
Flushed cheeks
F.
Increased temperature
G.
Decreased temperature
H.
Increased activity level
72.Baby Jenny who is small-for-gestation is at increased risk during the
transitional period for which complication?
E.
Anemia probably due to chronic fetal hyposia
F.
Hyperthermia due to decreased glycogen stores
G.
Hyperglycemia due to decreased glycogen stores
H.
Polycythemia probably due to chronic fetal hypoxia
73.Marjorie has just given birth at 42 weeks gestation. When the nurse
assessing the neonate, which physical finding is expected?
E.
A sleepy, lethargic baby
F.
Lanugo covering the body
G.
Desquamation of the epidermis
H.
Vernix caseosa covering the body
G.
H.
92. Cammile with sickle cell anemia has an increased risk for having a sickle
cell crisis during pregnancy. Aggressive management of a sickle cell crisis
includes which of the following measures?
E.
Antihypertensive agents
F.
Diuretic agents
G.
I.V. fluids
H.
Acetaminophen (Tylenol) for pain
93. Which of the following drugs is the antidote for magnesium toxicity?
E.
Calcium gluconate (Kalcinate)
F.
Hydralazine (Apresoline)
G.
Naloxone (Narcan)
H.
Rho (D) immune globulin (RhoGAM)
94. Marlyn is screened for tuberculosis during her first prenatal visit. An
intradermal injection of purified protein derivative (PPD) of the tuberculin
bacilli is given. She is considered to have a positive test for which of the
following results?
E.
An indurated wheal under 10 mm in diameter appears in 6 to
12 hours.
F.
An indurated wheal over 10 mm in diameter appears in 48 to
72 hours.
G.
A flat circumcised area under 10 mm in diameter appears in 6
to 12 hours.
H.
A flat circumcised area over 10 mm in diameter appears in 48
to 72 hours.
95. Dianne, 24 year-old is 27 weeks pregnant arrives at her physicians office
with complaints of fever, nausea, vomiting, malaise, unilateral flank pain, and
costovertebral angle tenderness. Which of the following diagnoses is most
likely?
E.
Asymptomatic bacteriuria
F.
Bacterial vaginosis
G.
Pyelonephritis
H.
Urinary tract infection (UTI)
96. Rh isoimmunization in a pregnant client develops during which of the
following conditions?
E.
Rh-positive maternal blood crosses into fetal blood, stimulating
fetal antibodies.
F.
Rh-positive fetal blood crosses into maternal blood,
stimulating maternal antibodies.
G.
Rh-negative fetal blood crosses into maternal blood,
stimulating maternal antibodies.
H.
104.
Answer: (B) Increased caloric intake. Glucose crosses the
placenta, but insulin does not. High fetal demands for glucose,
combined with the insulin resistance caused by hormonal changes in
the last half of pregnancy can result in elevation of maternal blood
glucose levels. This increases the mothers demand for insulin and is
referred to as the diabetogenic effect of pregnancy.
105.
Answer: (A) Excessive fetal activity. The most common
signs and symptoms of hydatidiform mole includes elevated levels
of human chorionic gonadotropin, vaginal bleeding, larger than
normal uterus for gestational age, failure to detect fetal heart
activity even with sensitive instruments, excessive nausea
and vomiting, and early development of pregnancy-induced
hypertension. Fetal activity would not be noted.
106.
Answer: (B) Absent patellar reflexes. Absence of patellar
reflexes is an indicator of hypermagnesemia, which requires
administration of calcium gluconate.
107.
Answer: (C) Presenting part in 2 cm below the plane of
the ischial spines. Fetus at station plus two indicates that the
presenting part is 2 cm below the plane of the ischial spines.
108.
Answer: (A) Contractions every 1 minutes lasting 7080 seconds. Contractions every 1 minutes lasting 70-80
seconds, is indicative of hyperstimulation of the uterus, which could
result in injury to the mother and the fetus if Pitocin is not
discontinued.
109.
Answer: (C) EKG tracings. A potential side effect of calcium
gluconate administration is cardiac arrest. Continuous monitoring of
cardiac activity (EKG) throught administration of calcium gluconate
is an essential part of care.
110.
Answer: (D) First low transverse caesarean was for
breech position. Fetus in this pregnancy is in a vertex
presentation. This type of client has no obstetrical indication for a
caesarean section as she did with her first caesarean delivery.
111.
Answer: (A) Talk to the mother first and then to the
toddler. When dealing with a crying toddler, the best approach is to
talk to the mother and ignore the toddler first. This approach helps
the toddler get used to the nurse before she attempts any
procedures. It also gives the toddler an opportunity to see that the
mother trusts the nurse.
112.
Answer: (D) Place the infants arms in soft elbow
restraints. Soft restraints from the upper arm to the wrist prevent
the infant from touching her lip but allow him to hold a favorite item
133.
Answer: (D) Physiologic anemia. Hemoglobin values and
hematocrit decrease during pregnancy as the increase in plasma
volume exceeds the increase in red blood cell production.
134.
Answer: (D) A 2 year old infant with stridorous breath
sounds, sitting up in his mothers arms and drooling. The
infant with the airway emergency should be treated first, because of
the risk of epiglottitis.
135.
Answer: (A) Placenta previa. Placenta previa with painless
vaginal bleeding.
136.
Answer: (D) Early in the morning. Based on the nurses
knowledge of microbiology, the specimen should be collected early
in the morning. The rationale for this timing is that, because the
female worm lays eggs at night around the perineal area, the first
bowel movement of the day will yield the best results. The specific
type of stool specimen used in the diagnosis of pinworms is called
the tape test.
137.
Answer: (A) Irritability and seizures. Lead poisoning
primarily affects the CNS, causing increased intracranial pressure.
This condition results in irritability and changes in level of
consciousness, as well as seizure disorders, hyperactivity, and
learning disabilities.
138.
Answer: (D) I really need to use the diaphragm and
jelly most during the middle of my menstrual cycle. The
woman must understand that, although the fertile period is
approximately mid-cycle, hormonal variations do occur and can
result in early or late ovulation. To be effective, the diaphragm
should be inserted before every intercourse.
139.
Answer: (C) Restlessness. In a child, restlessness is the
earliest sign of hypoxia. Late signs of hypoxia in a child are
associated with a change in color, such as pallor or cyanosis.
140.
Answer: (B) Walk one step ahead, with the childs hand
on the nurses elbow. This procedure is generally recommended
to follow in guiding a person who is blind.
141.
Answer: (A) Loud, machinery-like murmur. A loud,
machinery-like murmur is a characteristic finding associated with
patent ductus arteriosus.
142.
Answer: (C) More oxygen, and the newborns metabolic
rate increases. When cold, the infant requires more oxygen and
there is an increase in metabolic rate. Non-shievering thermogenesis
is a complex process that increases the metabolic rate and rate of
152.
Answer: (B) Buccal mucosa. Kopliks spot may be seen on
the mucosa of the mouth or the throat.
153.
Answer: (A) 3 seconds. Adequate blood supply to the area
allows the return of the color of the nailbed within 3 seconds.
154.
Answer: (B) Severe dehydration. The order of priority in
the management of severe dehydration is as follows: intravenous
fluid therapy, referral to a facility where IV fluids can be initiated
within 30 minutes, Oresol or nasogastric tube. When the foregoing
measures are not possible or effective, then urgent referral to the
hospital is done.
155.
Answer: (A) 45 infants. To estimate the number of infants,
multiply total population by 3%.
156.
Answer: (A) DPT. DPT is sensitive to freezing. The appropriate
storage temperature of DPT is 2 to 8 C only. OPV and measles
vaccine are highly sensitive to heat and require freezing. MMR is not
an immunization in the Expanded Program on Immunization.
157.
Answer: (C) Proper use of sanitary toilets. The ova of the
parasite get out of the human body together with feces. Cutting the
cycle at this stage is the most effective way of preventing the
spread of the disease to susceptible hosts.
158.
Answer: (D) 5 skin lesions, positive slit skin smear. A
multibacillary leprosy case is one who has a positive slit skin smear
and at least 5 skin lesions.
159.
Answer: (C) Thickened painful nerves. The lesion of
leprosy is not macular. It is characterized by a change in skin color
(either reddish or whitish) and loss of sensation, sweating and hair
growth over the lesion. Inability to close the eyelids (lagophthalmos)
and sinking of the nosebridge are late symptoms.
160.
Answer: (B) Ask where the family resides. Because
malaria is endemic, the first question to determine malaria risk is
where the clients family resides. If the area of residence is not a
known endemic area, ask if the child had traveled within the past 6
months, where she was brought and whether she stayed overnight
in that area.
161.
Answer: (A) Inability to drink. A sick child aged 2 months to
5 years must be referred urgently to a hospital if he/she has one or
more of the following signs: not able to feed or drink, vomits
everything, convulsions, abnormally sleepy or difficult to awaken.
162.
Answer: (A) Refer the child urgently to a hospital for
confinement. Baggy pants is a sign of severe marasmus. The
best management is urgent referral to a hospital.
163.
Answer: (D) Let the child rest for 10 minutes then
continue giving Oresol more slowly. If the child vomits
persistently, that is, he vomits everything that he takes in, he has to
be referred urgently to a hospital. Otherwise, vomiting is managed
by letting the child rest for 10 minutes and then continuing with
Oresol administration. Teach the mother to give Oresol more slowly.
164.
Answer: (B) Some dehydration. Using the assessment
guidelines of IMCI, a child (2 months to 5 years old) with diarrhea is
classified as having SOME DEHYDRATION if he shows 2 or more of
the following signs: restless or irritable, sunken eyes, the skin goes
back slow after a skin pinch.
165.
Answer: (C) Normal. In IMCI, a respiratory rate of 50/minute
or more is fast breathing for an infant aged 2 to 12 months.
166.
Answer: (A) 1 year. The baby will have passive natural
immunity by placental transfer of antibodies. The mother will have
active artificial immunity lasting for about 10 years. 5 doses will give
the mother lifetime protection.
167.
Answer: (B) 4 hours. While the unused portion of other
biologicals in EPI may be given until the end of the day, only BCG is
discarded 4 hours after reconstitution. This is why BCG immunization
is scheduled only in the morning.
168.
Answer: (B) 6 months. After 6 months, the babys nutrient
needs, especially the babys iron requirement, can no longer be
provided by mothers milk alone.
169.
Answer: (C) 24 weeks. At approximately 23 to 24 weeks
gestation, the lungs are developed enough to sometimes maintain
extrauterine life. The lungs are the most immature system during
the gestation period. Medical care for premature labor begins much
earlier (aggressively at 21 weeks gestation)
170.
Answer: (B) Sudden infant death syndrome
(SIDS). Supine positioning is recommended to reduce the risk of
SIDS in infancy. The risk of aspiration is slightly increased with the
supine position. Suffocation would be less likely with an infant
supine than prone and the position for GER requires the head of the
bed to be elevated.
171.
Answer: (C) Decreased temperature. Temperature
instability, especially when it results in a low temperature in the
neonate, may be a sign of infection. The neonates color often
changes with an infection process but generally becomes ashen or
mottled. The neonate with an infection will usually show a decrease
in activity level or lethargy.
172.
Answer: (D) Polycythemia probably due to chronic fetal
hypoxia. The small-for-gestation neonate is at risk for developing
polycythemia during the transitional period in an attempt to
decreasehypoxia. The neonates are also at increased risk for
developing hypoglycemia and hypothermia due to decreased
glycogen stores.
173.
Answer: (C) Desquamation of the epidermis. Postdate
fetuses lose the vernix caseosa, and the epidermis may become
desquamated. These neonates are usually very alert. Lanugo is
missing in the postdate neonate.
174.
Answer: (C) Respiratory depression. Magnesium sulfate
crosses the placenta and adverse neonatal effects are respiratory
depression, hypotonia, and bradycardia. The serum blood sugar isnt
affected by magnesium sulfate. The neonate would be floppy, not
jittery.
175.
Answer: (C) Respiratory rate 40 to 60 breaths/minute. A
respiratory rate 40 to 60 breaths/minute is normal for a neonate
during the transitional period. Nasal flaring, respiratory rate more
than 60 breaths/minute, and audible grunting are signs of
respiratory distress.
176.
Answer: (C) Keep the cord dry and open to air. Keeping
the cord dry and open to air helps reduce infection and hastens
drying. Infants arent given tub bath but are sponged off until the
cord falls off. Petroleum jelly prevents the cord from drying and
encourages infection. Peroxide could be painful and isnt
recommended.
177.
Answer: (B) Conjunctival hemorrhage. Conjunctival
hemorrhages are commonly seen in neonates secondary to the
cranial pressure applied during the birth process. Bulging fontanelles
are a sign of intracranial pressure. Simian creases are present in
40% of the neonates with trisomy 21. Cystic hygroma is a neck
mass that can affect the airway.
178.
Answer: (B) To assess for prolapsed cord. After a client
has an amniotomy, the nurse should assure that the cord isnt
prolapsed and that the baby tolerated the procedure well. The most
effective way to do this is to check the fetal heart rate. Fetal wellbeing is assessed via a nonstress test. Fetal position is determined
by vaginal examination. Artificial rupture of membranes doesnt
indicate an imminent delivery.
179.
Answer: (D) The parents interactions with each
other. Parental interaction will provide the nurse with a good
d) peripheral neuritis
14. The client with AIDS is diagnosed with cutaneous
Kaposi's sarcoma. Based on this diagnosis, the nurse
understands that his has been determined by which of the
following?
a) appearance of reddish blue lesions noted on the skin
b) swelling in the lower extremities
c) punch biopsy of the cutaneous lesions
d) swelling in the genital area
15. Which of the following individuals is least likely at risk
for the development of Kaposi's sarcoma?
a) a man with a history of same sex partners
b) a renal transplant client
c) a client receiving antineoplastic medications
d) an individual working in an environment where exposure
to asbestos exists
16. The clinic nurse assesses the skin of the client with a
diagnosis of psoriasis. Which of the following
characteristics is not associated with this skin disorder?
a) discoloration and pitting of the nails
b) silvery white, scaly patches on the scalp, elbows, knees,
and sacral regoins
c) complaints of pruritus
d) red purplish, scaly lesions
17. The nurse is assigned to care for a client with herpes
zoster. Which of the following characteristics does the
nurse expect to note when assessing the lesions of this
infection?
a) a generalized body rash
b) small, blue-white spots with a red base
c) a fiery red, edematous rash on the cheeks
d) clustered skin vesicles
18. The nurse manager is panning in the clinical
assignments for the day. Which of the following staff
members would not be assigned to the client with herpes
zoster?
a) the nurse who had chicken fox during child hood
b) the new nurse who never had german measles
c) the nurse who never had enteric fever
d) the new nurse who had flu vaccine
19. The nurse plans to instruct a client with candidiasis
(thrush) of the oral cavity about how to care for the disorder.
Which of the following is not a component of instructions?
a) to rinse the mouth four times daily with a commercial
mouthwash
b) to avoid spicy foods
c) to avoid citrus fruits and hot liquids
d) to eat foods that are liquid
20. The clinic nurse inspects the skin of client suspect of
having scabies.Which of the following
assessment findings would the nurse note if this disorder
were present?
a. the appearance of vesicles or pustules with a thick,
honey colored crust
b) the presence of white patches scattered about the trunk
c) multiple straight or wavy, threadlike lines beneath the
skin
d) patchy hair loss and round neck macules with scales
ANSWERS
1) C ..... 2) D ..... 3) D ..... 4) A ..... 5) B
6) C ..... 7) D ..... 8) D ..... 9) A ..... 10) A
11) D ..... 12) C ..... 13) D ..... 14) A ..... 15) C
16) D ..... 17) D ..... 18) B ..... 19) A ..... 20) C
Situation: Bobby, 3 years old, from a family of four older
siblings, a mother and a father, was admitted to the hospital
with a temperature of 101 F, a sore throat of four days
duration, with difficulty of swallowing, and a moderate
cervical adenitis. A diagnosis of pharyngeal diphtheria was
made.
61. The best means for providing complete bed rest for the
child include:
a) feeding the patient
b) giving sedation
c) providing quiet diversion
d) giving complete physical care
62. A positive nose and throat culture in a member of the
family in whom no signs of the disease are present would
indicate:
a) that he is developing diphtheria
b) that he is a carrier
c) that he is susceptible to diphtheria
d) that he is immune to diphtheria
Situation: Charles, an 8 year old boy, one of several
siblings in the family, is kept home by his mother because
he has a temperature of 100.2F and a history of hacking
cough for two weeks. A definite whoop has been heard and
the doctor made a diagnosis of whooping cough. The
visiting nurse is to instruct the mother in proper care of this
patient.
64. This young boy should be:
a) kept in warm, dry room
b) placed in a sunny room
c) kept in a room with a temperature of 60F
d) allowed free run of the house
65. The organism causing whooping cough is:
a) hemolytic streptococcus
b) hemophilus influenza
c) hemophilus pertussis
d) streptococcus albus
66. Whooping cough is most contagious:
a) in the paroxysmal stage
b) in the catarrhal stage
c( in the febrile stage
d) in the incubation stage
67. During the second stage of the disease the
characteristic paroxysm is frequently accompanied by:
a) involuntary micturation
b) spontaneous epistaxis
c) inspiratory whoop
d) expulsion of mucous from the trachea
68. The diagnosis of pertussis is confirmed by which of the
following tests?
a) nose and throat culture
b) nasopharyngeal culture
c) "rapid" culture of nose and throat organism
d) sputum culture
69. Oxygen is used in whooping cough for which of the
following reasons:
a) prevents the pertussis organism from multiplying
b) seems to lessen the occurrence of paroxysms
c) reduces the danger of convulsions
d) prevents atelectasis
70. One of the first signs of mumps is:
a) pain in the back
b) diarrhea
c) pain in the region of the parotid gland
d) otitis media
sites
c) deciding upon the appropriate to be antibiotic to be
administered to the client
d) supporting the client's body defense mechanisms
78. When giving a history, the patient reports that he had
discharge from his penis and burning when he urinates. A
nurse should recognize these as indicative of:
a) herpes
b) chlamydia
c) syphilis
d) HIV infection
79. When insect serves as the host for transmission, this is
called
a) airborne
b) vectorborne
c) vehicle
d) contact
80. When a health care worker is washing her/his hands,
which of the following observations made by the nurse
would indicate that the worker understands the principle of
proper hand washing?
a) washes hands prior to removing gloves
b) wash hands for 5 seconds
c) rinses hands with fingers pointed up
d) removes rings before washing
ANSWERS
61) B ..... 62) B ..... 63) ..... 64) A .....65) C
66) B .....67) C ..... 68) A ..... 69) B ..... 70) C
71) D ..... 72) C ..... 73) D ..... 74) C ..... 75) A
76) D ..... 77) C ..... 78) A ..... 79) B ..... 80) D
Infectious Agent or its toxic products - AGENT
Directly or Indirectly - MODE OF TRANSMISSION
Person, Animal or Intermediate Vector HOST
Environment - ENVIRONMENT
ECOLOGIC TRIAD OF DISEASE
Agent element, substance, animate or inanimate
that may serve as stimulus to initiate a disease
process
Host organism that provides nourishment for
another organism
Environment physical (climate), biological (plants
& animals)
CONTAGIOUS VS. INFECTIOUS
Contagious
Diseases that are easily spread directly transmitted
from person to person (direct contact) through an
intermediary host
Infectious
Diseases that caused by a pathogen not transmitted
by ordinary contact but require a direct inoculation
through a break in the skin or mucous membrane.
NOTE: ALL CONTAGIOUS DISEASE ARE INFECTIOUS
BUT INFECTIOUS DISEASE IS NOT ALWAYS
CONTAGIOUS
What is Infection?
INFECTION - "the state or condition in which the
body or part of the body is invaded by a pathogenic
agent ( bacteria, virus, parasites etc.) which under
favorable conditions multiplies and produces effects
which are injurious"
Infectious Agent
A. RESIDENT ORGANISMS
deeply seated in the epidermis, not easily removed
by simple handwashing,
Ex: Staphylococci
B. TRANSIENT ORGANISM
represent recent contamination,
survive for a limited period of time, acquired during
contact with the infected colonized patient or
environment,
easily removed by good handwashing
Ex: ( Klebsiella & Pseudomonas)
Infectious Agent
Bacteria heama organism, systemic
Virus nuero organism, systemic
Fungi skin organism, local
Protozoa GI organism, local
Infectious Agent
FACTORS THAT AFFECTS THE AGENT TO
DEVELOP A DISEASE
Pathogenicity ability to cause a disease
Infective dose no of organism to initiate infection
Virulence ability to enter or move through tissues
Specificity ability of the organism to develop
antigens
cyclical variation
a periodic increase in the number of cases of a
disease
a seasonal disease, an increase is expected or there
is usual increase- dengue fever during rainy seasons
are increased but it is not considered an epidemic
because it is expected to rise at this particular time
hot spot-a rising increase that may lead to an
epidemic
Time Related Patterns of Occurrence
Short time fluctuation
A change in the frequency of occurrence of a
disease over a short period of time
Maybe (+) or (-)
Secular variation
A change in the frequency of occurrence of a diseae
taking place over a long period of time
Ex: a.) the change in the pattern of occurrence of
polio after being eradicated in 2000, then sudden
repport of cases in 2001 due to mutant restraints.
b.) small pox virus-eradicated in 1979 (last case
reported) and no another incidence as of today
Types of Epidemiology
Descriptive Epidemiology - concerned with disease
frequency & distribution
Analytic Epidemiology
Is a study of the factors affecting occurrence and
distribution of the disease.
Ex. Epidemiologic investigation
Therapeutic/Clinical
Study of the efficacy of a treatment of a particular
disease
Ex. Clinical trial of a newly proposed therapeutic
regimen
Evaluation Epidemiology
Study of the over-all effectiveness of a total/
comprehensive public health program.
Ex. Evaluation of the under five clinic
Note: We make use of the epidemiology in CHN in
order to come up a community diagnosis and also
to determine the effectiveness of a particular
treatment
Types of Epidemiologic Data
Demographic data
Demography is the study of population groups
Ex. Population size and distribution
Vital Statistics
Environmental data
Health services data
Ex. Ratio between nurse and the population being
served
Contact precautions
skin to skin
Example: RSV Hep A, impetigo
Airborne infection
TB, chicken pox ( Varicella) , measles ( rubeola),
Droplets precaustion
when a patient cough and sneezing
Influenza, Pertussis.
pathogen
an agent that causes a communicable disease
viruses
______ are smaller than bacteria and cannot reproduce on
their own.
cancer
the uncontrolled growth of abnormal cells
person's behavior
A ________ can affect the risk of developing cancer.
cured
Some noncommunicable diseases can be _____.
arthrosclerosis
a disease in which fatty substances build up on the inside
of arteries
fungi
protist
Which kind of disease causes malaria?
skin
What is a major line of defense to keep pathogens out?
vaccine
A _______ is a dose of weakened or killed pathogens of one
kind.
cardiovascular disease
a disease of the heart and blood vessels
emphysema
a disease of the lungs in which air sacs are damaged
early diagnosis
What is the key to curing, controlling, damage done by
noncommunicable diseases?
immunity
the body's resistance to a disease through the presence of
antibodies
antibody
a substance made by certain white blood cells that
attaches to a pathogen and makes it harmless
vaccines
What is one way to develop immunity without getting sick?
smoking
What is the main cause of emphysema?
antibiotic
a medicine that kills bacteria
bacteria
Doctors give you an antibiotic when you have a disease
caused by a ________.
non-communicable disease
an illness that cannot spread and is not caused by a
pathogen
heredity
What is the main causes of noncommunicable diseases?
allergy
harmful reaction to certain substances
asthma
allergy that affects the respiratory system and may result
in breathing difficulty and wheezing
infectious dieseases
Communicable diseases are sometimes called _______,
infections, or contagious.
allergic reaction
All of the following are examples of _______:
itchy skin, rash, hives, stomach upset, swelling of lips or
tongue, sneezing
pollen
What triggers hay fever?
Pathogens
Disease causing microorganisms
Virus
Bacteria
One-celled organisms that multiply rapidly and make up
sick by releasing toxins.
Fungi
Feed on both living and dead organic matter. Most are
harmless but some can cause infections such as ringworm
and athlete's foot.
Protozoa (Protists)
Single-celled organisms that can have parasitic like
characteristics and may contain flagellum.
Symptoms
A physical or mental feature- fever, swelling, rash, aches,
runny nose, cough, headache- that indicates a specific
infection
Contagious Period
Length of time that a disease can spread from person to
person
Infectious Diseases
Often called communicable diseases as they can be
passed from one person to the next.
Infected animals
When pathogens spread diseases through bites
Occurs when there is physical contact with body fluidssaliva, blood, vomit, urine, feces, nasal secretionsbetween an infected person and a susceptible person via
touching, kissing & other sexual contact, direct contact
with body fluids, or contact with open wounds.
Agent
Germ that produced infection- Bacteria, Virus, Fungi,
Protozoa
Reservior
Place germ can live such as humans, animals, soil, objects,
air, water and food
Place of Exit
Where germ leaves reservoir such as through the mouth,
nose, rectum, genitals and wounds
Method of Transmission
How germ travels from point A to point B such as through
saliva, sneeze, wind, feces, urine, blood, water, soils,
kissing, infected sore
Place of Entry
Place where germ enters a person such as breathing in
through nose & mouth, germs in food- mouth and
digestive, cuts in skin, direct contact
Susceptible Host
Things that make a person more likely to get a disease.
These include behaviors (taking care of cuts, nutrition,
exercise, sleep, hygiene, abstaining from smoking and
drinking), conditions (receiving Chemo, AIDS/HIV+),
environment and inherited factors.
Skin
Hair
Around eyes and nose they trap germs and keep germs
from entering the body. The trachea has cilia that keep
germs from entering the lungs.
Tears
Wash away germs from eyes
Mucus
Sticky substance that exists in the nose & other places that
traps germs and contains chemicals defenses that attack
and destroy germs.
Antibodies
Specialize proteins that lock onto specific antigens and
mark invaders for other cells to destroy
Leukocytes
WBC or White Blood Cells
Phagocytes
Attach/engulf invaders
Lymphocytes
Remember & help destory
T lymphocytes
Destroy invaders
B lymphocytes
Seek out targets, produce antibodies, and send defenses
Antigens
Surface structures or markings that antibodies attach onto
Macrophage
Engulf invaders and trigger immune response
Vaccination
Contains weakened or dead strain of the organism/virus
which is injected into the body to prepare B-Cells and TCells to remember and destroy it quickly thus giving the
person immunity towards a specific disease and prevents
them from getting sick.
Antibotics
Treatment for bacterial infections
What process enhances topical
corticosteriods efficacy?
Soaking in water for 10-15 minutes
HIV
iatrogenic immunosuppression
prior lymphoma
typical prodromal sx
fever, malaise, HA, lack of appetite, rash
hand-foot-mouth disease
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-viral
-coxsackieviruses A16
-contact with body fluids or droplet
-fever, sore throat, malaise. In 1-2 days herpangina and
this disease begins with a low grade fever HA, mild cold
sx. these pass and the illness seems gone until a fine lacy
rash appears a few days later
fifth disease
Hep A
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-viral
-Hep A
-food born transmission
-fever, abd pain, N/V, diarrhea, jaundice.
tx: prevention, hydration, antipyretic, analgesics
Hep B
-transmission
-clinical manifestation
-treatment
-contact with bodily fluids
-jaundice, dark urine, fatigue, abd pain, loss of appetite,
N/V, and joint pain, skin rash
Hep c
-transmission
-clinical manifestation
-treatment
-contact with bodily fluids
-asymptomatic for a very long time. Can lead to liver
cancer and death. Non-specific sx: malaise, fatigue, weight
loss, vague abd pain.
-tx: prevention, antiviral meds, long term management.
may be passed from mom--> baby
Influenza
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-viral
-influenza A (H1N1) and B
-direct contact
-abrupt fever, progressive URI-like sx, malaise, anorexia
-prevention, antiviral (tammaflu) if detected early,
supportive care
Rubella
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-viral
-rubella virus
-droplets and contact with bodily fluids
-prodromal phase is ABSENT in kids. See rash starts on
face-->neck, arms, trunk, legs
-prevention, anti-pyretics, analgesics
chicken pox
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-viral
-varicella-zoster
-direct contact and droplet
-prodromal phase: slight fever and malaise. pruritic rash
begins as macule-->vesicle. pattern is centripetal
appearing on extremities, face
tx: acyclovir 20mg/kg/dose, 4 x day, also prevention,
antihistamines and skin care
shingles may develop at any age group but you are more
likely to get it if...
-you are older than 60
-you had chicken pox before the are of 1
-your immune syst is weakened by meds or disease
-you are a teen who was not immunized with two varicella
vaccines
rotovirus
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-viral
-rotovirus A-G
-contact with bodily fluids
-in kids 3-24mo, it is the most common cause of diarrhea.
also fever, vomiting, dehydration
-tx: prevention, hydration, antipyretics
Polyomyelitis (polio)
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-virus
-enterovirus
-contact with bodily fluids
-three different forms; abortive/inapparent, non-paralytic,
paralytic
-tx: prevention, bed rest, RT, PT, skin integrity, ADL's
this type of polio you see these sx: sore throat, HA,
vomiting, abdominal pain
abortive/inapparent
measles (rubeola)
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-viral
-mobillivirus
droplet and contact with bodily fluids
-prodromal state: fever and malaise, coryza (stuffy nose),
cough, conjunctivitis. Then Koplick Spots on mucosa, rash
appears on day 3-4 of illness
tx: prevention, vit A, bed rest, antipyretics
Roseola
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-viral
-contact with body fluids
-herpesvirus ty 6
-fever >103 for 3-7 days. a macular rash that is blanchable
-tx: antipyretics
mumps (parotitis)
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-viral
-droplet or direct contact
-paramyxovirus
-fever, HA, swelling of parotid gland on 3d day
tx: prevention, analgesics, antipyretics, hydration, AIRWAY
precautions.
condyloma/genital warts/HPV
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
viral
-human papillomavirus
-contact with body fluids
-lesions found on butt, vulva, vagina, anus, cervix
-tx: prevention, removal of warts, antimitotic drugs. not
sure if treatment actually reduces transmission...
Diptheria
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-bacterial
-corynebacterium dptheriae
-direct contact with bodily fluids
-URI which progresses to "bull's neck", white/gray mucus
membranes, fever cough
-antibiotics, bed rest, AIRWAY precautions, support
meningococcal meningitis
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-bacterial
-neisseria meningitidis
-contact with bodily fluids
-fever, HA, stiff neck, NV, photophobia, altered mental
status
-tx: prevention, antipyretics, anti inflamm, anti B
pneumococcal disease
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-bacterial
-streptococcus pneumonia
-direct contact with body fluids and droplet
-many manifestations (strep throat, scarletina, scarlet
fever, pneumonia, otis media, sinustitis, localized infec
scarlet fever
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-bacteria
-group A beta-hemolytic streptococci
-droplets and direct contact with body fluids
-prodromal: abrupt high fever, halitosis, HA enanthema:
tonsils large, edematous, "strawberry tongue, both white
then red...
tx: penicillin, bed rest, analgesics, antipruritis, hydration
tetanus
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-bacterial
-clostridium tetani
-spores in soil, dust, excretions
-muscle contractions of masseter, neck, and trunk
-tx: immunoglobulin, tetanus toxoid, analgesics
meningitis
onset
clinical manifestations
-tx
rapid onset; bac, viral, fungal, aseptic
-nucchal rigidity, change in mental status, fever, rash
-tx: antipyretics, analgesics, antifungal/antibiotics,
hydration
giardiasis
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-treatment
-protozoan
-giardia intestinalis
-direct contact with contaminated water or food
-diarrhea, NV, anorexia, failure to thrive, abd cramps,
constipation, bloating, flatulence
-tx: flagyl, tindamax, and prevention of reoccurance
enterboiasis (pinworms)
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-diagnosis
-treatment
protozoan
-nematode enerobius vermicularis
-inhalation or ingestion of eggs from contaminated hands
-itchy butt, restless, bed wetting, short attention span, poor
sleep, possible urethral infection
-dx: tape test
tx: pyrantel pamoate or albendazole x1 then again in 2
wks. treat whole family. prevent occurrence
lyme disease
-what kind of disease (viral, bac...)
-scientific name
-transmission
-clinical manifestation
-vector borne
-borrelia burhdorferi
-transmitted by deer tick bite
{stage 1: }"bull's eye", fever, HA, malaise
{stage 2:} (1-4mo) rash on hands/feet, fever, HA, malaise,
fatigue, lymphadenopathy, cough, stiff neck
{stage 3:} systemic involvement (2-12mo)
arthritis, CNS changes, cardio complications,
encephalopathy, cognitive and behavioral changes, chronic
arthritis
tx for lyme
>8 yo, doxycycline
<8 yo, amoxicillin
-transmission
-clinical manifestation
-treatment
-vector borne
-ricketsia ricketsi
-gradual or abrupt onset of fever, malaise, HA, rash on
palms/feet
-tx: antipyretic, analgesic, antibiotics
lice
-scientific name
-clinical manifestation
-treatment
-pediculus humanus capitis
-intense pruritus of scalp, behind ears, nape of neck, nits
(eggs) attached to hair shaft
-pediculicide and removal of nits, education and support.
kid infected, family and home must all be treated.
scabies
-scientific name
-transmission
-clinical manifestation
-treatment
-sarcoptes scabiei
-prolonged close contact. mites burrow into skin and lay
eggs in CLUSTERS
-intense itching, excoriation and burrows, inflammation
btwn fingers, neck folds and groin
tx: scabicide, >2 yr permethrin, wash linen and clothes and
dry high heat, supportive care for itching 2-3 weeks
bedbugs
-scientific name
-transmission
-clinical manifestation
-treatment
-cimex lectularis
-contact with infested mattress. mites burrow and feed on
blood.
-intense itching, all over bites, may progress to
follicularitis/cellulitis. may trigger asthma/anaphylaxis
-identification and eradication of bugs, topical application
of steroids, hygiene of linens and clothing, supportive care
pruritis 2-3 wks
goals of stomatitis?
NSAIDs, anesthetics, prevent spread by oral secretions and
poor handwashing
sx of encephalitis
personality changes, seizures, weakness
communicable disease
...a disease that can be given from one person to another
microbe (microorganism)
...a living thing that cannot be seen with the naked eye;
examples include bacteria and viruses
pathogens
...a microbe that can cause illness
opportunistic microbes
...microbes that are considered normal (resident) flora
when they are in or on one part of the body, but can cause
infection if they move out of that area and into or onto
another part of the body
colonies
...groups of bacteria
aerobic
...bacteria that need oxygen in order to live
anaerobic
...bacteria that can survive withhout oxygen
antibodies
...specialized proteins produced by the immune system
that help our bodies to fight specific microbes, preventing
infection.
infection
...disease caused by pathogenic microbes
chain of infection
...the six key conditions that must be met for a person to
get a communicable infection: pathogen, reservoir, portal
of exit, method of transmission, portal of entry, and a
susceptible host.
contaminated
...describes an object that is soiled by pathogens
fomite
...a non-living object that has been contaminated (soiled)
by pathogens
vector
...a living creature, such as an insect, that can transmit
disease
virulence
...the strength or disease-producing potential of a
pathogen
nosocomial infections
...Infections that a patient or resident get while receiving
treatment in a hospital or other health care facility; a type
of health-care associated infection (HAI)
infection control
...basic practices designed to decrease the chance that an
infection will spread from one person to another in a health
care facility
medical asepsis
sanitization
...practices associated with basic cleanliness,such as hand
washing, cleansing of eating utensils and other surfaces
with soap and water, and providing clean linens and
clothing; one of the techniques of medical asepsis
antisepsis
...practices that kill microbes or stop them from growing;
one of the techniques associated with medical asepsis
(compare with sanitization, disinfection, and sterilization)
disinfection
...the use of strong chemicals to kill pathogens on nonliving objects that come in contact with body fluids or
substances, such as bed pans, urinals, and over the bed
tables; one of the techniques of medical asepsis (compare
with sanitization, disinfection, and sterilization)
sterilization
...the process of completely eliminating microbes from the
surface of an object using an autoclave (sterilizer) or
chemicals; (compare with sanitization, disinfection, and
sterilization)
transient flora
...microbes that are picked up by touching contaminated
objects or people who have an infectious disease
isolation precautions
...guidelines, based on a pathogen's method of
transmission, that health care workers follow to contain the
pathogen and limit others' exposure to it as much as
possible
standard precautions
transmission-based precautions
...precautions that a health care worker takes when a
person is known to have a disease that is transmitted in a
certain way; include airborne precautions, droplet
precautions, and contact precautions
airborne precautions
...used when caring for patients or residents infected with
pathogens that can be transmitted through the air; include
placing the patient or resident in a private room with the
door closed, wearing a mask when caring for the patient or
resident, and minimizing the amount of time the person
spends out of his or her private room
droplet precautions
...used when caring for patients or residents infected with
pathogens that can be transmitted by direct exposure to
droplets released from the mouth or nose (for example
when the person coughs, sneezes or talks)
contact precautions
...used when caring for patients or residents infected with
pathogens that can be transmitted directly (by touching
the person), or indirectly (by touching fomites); include
using barrier methods whenever contact with the infected
person or items contaminated with wound drainage or
body substances is necessary
Callose
is a large polysacchride that blocks old sieve tubes
Tylose
a balloon-like swelling, also blocks old xylem vessels
primary defences
which prevent entry of pathogens into the body
Secondary defences
help to remove a pathogen after it has entered the body.
immune response
the body's response to invasion by pathogens.
Blood clots
reduce the loss of blood and make a temporary seal,
preventing access by pathogens
Inflammation
the swelling and redness seen in infected tissues. Infected
tissue often feels hot and tender. This is caused by a cellsignalling substance called histamine.
Antibodies
proteins that are secreted in response to stimulation by the
appropriate antigen. They have specific binding sites and
are capable of acting against the pathogen.
Antigens
molecules on the surface of cells that the immune system
can use to recognise pathogens.
Antigen presentation
primary response
the immune system's response to a first infection
secondary response
the immune system's response to a second or subsequent
infection by the same pathogen.
Active immunity
immunity acquired by activation of the immune system
Passive immunity
when someone is given antibodies produced by someone
else
autoimmune disease
one in which the immune system attacks the body's own
healthy cells and tissues
Vaccination
the deliberate introduction of antigenic material in order to
stimulate the production of antibodies
vector
an organism that carries the pathogen from one host to
another.
disease
an illness
communicable disease
caused by pathogens from one living thing to another
pathogen
a disease causing organism
non-communicable disease
a disease that can not be spread other than through
heredity (no pathogens-heart disease)
virus
smallest pathogens (ex: common cold, herpes)
bacteria
singled-celled microorganisms (ex: strep throat,
tuberculosis, syphilis, and lyme disease)
rickettsia
pathogens that grow in living cells and resemble bacteria
(ex: rocky mountain spotted fever and typhus)
fungi
single-celled or multi-cellular plantlike organisms, yeast
and mold (ex: athlete's foot, jock itch, nail infection,
ringworm)
protozoa
tiny, single-celled organisms that produce toxins that
cause disease (ex: malaria and dysentery)
direct contact
sexual intercourse, intimate kissing, blood transfusion,
touching ulcers or sores, handling body fluids (blood or
urine)
indirect contact
contact with an object that has been used by an infected
person
skin
unbroken skin prevents pathogens from entering the bodybathing rids the body of the pathogens
mucous membranes
tissues that line the body opening and secrete mucus
mucus
is thick secretions that coats the mucous membranes
stomach acid
acid in stomach that kills most pathogens
T cells
white blood cells that regulate the action of the immune
system
phagocytes
white blood cells that surround and kill pathogens by
ingesting them
B cells
...
What is the primary prevention of disease?
Immunization
What is Varicella?
Chicken Pox
Incubation of Varicella
14-16 days but can be as long as 18-21 days
Varicella-Manifestations
Rash erupts 1 day after prodromal period
Very itchy
Begins as a macule and progresses to a papule
Then becomes a fluid filled vesicle resembling a dew drop,
which breaks and forms a crust
starts in trunk and progress to proximal extremities and
face
Varicella-Treatment
Acyclovir and Varicella Zoster Immune Globin in High Risk
Children After Transmission
Strict Isolation
Skin care-Comfort, Cool Bath, Calamine
Avoid use of aspirin/salicylates
Manage itching w/distraction, benadryl in moderation
Varicella-Complications
Secondary bacterial infections
Encephalitis
Pneumonia
Hemorrhagic Varicella
Chronic or transient thrombocytopenia
Erythema Infectiosum-Manifestations
Mild Fever
Joint Pain
Lethargy
Rash-3 stages
Erythema Infectiosum-Management
Self Limiting, can only manage symptoms
*anti-pyretics
*analgesics
Erythema Infectiosum-Complications
chronic joint pain
aplastic crisis
myocarditis
Exanthem Subitum-Characteristics
High fever with unknown etiology for several days
Followed by rash once fever is resolved
may have lymphadenopathy, inflamed pharynx, cough,
coryza
Exanthem Subitum-Treatment
Self limiting. Treat the symptoms!
What is Pertussis?
Whooping Cough
Caused by bordetella pertussis
Pertussis-Characteristics
Short, rapid coughs followed up a crowing or "whoop"
sound
What is Rubeola?
Measles
Viral Infection
Rubeola-Characteristics
Fever and Malaise
Followed by coryza, cough, conjunctivitis, Koplik spots,
anorexia, lymphadenopathy then rash
Rubeola-Treatment
Treatment includes supplementation w/vitamin A;
supportive care
Maintain isolation until 5th day of rash, bedrest
Rubeola-Complications
Complications include otitis media, pneumonia,
bronchiolitis, obstructive laryngitis/laryngotracheitis,
encephalitis
Mumps-Characterized
Mumps-Treatment
Supportive: analgesics, antipyretics; IV fluids if unable to
drink/vomiting due to meningoencephalitis
Maintain isolation
Mumps-Complications
sensorineural deafness, postinfectious encephalitis,
myocarditis, arthritis, hepatitis, epididymo-orchitis, sterility
in adult males (rare)
German Measles-Characteristics
No prodromal symptoms in children; in adults, adolescents:
low grade fever, headache, malaise, anorexia,
conjunctivitis, coryza, sore throat, cough,
lymphadenopathy; followed by rash, starting on face and
progressing downward, by end of 1st day body is covered
German Measles-Treatment
Self limiting, treatment includes antipyretics, analgesics
German Measles-Complications
Rare-but include arthritis, encephalitis, purpura
What is Poliomyelitis?
3 types of enteroviruses
No wild type virus since 1979; few vaccine-induced cases
until 1998, development of IPV
Poliopmyelitis-Chracteristics
May be inapparent (fever, sore throat, headache, vomiting,
abdominal pain), nonparalytic (sl. more severe than
inapparent)
Poliomyelitis-Treatment
No treatment other than supportive
Poliomyelitis-Complications
Complications include complete paralysis, respiratory
arrest, hypertension, and those things caused by
immobility
Scarlet Fever-Characteristics
Fever, malaise, headache, lymphadenopathy, vomiting,
chills, abdominal pain, enlarged tonsils w/exudate,
erythematous pharynx, strawberry tongue, and RASH
Scarlet Fever-Treatment
antibiotics (penicillin, erythromycin) x 10 days, analgesics,
antipyretics.
Scarlet Fever-Complications
otitis media, peritonsillar/retropharyngeal abcess, sinusitis,
glomerulonephritis, carditis/polyarthritis
Conjunctivitis-Causes in Newborns
chlamydia, gonorrhea, or herpes simplex virus
Conjunctivitis-Causes in Infants
may be sign of tear duct obstruction
Conjunctivitis-Causes in Children
bacterial (most common), viral, allergic, or foreign body
Hep B
RV
Definition of Immunization?
Process when an animal or person becomes protected
against a disease
Definition of Vaccination?
Injection of a killed or weakened infectious organism to
prevent a disease
Definition of Vaccine?
Product that produces immunity to protect the body from a
disease.
Safety of Vaccines?
Studied before giving to public
Scientist monitor safety of vaccines
Serious adverse effects are rare
Multiple vaccines at one visit is considered safe and
quickest protection against diseases
What is infection?
Invasion of bacteria or viruses
communicable disease
a disease that can be passed from one person to another
pathogen
a disease causing organism when germs enter your body,
you can develop an infection
infection
a condition that occurs when pathogens enter your body,
multiply and cause harm
virus
the smallest pathogen that can be heeled with antibiotics
bacteria
tiny one celled organism that can be cured with antibiotics
fungi
more complex organism than bacteria but cannot make
their own food. Thrive in warm, moist areas ex. ringworm,
athletes foot
protozoa
one celled organism that are more complex then bacteria
skin
first line of defense,
covers and protects body
mucous membranes
lines the mouth, nose , throat and eyes,
their job is to trap jerms
saliva
destroys harmful organisms
tears
wash away germs
stomach acid
vaccine
a preparation of dead or weakened pathogens that causes
the immune system to produce antibiotics
immunization
helps the immune system make antibiotics for certain
diseases
immunity
your body's ability to resist the germs that causes a
particular disease
specific reactions
some pathogens survive the nonspecific reaction. when this
happens your body is self off a specific immune system.
Our immune system recognizes a pathogen it has already
battled so it is ready to re attack
antigen
substance realised by invading pathogens
types of immunization
Hepatitis B, Polio, measles, chicken pox, tetanus shot
not only do they help you but they also surround you
colds
are caused by hundreds of different viruses and can be
spread by direct and indirect contact
treatments of cold
getting rest and drinking fluids, OTC medicines can help,
stay home for at least 24 hours
flu (influenza)
symptoms are fever, chills/ fatigue, headaches/muscle
aches and respiratory pain
mononucleosis
''mono'' or the ''kissing disease'' is a viral diseases
characterized by a severe sore throat and swelling of the
lymph glands in the neck and throat area
hepatitis
a viral disease if the liver characterized by yellowing of the
skin and whites of the eye
3 types of hepatitis
hep A,B and C
hepatitis A
common in areas of poor sanitation , like food or water
contaminated with human waste or enters the body
through an open wound
hepatitis B,C
spread through contact with contaminated blood or other
body fluids. There are vaccines to protect people with Hep
A and B. There are medicines to treat people with Hep.C
tuberculosis (TB)
bacterial disease that affects the lungs. TB can be spread
easily through air ,sometimes no symptoms but can still be
spread.
pneumonia
serious inflammation to the lungs
symptoms are fever, chills, and difficultly breathing
strep throat
sore throat causes by streptococcal bacteria
symptoms are red and painful throat, fever,and swollen
lymph nodes in neck
H.i.v
human, immunodeficiency, virus
human
immunodeficiency
this disease attacks the immune system
virus
the smallest and simplest form of life
A.I.D.S
acquired, immune, deficiency, syndrome
Acquired
this disease comes from outside the body. A person must
do something to take it in
Immune
this disease attacks the immune system
deficiency
lack of something. Aids destroys the T-cells
syndrome
a medical condition that has no cure
opportunistic disease
a disease that takes advantage of a weakness in the body.
People die from it because aids kill the immune system.
Hiv
2-10 years looks and feels good
Arc,Aid
body shuts down
death
male 3 years
females 1-5 years
A.R.C
aids realistic complex
what is arc
symptoms of arc
lost of appetite
symptoms of arc
fatigue
symptoms of arc
weight loss
symptoms of arc
fever
symptoms of arc
night sweats
symptoms of arc
diarrhea
what it does
slows down the disease
what it does
decreases the number of immune cells
is there a cure
no
C) C. C/HCV
D) D. D/delta
C
C) a. Communicable period
D) c. Latent period
A
C) b. Hand-to-hand contact
D) d. Sexual intercourse
D
The condition that results in bacteria passing the bloodbrain barrier and increasing cerebral vascular
permeability, thus increasing intracranial pressure, is
known as:
A) d. Tuberculosis
B) c. Meningitis
C) a. Hepatitis
D) b. HIV
B
Trichinosis
Escherichia coli (E. coli)
Cholera
Diphtheria
Encephalitis
Giardiasis
Gonorrhea
Hepatitis A-D
Influenza activity
Legionellosis/Legionnaires' disease
Leprosy
Lyme disease
Malaria
Meningococcal infections
Mumps
Pertussis
Poliomyelitis
Rabies
Rocky Mountain spotted fever
Rubella
Rubeola (measles)
Salmonellosis
Shigellosis
Severe acute respiratory syndrome-associated
Coronavirus disease (SARSCoV)
Syphilis
Smallpox
Tetanus
Toxic shock syndrome
Trichinosis
Tuberculosis
Typhoid fever
Vancomycin-resistant Staphylococcus aureus (VRSA)
Varicella (chickenpox)
bioterrorist attack.
Set up protocols for
different biosafety levels
of infection control and
containment.
mortality rates.
Examples include smallpox (variola), botulism toxin,
anthrax, tularemia,
hemorrhagic viral fevers, and plague.
Antigen
Substance capable of triggering an immune response
Antibodies
Protein that fights against a specific antigen
Lymphocytes
Specialized white blood cells (t & b)
Active immunity
Developed from natural or artificial processes (flu vaccine)
Passive immunity
Your body receives antibodies from another person or
injection
HIV
Damages T cells and leads to aids
Physical barriers
Skin, nose, hair
Chemical barriers
Tears, stomach acid, mucus
Immune system
A network of cells, tissues, organs, and chemicals that fight
off pathogens
Inflammatory response
A reaction to tissue damage caused by injury or infection
Phagocytes
White blood cells that attack invading pathogen
Helper T cells
Trigger the production of B cells and killer T cells
Killer T cells
Attack and destroy infected body cells
Suppressor T cells
Turn off T cells when infection is cleared
B cells
Produce antibodies
CDC
Centers for disease control
WHO
World health organization
Live-virus vaccines
Vaccines made from pathogens in labs
Killed-virus vaccines
Vaccines using dead pathogens
Toxoids
Vaccines with inactivated toxins from pathogens &
simulates the growth of antibodies
Pathogens
Microorganisms that cause disease
Rickettsias
Resembles a bacteria and enters the body through insect
bites
Protazoan
Single celled microorganisms that are larger and more
complex than bacteria
Vectors
And organism that carries and transmits pathogens to
humans or animals
Communicable disease
Disease that is spread from one living organism to another
or through the environment
This policy serves as the Sheriff's Office
"Infectious Disease Exposure Control Plan" and the
"Biomedical Waste Operating Plan."
1.
2.
3.
4.
5.
6.
Gloves;
Masks, Eyewear, and Gowns;
CPR mask;
Boot or shoe covers;
Disposable Personal respirator
Water-soluble plastic bags (clear w/ red stripe).
Influenza Type B
* Vancomycin
or
*Chloramphenicol
* short
* 1 min to 6 hours
* Soil
* Marine sediment
* Honey
* Meat Pies
* Gravies
*
*
*
*
Modes of transmission
Droplet, Vector (vehicle transmission... aka mosquitoes),
Airborne (droplet nuclei, remain suspended in air, varicella)
Passive artificial
What are some signs and symptoms for the Chicken Pox?
Fever, Fatigue, Upper Respiratory Infection
Maculare Rash that is more concentrated toward the center
at the body and thins out towards the distal part of the
body.
Nurse's Role
in Infection Control
Promote infection control strategies
Report infectious and communicable diseases to state
health officials
Active immunity
An antigen is introduced into the body in a vaccine, which
stimulates antibody production without causing clinical
disease
Passive immunity
Antibodies produced in another human or animal host is
given.
Provides immediate protection
Does not provide lasting immunity
Example: Tetanus immune globulin
Immunization Type
Inactivated
DTaP, IPV, Hep B, Hib, PCV, Hep A, Influenza
Fever Benefits
Rid of organisms that thrive in lower body temperatures
Mobilizes immune response
plasma iron concentration - limits microorganism growth
Fever Risk
When body temp reaches 41 C (105.9)
Febrile seizure
Sepsis
Definition: Overwhelming infection in the bloodstream
Causes from infectious diseases:
Infected pox
Can lead to septic shock
septic shock
Signs of Sepsis
Hypothermia or hyperthermia
Abdominal distention
Anorexia
Respiratory distress
Vomiting
Cool extremities
Mottling
Lethargy
Management of Lesions
Use cool wet compresses or giving baths in cool or
lukewarm water (Oatmeal bath, e.g., Aveeno)
Keep fingernails short and clean.
Put calamine lotion on itchy areas
Meningococcus
Transmission: respiratory droplets
Highest rates < 5 years of age.
Incubation: 1-10 days
Communicable until 24 hours after start of antibiotics
Clinical manifestations -onset is rapid and life-threatening
Onset - flu-like symptoms with prostration
Neuro signs
Meningococcemia - urticarial, maculopapular
Shock, hypotension, DIC, coma
Meningococcus (cont)
Complications
Loss of limbs d/t necrosis; hearing loss, arthritis, seizures,
pericarditis, hemiparesis
Up to 15% with invasive type die
Prevention
Vaccine for children > 2 years for persons at high-risk
Close contact - prophylaxis treatment
Treatment
Penicillin G (cefotaxime, ceftriaxone - alternatives)
In ICU
DIC treated with plasma, blood, or platelets
Meningococcus
Nursing management
Standard and droplet precautions
Monitor for shock and respiratory compromise
Monitor for fluid overload and ICP -watch fluids
Help identify close contacts that need prophylaxis
Help family identify and connect with supports
Surviving child will likely need rehab
Roseola
Transmission: likely to be respiratory
Incubation : 5-15 days
Clinical manifestations:
Sudden, high fever for 3-8 days; normal behavior and
appetite
Fever followed by pale, pink, discrete, maculopapular rash
Treatment: Supportive
Herpes Zoster (shingles)
Hepatitus B
below the belt,
comes from infected or contaminated blood
vaginal fluids, saliva, urine, semen etc
Hepatitus C
affects the liver
a symptomatic
and causes cirrohsis or hardening of the liver
auto infection
the infection of a primary host with a parasite. Particularly
a helminth
Legionairres disease
produces high fever and pnumonia
out breaks occur in warm moist environments during
summer and winter
uncommon to those 20 years or younger
pennicillin ineffective
Hepatitus A
Treansmited through fecal oral route
ingestation of contaminated food
shellfish from contaminated waterrs
no treatment
Staff
natural inhabitant found in the human body
responsible for boils and other infections
inflammation of the stomach and intestines
source of food intoxication
Poliomyelitus
feared more than aids
fecal oral route
Botulism
Paralytic type illness
recovery takes months or years
paralysis of the breathing muscles
casues respirtory failure
Mumps
contracting it equals life long immunity
inflammed glands
small pox
occurs only in humans
only infectious for a short time
1st communicable disease officially eradicated
not strong enough to survive.
e-Coli
can cause distruction of the kidneys
if excreted con become communicable
found in the lower intestines of warm blooded animals.
fecal oral transmission
Rubella
normally seen in children
communicable for one week
immunity accquired through vaccime or infection
salmonella
2000 different species
communicable for the duration of the infection
ingested of food derived from infected animal
transferred between human and non human
diarhea, feve and abdominal cramps
measles
disease is communicable
spread through respiratory contact
vaccination during second year of life
Histoplasmosis
Plague
spread to humans via fleas
depending on sanitation, van be spread through the air.
can come from contaminated or undercooked foods.
anthrax
used as a biological weapon
spread by spores
anthropod Vector
any tiny organism that can transport infectious pathogens
via bacteria or prion.
mosquitos
flies
mites
ticks
encephalitis
caused by bacterial infections by
rabies
west nile
measles
polio
and herpes simplex
toxic shock
caused by staff and strep
causing problems with several body ogans
can be treated with antibodies
conjunctivitus
eyes become red and inflammed
treated with drops
casued by bacteria rubbed into the eye
caused due to poor handwashing
affects the mucous membrane that lines the eyelid
rhino viruses
commom cold
most common of all communicable diseases
created through rhnoviruses
bacterial exudate is clear
can be transmitted directly or indirectly
Reyes syndrome
causing detrimental harm to many organs such as the brain
and liver
associated with giving children asprin
damages cellular mitochondria
inluenza
communicable 3 to 5 days after inicial symptoms appear
Vaccine is 80 percent effective
Mono
kissing disease
part of the herpes group
smptoms are non specific
carrier has EBV on the throat
affected individuals restricted form contact sport.
meningitis
caused by a bacteria
can be treatd with antibiotics
starts with an upper respiratory infection
Herpes simplex 1
herpes type 1 causes sores around the mouth and lips
(sometimes called fever blisters or cold sores).
Alkalosis
The main cause of respiratory alkalosis is hyperventilation,
resulting in a loss of carbon dioxide having to use a paper
bag
plantar warts
The HPV type 1 causes most plantar warts.
The virus gains access to the skin through direct contact.
endocarditus
inflammation on the inside lining o the heart
hansens disease
effects the skin and perrifrial nerves; leoprosy
necrotising facilitus
bacteria capable of deteriorating the skin and the tissues
covering the muscles due to bacteria entering into the skin.
What is an emergency?
An emergency is a serious event that
requires an immediate response. The
affected population is usually small in
scale. Examples include a house or
neighborhood fire, a car accident, or an
avalanche that traps several people.
What is a disaster?
A disaster affects many people in various
ways. Some examples of disasters include
an earthquake or a hurricane destroying a
city or several cities across a wide area, a
tornado that causes damage and death
over many miles and several cities, or a
man-made disaster such as a nuclear
bomb.
Conventional warfare
Nonconventional warfare (e.g., nuclear,
chemical)
Transportation accidents
Structural collapse
Explosions and bombings
Fires
Hazardous materials incident
Pollution
Civil unrest (e.g., riots)
Terrorism (e.g., chemical, biological,
radiological, nuclear, explosives)
Cyber attacks
Airplane crashes
Radiological incidents
Nuclear power plant incidents
Critical infrastructure failures
Water supply contamination
Pollutants
Medications/drugs
What is toxicity?
The ability to produce a poisonous reaction
what is invasiveness?
the ability to penetrate and spread
throughout a tissue?
What is antigenicity?
the ability to stimulate an immunological
response
What is resistance?
What is infectiousness?
a measure of the potential ability of an
infected host to transmit the infection to
other hosts.
What is an epidemic?
refers to the occurrence of a disease in a
community or region in excess of normal
expectancy.
What is a pandemic?
an epidemic that occurs worldwide and
affects large populations. HIV/AIDS is both
What is a zoonosis?
an infection transmitted from a vertebrate
animal to a human under natural
conditions. The agents that cause
zoonoses do not need humans to maintain
their life cycles; infected humans have
simply somehow managed to get in their
way
infection
A condition that occurs when pathogens enter the body,
multiply, and damage body cells
virus
(virology) ultramicroscopic infectious agent that replicates
itself only within cells of living hosts
toxins
Any of various poisonous substances produced by some
microorganisms
vectors
An organism that transmits disease by conveying
pathogens from one host to another
airborne transmission
Spread of disease-causing microorganisms over long
distances through the air.
respiratory tract
Nasal Cavity, Pharynx, Glottis, Larynx, Trachea, Bronchus,
Bronchioles, Lung, Diaphragm.
mucous membrane
Membrane that lines passages that communicate with air
influenza
Acute, contagious respiratory infection characterized by
sudden onset, fever, chills, headache.
pneumonia
An inflammation of lung tissue, wherer the alveoli in the
affected areas fill w/fluid
strep throat
Bacterial infection of the throat; if left untreated may lead
to high fever and other serious complications
tuberculosis
An infectious disease that may affect almost all tissues of
the body, especially the lungs
jaundice
yellowing of the skin and the whites of the eyes caused by
an accumulation of bile pigment (bilirubin) in the blood
hepatitis A
A virus that is spread by the fecal-oral route through
contaminated food and water or by close and intimate
contact and results in liver inflammation, flu-like
symptoms, nausea, poor appetite, abdominal pain, fatigue,
yellow eyes and skin, and dark urine that can last weeks to
months.
A microorganism that causes disease
pathogen
pandemic
T or F
A disease that is spread from one living organism to
another is called a(n) COMMUNICABLE DISEASE.
True
T or F
Common PATHOGENS include flies, mosquitoes, and ticks.
False vectors
T or F
The common cold and strep throat are both diseases of
the digestive tract.
False respiratory tract
T or F
PNEUMONIA can be caused by either a virus or a bacteria.
True
T or F
The RESPIRATORY SYSTEM is a network of cells, tissues,
organs, and chemicals that fight of pathogens.
False immune system
T or F
A(n) VACCINE is a protein that acts against a specific
antigen.
False
T or F
The body develops ACTIVE IMMUNITY when it is exposed
to antigens from invading pathogens.
True
T or F
LIVE-VIRUS VACCINES use dead pathogens.
False dead-virus vaccines
T or F
T or F
EMERGING INFECTIONS are communicable diseases
whose occurrence in humans has increased within the
past two decades or threatens to increase in the near
future.
True
T or F
Salmonella and E. Coli are VIRUSES that live in animal's
intestinal tracts.
False bacterias
carcinogen
chemicals known to cause cancer
malignant
cancerous
benign
noncancerous. does not spread
Cancer
abnormal, uncontrolled cell growth.
Takes over and destroys normal cells and tissue
Tumor
abnormal growth of tissue
Metastasis
the spread of cancer
Carcinomas
cancers that develop in the skin and linings of organs
Sarcomas
cancers that develop in bones, muscles and tendons
Lymphomas
cancers that develop in the lymphatic system (immune
system)
Diabetes
a chronic disease that affects the way body cells convert
food into energy
Glucose
sugar
Insulin
hormone that helps turn glucose into energy for the cells
Type 1 diabetes
Occurs most often before age 15
The pancreas produces NO insulin
Frequent urination, abnormal thirst and hunger are
symptoms
Must have daily injections
Type 2 diabetes
Usually in adults over 40
The body's cells do no use insulin correctly
Excess weight, drowsiness and blurred vision are symptoms
Must maintain diet and exercise
Usually caused from being overweight
Atherosclerosis
When fat deposits (plaque) build up in the blood vessels it
is called
Stroke
Blood vessels in the brain are blocked or broken
Biopsy
a procedure that removes and examines a group of cells
that may be cancerous.
Virus
The smallest pathogen that multiplies after entering a cell
Bacteria
Single-celled microorganism
Protozoa
Larger, more complex single-celled organism
Fungi
A plant-like organism that causes diseases of the skin
Heart Attack
The death of the cardiac muscle caused by a lack of blood
flow to the heart
Arteriosclerosis
A term used to describe several conditions that cause
hardening or thickening of the arteries
Angina Pectoris
Chest pain from narrowed coronary arteries
Vector