STUDY GUIDE FOR EXAM #2: FRIDAY CLASS, SECTION 02 General Information: 1. 2. 3.

Exam # 2 will be given on Friday, February 22, 2013 The exam will be composed of 40-50 questions and will last 60 minutes There will be no questions on this exam covering the Incident Command System (ICS) for management of disasters as you are earning separate certification for this material.

Review powerpoints and handouts from the class material indicated below: 1. The material presented by (or in): -Marta Browning in January 10 & 17 classes on Community assessment and screening & February 8 class on Disaster nursing, Health Education and Epidemiology -Healthy People 2020 Study guide -Huntsville Hospital Isolation Basics and STATs (distributed in class) -Dr. Robeys Power points for the January 24 and 31 classes on management of communicable diseases and the role of the Alabama health department -Dr. Peggy Hays presentation on communication and group process (see pages 276299 in your text) 2. Assigned readings in your text 3. Relevant pages in your HESI NCLEX Study Book HESI Material Related to Community Health and Leadership HESI HESI, (2011), Comprehensive Review for Content the NCLEX-RN Examination 3nd Edition, St. Louis, Missouri: Mosby/Elsevier. Pages NANDA Approved Nursing Diagnoses Pages 3-5 Review major categories of client needs Page 7 HESI, (2011), Comprehensive Review for Content the NCLEX-RN Examination 3nd Edition, St. Louis, Missouri: Mosby/Elsevier. Pages Maslows Hierarchy of Needs Page 8 Legal Pages 11-16 HIV/AIDS Infection Pages 53-58, 291 Hepatitis Pages 116-117 Sexually Transmitted Diseases Pages 173-175, 291-293 1

Communicable Diseases of Childhood (In community health, we will address these as they apply to adults; however, the HESI may also ask you about Peds) Immunization Schedules HPV Disaster Nursing

Pages 190

Pages 186-189 Pages 168, 174, 291, 187 Pages 19-26

4. Answer the following additional study questions: 1. Community Assessment 1. What is a community? - a social group determined by geographic boundaries and/or common values and interests. Its members know and interact with one another. It functions within a particular social structure and exhibits and creates norms ,values, and social institutions. - Community is a locality based entity - Composed of formal organizations - Reflects societys institutions, informal groups, & aggregates - Components are interdependent - Systems interact Can you identify examples of communities? o Communities of Faith o Neighborhood o School/day care center o Professional organizations o Social organizations 2. Why do we perform community assessment/analysis/community needs assessment? - to provide primary, secondary, and tertiary prevention by observing for health, absence of health, and potential for improvement 3. What is a windshield survey? (text, pg 404) - relies on observations of data and other information instead of directly surveying the people - an activity often used by nursing students in community health courses and by new staff members in agencies. They drive/walk around the community of interest; find health, social, and governmental services; obtain literature, introduce themselves and explain that they are working in the area, and generally become familiar with the community and its residents. This is needed whenever the community health nurse works with families, groups, organizations, or populations. This method provides a knowledge of the context in which these aggregates live and may enable the nurse to better connect clients with community resources. Community core: history, demographics, ethnicity, values and beliefs Subsystems: physical environment, health and social services, economy, transportation and safety, politics and govt, communication, education, recreation Perceptions: the residents (how do the people feel about the community? Strengths and weaknesses) YOUR perceptions (What do you think of the community?) 2

4. What data is included when we refer to demographics? - HOW MANY? - AGE - SEX - RACE - INCOME - FAMILY SIZE - HOUSEHOLDS 5. Who should be interviewed when conducting a community assessment/analysis? - community leaders, invisible people (behind the scenes) 6. What information is collected to determine community quality of life? - Interviews of the people within them - description of community by citizens - sense of belonging or alienation among citizens: commitment to community and involvement in activities - major issues impacting community life identified by residents - methods residents use to communicate with one another, etc. 7. Why is the consumer (community resident) point of view critical in community Assessment? - it is important to understand their vision of the future, health and social problems in the community, and the assets of the community to get an insider view of what their community is really like from the inside. - they are the receiving end of the health care - the nursing process is client-focused - clients as total systems-whether groups , populations, or committee are the PHNs target of the nursing process 8. What roles do connectors, mavens, and salesmen play in the success of your community project? o law of the few= social epidemics or trends are started by a few exceptional people o connectors= 6 degrees of separation, top of pyramid that creates social circles, special gift for bringing others together; observers: like people, collect people o mavens= accumulates knowledge, detail oriented, consumer superstars: price vigilantes, love to inform others and fond of teaching, wonderfully unselfish o salesmen= persuader, bends over backwards for clients, anticipates questions and has answers, exhibits charm, energy, enthusiasim, optimism; expressive, non verbally mimics clients (interactional synchrony) 9. How is the health status of a community assessed?

-data and statistics: national data bases, state data bases, research data, health care think tank reports, pt census, data, clinical paths, variance reports, infection rates, JCAHO surveys, local surveys, local need assessments birth rates, death rates, infant death rates, disease rates: incidence, prevalence

- quality of care reports: health care report cards What data sources are used to compile this information? (Text, pages 406-408) - Surveys o Goal: to determine the variables (selected environmental, socioeconomic, and behavioral conditions or needs) that affect a communitys ability to control disease and promote wellness. - Descriptive Epidemiologic Studies o Examines the amount of distribution of a disease or health condition in a population by person (who is affected), by place (Where does the condition occur) and by time (when do the cases occur) o Also good for suggesting which individuals are at highest risk and where and when the condition might occur o Health planning purposes - Community forums or Town Hall meetings o Elicits qualitative public opinion o Drawback: only the most vocal community members, or those with the greatest vested interests in the issue, may be heard. - Focus groups o Smaller group of participants, 5-15 o Members chosen are homogenous with respect to demographics Interviewer guides the discussion 10. What role do community leaders play in health care decision making? - influence, trust, and knowledge over the community 11. What factors should be taken into consideration in setting priorities for community health interventions? (Text, pages 412-413) significance of the problem or the number of people affected in the community level of the community awareness of the problem community motivation to act on the problem (Is it this important for the community?) nurse and partnerships ability to reduce risk and/or influence the solution cost of risk reduction in terms of financial, social, ethical capital ability to identify a specific target population for an intervention availability to expertise to solve the problem within the partnership, coalition, or community severity of the outcome if left unresolved or the consequences of inaction speed with which the problem can be resolved

Criteria for prioritizing health problems: SIMPLIFIED o numbers of community members affected by problem o community awareness o ability to reduce risk or influence o cost of risk reduction 4

o o o o 2. Screening 1.

ability to identify a target or risk population availability of expertise consequences of inaction speed of resolution

What is the purpose of screening? Identify risk factors Identify disease Apply secondary prevention Apply tertiary prevention if secondary fails How is screening related to prevention? Secondary Prevention involves efforts to detect and treat existing health problems at the earliest possible stage, when disease or impairment is already present. Secondary prevention attempts to discover a health problem at a poin t when intervention may lead to its control or eradication. Allender, Rector, Warner text pg. 15 What is the difference between screening tests and diagnosis of disease? Screening: What it is: Risk Identification-Presumptive result which must be verified What it is not: Diagnosis Diagnosis: Identifies the conclusion the nurse draws from interpretation of collected data and describes a communitys healthy or unhealthy responses that can be influenced or changed by nursing interventions When evaluating screening tests, what is the difference between sensitivity and specificity? Sensitivity: Proportion of people with the disease or trait whom the test correctly identifies as positive (true positives) Specificity: Indicates how accurately the test identifies those without the disease or trait: i.e. the proportion of people whom the test identifies as negative for the disease (true negatives) Sensitivity and Specificity are inversely related The more true positives identified, the fewer true negatives will be identified The more true negatives identified, the fewer true positives will be identified What legal aspects of nursing must be considered when establishing a screening program? 1. Permissions and consents 2. Competent performance of screening tests 3. Reporting of results 4. PATIENT FOLLOW-UP What counseling activities should be planned when conducting a screening program? i. What information do you need from the client before screening? ii. What equipment do you need? iii. How will you pay for it? 5

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Contact

Isolations/ Precautions Direct-contact transmission involves skin-to-skin contact and physical transfer of microorganisms to a susceptible host from an infected or colonized person.(such as turning or bathing the patient, hand contact, Indirect-contact transmission involves contact of a susceptible host with a contaminated intermediate object

Equipments needed Hand hygeine Use gloves and gown for all patient contact. Use dedicated equipment such as stethoscopes, disposable blood pressure cuffs, disposable thermometers, etc.

Droplet Droplet Precautions apply to any patient known or suspected to be infected with epidemiologically important pathogens that can be transmitted by infectious droplets. Droplet transmission involves contact of the conjunctivae or the mucous membranes of the nose or mouth of a susceptible person containing microorganisms generated from a person who has a clinical disease or is a carrier of the disease. Droplets are generated from the source person primarily during coughing, sneezing, talking, and performance of certain procedures such as suctioning and bronchoscopy. Airbone Airborne transmission occurs by dissemination of either airborne droplet nuclei or dust particles containing the infectious agent. Airborne precautions apply to patients known or suspected to be infected with epidemiologically important pathogens that can be transmitted by the airborne route. Examples include measles (rubeola), varicella zoster virus infections, Legionella infection, disseminated zoster, and tuberculosis

Surgical mask for those with symptoms& healthcare workers (HCWs) Protective eyewear Space out patients/clients barriers, e.g. single rooms Other PPE for patient/client care and procedures

Special air handling and ventilation are required to prevent airborne transmission. Place the patient in an airborne isolation room (AIR). Such rooms should have monitored negative air pressure in relation to corridor, with 6 to 12 air changes per hour (ACH), and exhaust air directly outside or have recirculated air filtered by a high efficiency particulate air (HEPA) filter. If an AIR is unavailable, contact the healthcare facility engineer to assist or use portable HEPA filters (see Environmental Infection Control Guidelines) to augment the number of ACH. Use a fit-tested respirator, at least as protective as a National Institute of Occupational Safety and Health (NIOSH)approved N-95 filtering facepiece (i.e., disposable) respirator, when entering the room.

iv. Will you have enough supplies? 6

Who will do what? Data given to the client Statistical data to measure outcomes Follow-up: referral, where? Reports to stakeholders Watch HIPAA! Nursing Fucntion: xi. Privacy xii. What do test results mean? (screening is always an indicator. Not a diagnosis) xiii. Worried well xiv. Panicked sick xv. Use of screener to validate MD 3. Isolation Basics and Bloodborne pathogens 1. What are the differences between contact, droplet, and airborne isolation precautions? What equipment is needed for each? Using the Huntsville Hospital isolation basics and STATs, what isolation/infection control precautions would be required for each of the communicable diseases Dr. Robey presented in class?

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4.The Role of the Alabama Department of Health in Communicable Disease Management 1. Who is the county medical officer/ Medical director for the Madison county health department? Who is the State health officer/Medical director for the state of Alabama? 1. County medical officer/Medical Director: Dr. Lawrence Robey 2. State Health Officer/Medical Director: Don Williamson 2. How have the major caused of death/illness changed in the last century? At the beginning of the last century, causes of death/illness were mainly r to pathogens (pneumonia, diarrhea/enteritis, typhoid, pellagra, malaria, whooping cough, diphtheria) and currently the causes of death/illness are mainly related to lifestyle/things we dont know how to cure yet (Heart disease, cancer, chronic lung disease, stroke, accidents, alzheimers, flu, pneumonia, septicemia, suicide, hypertension). While there are outliers, the gist is a change from pathologic agents to chronic disease as a result of lifestyle. What are the current responsibilities of the Madison County Health Department? 1. Pure Prevention a. Immunizations, abx prophylaxis, TB, STDs, HIV, Food, water, lodging inspection, Animal bites, vermin control 2. Relative Prevention a. Family planning, WIC, Sewage inspection 7

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3. Data Collection a. Disease reporting and vital records 4. Health Care Access a. Screening and referrals b. Barrier elimination (social work) 5. Communicable Diseases 1. What is a reportable communicable disease? a. diseases that must be reported by LAW b. legal concept, not a biological concept Which diseases must be reported to the Alabama Department of Public Health within 4 hours of diagnosis? a. anthrax b. botulism c. plague d. poliomyelitis, paralytic e. SARS-Coronavirus f. smallpox g. tularemia f. viral hemorrhagic fever g. cases related to nuclear, biological, or chemical agents 4. What is an epidemic? affecting or tending to affect a disproportionately large number of individuals within a population, community, or region at the same time A pandemic? o an infectious disease that is spreading to many people over a large area usually global Which vaccines must children receive to attend school in the state of Alabama? - DTaP series - Polio series - 2 MMR after 12 mo - Chickenpox: disease/shot, K-11 - Tdap, 6, 7, 8 - HIB and PCV, pre K

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What is the difference between legally required vaccines and recommended vaccines? - recommended vaccines - everyone 6 mo of age or older - pregnant woman - elderly - persons with chronic conditions - children 6 mo through 18 years on chronic aspirin therapy 5. What vaccines are recommended for adults? (You have learned the pediatric immunizations in peds and will need to review them for your final HESI but this exam will focus only on recommended adult immunizations as listed on the Recommended Adult Immunization ScheduleUnited States 2013 Dr. Robey distributed in class) This is in that handout he gave us with the immunization schedules3rd page 8

6.

What is a VIS? Vaccine information statements, federal requirements!! A handout that Method of transmission & Prevention including Vaccine if applicable Coughs, sneezes, or talks, inhaled infected droplets, rubbing fingers into mouth or nose or eyes MMR Vaccine Administered at 12 to 15 months of age and repeated 4 to 6 years later or by 11 to 12, not meant for people with allergy to eggs, neomycin, or immunosuppressed

Complete the following chart: Disease Signs & symptoms

Treatment of disease

Measles

Rash, fever, kopolik spots, sore throat, dry cough, runny nose, conjunctivitis, sensititvy to light

Measles vaccination after 72 hours of exposure, Immune serum globin, fevers, antibiotics, Vit A

Hepatitis A (Infectious Hepatitis)

Fever, malaise, anorexia, nausea, abdominal discomfort, in severe cases jaundice Mild illnesses last 1 to 2 wks but more severe cases last 1 month or longer. It does not result in chronic infection or chronic liver disease

Contaminated food, water or shellfish

No specific treatment, body heals on own

Transmitted fecal-oral route, parental, contaminated water food Inactivated Hep A vaccines administered in two doses series to proceed antibodies available for children other than 12 months Combined HepA and HepB vaccines, especially before traveling outside the country Contaminated blood products 9 Antiviral meds

Unnoticeable to

Hepatitis B (Serum Hepatitis)

fulminating, and include anorexia, vague abdominal discomfort, can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure or death

Contaminated needles Liver transplant or surgical instruments Mother to child at birth Parental, oral, fecal, direct contact, breast milk, sexual contact Vaccination for prevention 1st dose: Birth 2nd dose: 1-2 months of age 3rd dose: 6-18 months of age

Hepatitis C (Non-A, Non-B Hepatitis)

Symptoms are similar to those of HepA and B , and may be unrecognizably mild to fulminating Not associated with jaundice Main reason pt seek liver transplant

Parental and sexual contact Contaminated blood products, needles IV, drug use, dialysis No Vaccine to prevent it,

Clears without treatment, antivirals Avoid alcohol, medications toxic to liver (OTCs, acetaminophen)

Hepatitis D (viral hepatitis)

Sudden onset of fever, extreme tiredness, nausea, lack of appetitie, abdominal pain, jaundice

Parental, sexual contact, bodily fluids (toothbrush, razor, or tools used for manicures) Hep B infection (active or coinfected Hep D) present to multiply I Hep D virus

Antivirals, organ transplant, alpha interferons, avoid meds, avoid alcohol, eat enough calories, plenty fluids

Avoiding unsafe sex Avoiding sharing needles Asking your doctor about tests to 10

check for liver damage Asking your doctor about the hepatitis A vaccine Learning how to protect yourself from other hepatitis viruses.

Hepatitis E Fecal-oral route

Comparable to Hep A jaundice (yellow discoloration of the skin and sclera of the eyes, dark urine and pale stools); anorexia (loss of appetite); an enlarged, tender liver (hepatomegaly); abdominal pain and tenderness; nausea and vomiting; fever.

Prevention: No vaccine, bottled water, but sanitation The risk of infection and transmission can be reduced by: maintaining quality standards for public water supplies ; establishing proper disposal systems to eliminate sanitary waste. On an individual level, infection risk can be reduced by: maintaining hygienic practices such as hand washing with safe water, particularly before handling food; avoiding drinking water and/or ice of unknown purity; avoiding eating uncooked shellfish, and uncooked fruits or vegetables that are not peeled or that are prepared by people living in or travelling in highly endemic countries.

There is no available treatment capable of altering the course of acute hepatitis. Prevention is the most effective approach against the disease. As hepatitis E is usually self-limiting, hospitalization is generally not required. However, hospitalization is required for people with fulminant hepatitis and should also be considered for infected pregnant women.

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Bacterial meningitis

Increased ICP, fever, chills, nick stiffness, opithotonos, photophobias, Positive Kernig Sign ( inability to extend leg when thigh is flexed anteriorly at hip, Postive Brudzinski sign ( neck flexion causing adduction and flexion movements of lower extremities, Lumbar puncture: Increased WBC, decrease glucose, positive culture

Middle ear, or the nospharynx, fractures of the skull, lumbar punctures, and shunts

Prevention Hib vaccine to protect against H. influenza infection Antibiotics (penicllin, amplicillin, chloramphenoical, and antipyretics, isolate for 24 hours, quiet and dark room, head of bed slightly elevated, monitor I and O

Prevention Hib vaccine to protect against H. influenza infection

Agitation Bulging fontanelles in infants Decreased consciousness Poor feeding and irritability in children Rapid breathing Unusual posture, with the head and neck arched backwards

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Disease

Signs & symptoms

Method of transmission & Prevention including Vaccine if applicable Inhaling affected droplets through coughing and sneezing and close contact Hib Vaccine Pneumonia vaccine, early diagnosis,

Treatment of disease

Pneumococcal meningitis

Ear ache, bronchitis, speticaemia, seizures, confused, rash, light sensititivity, vomiting, high-pitched cries in babies similar to bacterial meningitis

Meningococcal meningitis

A reddish or purple skin rash is a very important sign to watch for. If it does not turn white when you press a glass against it, the rash may be a sign of blood poisoning. This is a medical emergency. similar to bacterial meningitis

IV antibiotics, steroids, other meds to treat spinal fluid pressure .

Exposure of bacteria entering the skin, gi tract, resp, tract, into the bloodstream and nervous system after severe head trauma. Surgery, or infection

Meningococcal conjugate vaccine (MCV4) -- One of these vaccines, Menactra, is approved for people ages 9 months to 55. The other, Menveo is used in those ages 2 through 55. Meningococcal polysaccharide vaccine (MPSV4) -the only vaccine used for people older than age 55.

Haemophilus meningitis

Similar to bacterial meningitis

H. influenzae meningitis may occur after an upper respiratory infection. The infection 13

Antibiotics should be given as soon as possible. Ceftriaxone is one of the most

usually spreads from your lungs and airways to your blood, then the brain area. Hib Vaccine at ages 2 and 4 months, or 6 months have elapsed since the third dose Final dose 4-6 years

commonly used antibiotics. Ampicillin may sometimes be used. Corticosteroids may. Unvaccinated people who are in close contact with someone who has H. influenzae meningitis should be given antibiotics to prevent infection. Such people include:

Household members Roommates in dormitories Those who come into close contact with an infected person

Influenza Sudden onset with a Respiratory tract shaking chill, fever, pleural pain, dyspnea, a Injectable influenza is productive cough of inactivated rusty sputum, and tachypnea Fever, headache, myalgia (muscle pain), prostration, coryza, sore throat, and cough Lyme Disease -rash-erythema migranes -fever, chills, fatigue, muscle and acute joint pain -later involves neurological systems and joints Heart rhythm problems Fever, chills, myalgia, 3 to 30 days after tick bite, feeding ticks deer/mouse cycle, humans are incidental hosts

Antimicrobial agets:

Rocky Mountain Spotted Fever

Transmitted by tick 14

PCN or cephalasporins but 20% may have persistence

headache -Rash-maculopapular 3rd to 5th day

bite Feeds for 4 to 6 hrs Also feces and body fluids of tick Prevention: pet care, check for ticks; insect repellants or insecticide impregnated clothing; general spraying of environment possible but discouraged; cut tall grass ans weeds in play areas, check children immediately after play, clean clothes kills critters, remove imbedded ticks quickly

Urethritis/cervicitis

-Discharge -copious discharge cervix -pharyngitis -abscess from local soft tissue extension The main symptom of urethra inflammation from urethritis is pain with urination (dysuria). In addition to pain, urethritis symptoms include: o o o o o o

Bacteria that commonly cause urethritis include:

E. coli and other bacteria present in stool. Gonococcus. It is sexually transmitted and causes gonorrhea. Chlamydia trachomatis. It is Feeling the frequent sexually transmitted or urgent need to and causes urinate chlamydia. Difficulty starting urination The herpes simplex Other symptoms of virus (HSV-1 and HSV-2) can also urethritis include: cause urethritis. Pain during sex Trichomonas is Discharge from the another cause of urethral opening or urethritis. It is a singlevagina celled organism that is In men, blood in the sexually transmitted. semen or urine Sexually transmitted infections like 15

Antibiotics can successfully cure urethritis caused by bacteria. Many different antibiotics can treat urethritis. Some of the most commonly prescribed include: Adoxa, Monodox, Oracea, Vibramycin (doxycycline) Rocephin (ceftriaxone) Zithromax, Zmax (azithromycin) Urethritis due to trichomonas infection (called trichomoniasis) is usually treated with an antibiotic called Flagyl (metronidazole). Tindamax (tinidazole) is another antibiotic that can treat trichomoniasis. Urethritis due to herpes simplex virus can be treated with:

gonorrhea and chlamydia are usually confined to the urethra. But they may extend into women's reproductive organs, causing pelvic inflammatory disease (PID).

Famvir (famciclovir) Valtrex (valacyclovir) Zovirax (acyclovir) Often, the exact organism causing urethritis cannot be identified. In these situations, a doctor may prescribe one or more antibiotics that are likely to cure infection that may be present.

Gonorrhea Septic arthritis common. Also may develop into meningitis (brain), To reduce your risk of endocarditis (heart), or getting infected, use osteomylitis (bone) a condom each time you have sex. Limit Often chlamydia will the numbers of sexual partners, or consider present no practicing abstinence. symptoms. When symptoms are If you think you are present, common infected, avoid sexual ones include: contact and see a doctor A clear or whitish yellow discharge from the tip of the penis A frequent urge to urinate or a burning sensation while urinating Redness at the tip of the penis In women: Mild discomfort that you may mistake for menstrual cramps

No single drug works for both gonorrhea and chlyamdia Cefiraxone (Rocephin) IM Azythromycin 1g PO

Chlamydia

Vaginal discharge that may have a 16

bad smell Bleeding between periods Painful periods Pain when having sex Itching or burning in or around the vagina Pain when urinating

Trichomoniasis

Some asymptomatic for years Vaginal discharge and itching; males usually without symptoms, Strawberry cervix

STD Metronidazole 2g sing dose Metronidazole 500 mg PO BID x7 days Tinidazole 2g single dose Uncircumcised male pattern , ping-ponging with environmental factors, Antifungals: Fluconazaole , IV : Nyastin , Butaconzole, terconzale

Candidia Vaginitis Extreme itching in the vaginal area Soreness and redness in the vaginal area White, clumpy vaginal discharge that looks like cottage cheese Painful intercourse Syphilis, primary Syphilis, secondary Rash may mimic almost any disease; palmar/plantar rash is diagnostic Condyloma lata, spotty hairless, loss of architect of tongue Flat, pealing, scaling raised Syphilis, tertiary No symptoms Chancre, a painless ulcer

contagious Penicillin, no resistance contagious Benzathine penicillin G 2.4 million units IM single 3 doses 1 week apart Only treatment for pregnant women Less Effective: Doxycyline 100mg PO BID x 2weeks Azithromycin 2g 17

Late: symptomatic, neurological damage (dementia and insanity), gumma (inflammatory lesion, highly infectious, eats away tissue and bone), syphilitic aneurism, charcot knee Herpes Type 1-above the waist Type 2-below Oral-genital contact has blurred distinctions Often swollen lymph nodes, esp. with initial infections Late: lesions with erosions and dead skin, lesions of cervix Ayclovir and others suppressive not curative Acylovir 400 mg PO TID x 7-10 days Acyclovir 200mg PO 5 times a day x 7-10 days Famclclovir 250 mg PO TID for 7-10 days Valacyclovir 1g PO BID for 7-10 days Rough irregular growth, variable more profilific on moist skin, pearly papula, Vaccine available 3 shot series -Garadasil-HPV 6, 11, 16, 18 (males and females) -Cervarix-HPV 16 and 18 ) females Purpose of vaccine is to prevent cancer! Crab louse itching Transmitted by bite Pyrethrin or permethrin head louse preparations-OTC 5% permetrin lotion Lindane little used due to toxicity ( Not good for pregnant women and babies) No cure Removal by various means, mechanical and chemical, none very effective, not curative Immune stimulatorImiquimod (Aldara)

Genital warts: condyloma accuminatum

Scabies Severe allergic reaction with itching Transmitted by close personal contact or contact with items that touch skin

Nonspecific viral

Transmitted by sex and percutaneous 18

HIV/AIDS

syndrome illness-low grade fever, transient lymphadenopathy skin rash, Kaposis sarcoma a type of cancer, hairy leukoplakia Non-Hodgkins lymphoma, wasting disease (chatexia), drug reactions, shingles ( chickenpox virus), herpes, warts, fungal infections

routes Combination antiviral rx hitting stages of viral replication has reduced and eliminated detectable virus HARRT -Lifelong rx-compliance -drugs are toxic, many side effects -resistance has emerged -expensive - New drugs and combos have improved compliance

7.What is herd immunity and why is it important? a. when the percentage of the immunized population and spread of disease are directly related ex) when most of the population gets immunized, spread of contagious disease is contained b. when no one is immunized, contagious disease spreads throughout the population 8.Who should get an annual influenza vaccination? QUESTION 4 Can influenza be contracted from the vaccine? Does the 2012-2013 flu immunization protect the client from H1N1? 1. When should a client not get influenza vaccine? a. Concern about adverse effects b. Perception of a low personal risk c. Insufficient time or inconvenience d. Reliance on homeopathic medications e. Avoidance of all meds f. Fear of needles 2. What special problems does pertussis currently pose in the United States? a. It is increasing!!! What actions must be taken to prevent the spread of pertussis? a. Tdap Vaccine b. Long standing recommendation for Td booster every 10 yrs c. Goal: have each adult receive one dose of Tdap instead of Td a. Important for those around infants b. Phasing into schools for economic reasons 6,7,8 3. What is a vector? An insect or similar animal that transfers infective agents, actively or passively, from one host to another 4. What diseases are caused by mosquitoes and how are these controlled? West Nile virus, Malaria, yellow fever, Dengue, Encephalitis, use larvicide, growth regulator, treat standing water, fish eat eggs and larvae, adulticiding 5. Which diseases are caused by ticks? Rock Mountain Spotted fever, tularemia, Lyme disease, Ehrlihiosis, Babesiosis, Colorado Tick fever, Q-fever 19

What primary prevention should be used to prevent tick borne diseases? Insect repellents, or insecticide impregnated clothes, general spraying of environment possible but discouraged, treat pets with pest control preparations, cut tall grass and weeds in play areas, check children immediately after play, remove embedded ticks quickly, cleaning clothes kills critters 14. 15. 16. 17. How should a tick be removed after it has bitten a client and attached itself to the body? Use tweezers and pull them straight up from site by pinching its head What special precautions should be taken when using insect repellants such as Deet, especially when applying them to children? What dangers are posed by head lice? What actions must be taken to prevent the spread of bedbugs? a. avoid throw aways, thrift stores b. treat any object that is suspect c. develop travel plans : luggage, site inspections What are the major sources for spreading salmonella? FROGS! What zoonoses are considered to be bio-terror organisms? a. anthrax b. plague c. Tularemia d. hemorrhagic viruses

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6. Food Borne Illnesses Be sure to know: 1. How do the concepts of low versus high innoculum impact the transmission of food borne illnesses? o Low Innoculum-few organisms in food (mechanisms) Uncooked or contamination after cooking Highly pathogenic bacteria or viruses Fewer organisms needed to produce disease Low attack rates Fewer organism per serving, fewer caters affected Longer incubation Organisms may have to proliferate is host Frequently result from cross contamination o High innoculum- Many organisms o Uncooked or Contamination afterwards o Greater variety of organisms, even non pathogens may produce symptoms o High attack rates: More organisms per serving o Shorter incubation: Fewer generations of growth before clinical illness o Requires sustained period of microbial growth ( 2+ hours at temperatures out of range) o infections (mechanism) Which type of food causes the most food borne illness? Poultry Complete the following chart: 20

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Organism Salmonella

Source of transmission o Salmonellea: Surface of foods (melons, nuts) o Contaminated seeds, chicken to egg, birds and reptiles intestinal salmonella Contamination with highly contaminated water Fragile product or one with textured surface cannot be adequately washed Usually eaten raw and whole o Fecal-oral route o Food- or waterrelated illness o The contamination can occur at the source (contamination by animal into the food or water chain) or through unsanitary food handling practice

Shigella

E.Coli

(source from textbook) E. Coli: Uncooked items directly transmit Meat is contaminated at processing plant. Ground meat minimizes surface contamination into the produce. Only through kicking kills organism

Botulism Germinate in oxygen free environment such as oil, they germinate and grow producing toxins esp in hot environments Lives on cooked potatoes, spores do not die Ingestion of inadequately cooked food or processed or refrigerated foods in which toxin has formed, particularly canned and alkaline foods. Most cases of wound botulism are due to ground-in soil or gravel. Several cases have been reported amongst chronic drug users. Infant botulism arises from ingestion of spores rather than pre-formed toxin. Sources of spores include foods such as honey and dust. Honey has been described in the US literature as a source of infection but never implicated in Australia and surveys of Australian honey have failed to identify C. botulinum.

Listeria

The main route of transmission is oral through ingestion of contaminated food. Other routes include mother to foetus via the placenta or at birth. The infectious dose is unknown.

Notovirus

Contamination of raw meat, cross contamination at food preparation areas, many precooked food are not reheated prior to consumption Fecal-oral

You can become infected with norovirus by accidentally getting stool or 21

vomit from infected people in your mouth. This usually happens by

eating food or drinking liquids that are contaminated with norovirus, touching surfaces or objects contaminated with norovirus then putting your fingers in your mouth, or having contact with someone who is infected with norovirus (for example, caring for or sharing food or eating utensils with someone with norovirus illness).

4. 5.

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What precautions should be taken when preparing ground beef to prevent the spread of E. coli? Only through cooking kills organism What trends in food processing, marketing, and distribution contribute to the rise in food borne illnesses? Centralization of Food processing: slaughter houses Growing Public Appetitie for Fresh, Unprocessed Foods Globalization of Food sources: moving processing to other countries to save labor cost Why is training of food service workers essential? To prevent foodborne illnesses What role does restaurant inspection play in preventing the spread of food borne illness to the public? It is the threat of being caught that helps drive compliance with best safety practices Hot foods must be maintained at a temperature of __greater than or equal to 140______. Cold foods must be maintained at a temperature of_less than or equal to 40______. What instructions should be given to clients to maintain food safety in the home? -treat ones home like a restaurant - handwashing - avoid cross contamination : cutting boards, plates/tongs - thermometer use - if in doubtthrow it out!! What is the lowest score a restaurant can earn in north Alabama and remain open to the public? Was it 85?? I didnt write it down, but I thought I remember him saying 85let me know if Im wrong!!!

7. 8. 9.

10.

7. Healthy People 2020 (read 6 page summary) 1. 2. 3. 4. 5. What is Healthy People 2020? What government agency designs and releases Healthy People 2020? What does Healthy People 202 0 measure? What is a leading health indicator? What are the overarching goals of Healthy People 2020?

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8. Health Education 1. What are the characteristics of the major domains of learning: Cognitive, affective, and psychomotor? What are examples of teaching strategies that address each of these learning domains? 1. Cognitive Domain of learning: Involves the mind and thinking processes. When the meaning and relationship of a series of facts is grasped cognitive learning is experienced 2. Deals with recall or recognition of knowledge and development of intellectual abilities and skills 3. 6 major levels in this domain Knowledge-lowest level of learning-involves recall, the ability to recall something without necessarily understanding the concept or reasoning associated with it. 1. TEACHING: use of memorization/recall tactics, repetitive exposure, routines 2. GOAL: client recall 3. EX: The client can recall 6 fruits to eat as nutritious snacks. 4. VERBS: recall, define, repeat, list, and name Comprehension-2nd level of learning-combines recall and understanding 1. TEACHING: aims at instilling at least minimal understanding 2. GOAL: clients grasp meaning and recognize importance of desired interventions 3. EX: Client will describe a well balanced diet during pregnancy 4. VERBS: describe, discuss, explain, identify, tell, and report Application- 3rd level- learner not only understands material but can also apply it to new situations. 1. TEACHING: Suggesting a student in a weight loss group develop a diet plan, track and trend weight loss & share with group at next meeting. 2. GOAL: The transfer of understanding into practice 3. EX: The client will practice eating well-balanced meals at least two times a day 4. VERBS: practice, apply, use, demonstrate, and illustrate. Analysis-4th level-learner breaks down material into parts, distinguishes between elements, and understands the relationships among parts. Preliminary step towards problem solving 1. TEACHING: Nurse can foster analytic skills by (a) demonstrating how to isolate the parts in a situations, and (b) encouraging the clinets to consider the relationships among the parts and to draw conclusions from their thinking. 2. GOAL: learner carefully scrutinizes all types of variables or elements and their relationships to each other to explain the situation. 3. EX: The seniors should be able to compare the fat content in a variety of packaged foods 4. VERBS: compare, differentiate, contrast, debate, question, examine Synthesis-5th level-ability to not only break down and understand the elements of a situation, but also to form elements into a new whole. Combines all earlier levels of Cognitive Domain. 1. TEACHING: RN may assist mental health clients in therapy group to examine their frequent depression and then to generate their own plan for alleviating it. RNs facilitate synthesis by assisting and encouraging clients to develop their own solutions with specific plans, once a problem is identified client should be asked to identify possible causes & possible solutions that they might carry out 23

2. GOAL: being able to analyze problems and find solutions 3. EX: The client will be able to prepare an enjoyable meal using low-sodium foods. 4. VERBS: prepare, compose, design, create, formulate, organize Evaluation- 6th level-learner judges the usefulness of new material compared with a stated purpose or specific criteria 1. TEACHING: Judging ones own health behavior by comparing it with standards established by others such as complete abstinence from smoking, maintenance of normal weight, or exercising 3x per week. 2. GOAL: client is able to compare and contrast 3. EX: The clients in a nutrition class will be able to measure the cholesterol content in one portion of the low-cholesterol dish they brought to share 4. VERBS: measure, judge, rate, choose, estimate 4. How to measure Cognitive learning: measured in terms of learner behaviors. Nurses know a client has achieved teaching objectives for the application of knowledge if their behavior demonstrates actual use of the information taught. 5. Affective Domain of learning: learning that involves emotion, feeling, or affect. Deals with changes in interest, attitudes, and values. Task of trying to influence what clients value and feel. Want clients to develop an ability to accept ideas that promote healthier behavior patterns, even if those ideas conflict with the clients own values Attitudes and values are learned, result of imitation and conditioning, difficult to change Affective learning develops on several levels 1. 1st level -receptive- willing to listen, show awareness, be attentive, a. RN aims to acquire and focus learners attention b. May be all client is ready for early on in nurse-client relationship 2. 2nd level Responsiveness- responds to information in some way, willingness to read educational material, participate in discussions, complete assignments, or voluntarily seek out more information 3. 3rd level Valuing- ranges from simple acceptance through appreciation to commitment. Acceptance is show through acknowledging the importance of an idea, appreciation by practicing, commitment through assuming responsibility 4. 4th level Internal consistency- value system now controls the behavior. Consistence practice is a crucial test at this level. For ex, clients who know and respect the value of exercise but only exercise occasionally have not internalized the value. 5. 5th level Adoption- incorporates new values into lifestyle, ex: consistently practices birth control Affective learning is difficult to measure, attitudes and values change quickly 6. Psychomotor Domain-includes visible, demonstrable performance skills that require some kind of neuromuscular coordination. For psychomotor learning to take place 3 conditions must be met: 1. Learners must be capable of the skill 2. Learners must have a sensory image of how to perform the skill 3. Learners must practice skill Client must be physically intellectually and emotionally capable of performing the skill The degree of complexity should match the learners level of functioning Educational level should not be equated with intelligence 24

Consider developmental stage to gauge appropriateness to teach a particular skill Learners must have sensory image of how to perform skill. This is gained through demonstration and careful explanation (one point at a time-sometimes repeatedlyuntil the client understands how to perform the task. The client will then practice the task to obtain mastery of the task. RN should be available to provide guidance and encouragement

2. What are the four characteristics of adult learners identified in Knowles Adult Learning theory? (page 316, display 11.2) 1. Self-Concept: Adult learners are self directed 2. Experience: Adults have a lifetime of experience and define self in terms of this experience 3. Readiness to learn: Learning is focused on social and occupational roles 4. Need to learn: Adults have a problem-centered time perspective 3. How is the Health Belief model applied in health education? (pg 317) 1. Useful for explaining the behaviors, cultural beliefs and actions taken by people to prevent illness and injury. Postulates that readiness to act on behalf of a persons own heal is predicated on the following: Perceived susceptibility to the condition in question Perceived seriousness of the condition in question Perceived benefits to taking action Barriers to taking action Cues to action, such as knowledge that someone else has the condition or attention from the media Self-efficacythe ability to take action to achieve the desired outcome. 2. Example: Using concepts from this model, researchers looked at beliefs about the ability to control diabetes and beliefs about the degree to which family members supported a targeted Mexican American population in following their diabetes treatment regimen. Turkish researchers developed a 33-item health belief model scale for use with diabetic pts. They studied the validity and reliability of the tool with 352 pts with type 2 diabetes mellitus. Their findings support the use of this tool with this population and noted that it could provide the means to test the effectiveness of intervention strategies. 4. What are the Seven Principles for Maximizing the Teaching-learning process and what learning principles are associated with these? (see table 11.6 on page 321 of your text) 1. Teaching Principle: Adapt teaching to clients level of readiness Learning Principle: The learning process makes use of the clients experience and is geared to their level of understanding. 2. Teaching Principle: Determine clients perceptions about the subject matter before and during teaching Learning Principle: Clients are given the opportunity to provide frequent feedback on their understanding of the material taught. 3. Teaching Principle: Create an environment that is conductive to learning Learning Principle: The environment for learning is physically comfortable; offers and atmosphere of mutual helpfulness, trust, respect, and acceptance; and allows for free expression of ideas. 25

4. Teaching Principle: Involve clients throughout the learning process. Learning Principle: Clients actively participate. They assess needs, establish goals, and evaluate their learning progress. 5. Teaching Principle: Make subject matter relevant to clients interest and use. Learning Principle: Clients feel motivated to interest and learn. 6. Teaching Principle: Ensure client satisfaction during the teaching-learning process. Learning Principle: Clients sense progress toward their goals. 7. Teaching Principle: Provide opportunities for clients to apply material taught Learning Principle: Clients integrate the learning through application. 5. Why is goal setting important in client teaching? Write appropriate behavioral outcome statements (learning objectives/cognitive outcomes). 1. Goals are broad statements of intent, and objectives are more specific descriptions of an intended outcome. 2. Goals are important because they provide a means of measuring a clients progress 3. Objectives should be stated in measureable behavioral terms, using grammatical structure that contains a subject, verb, condition/criterion, and a time frame. 4. Each behavioral objective is stated in measurable terms and includes a verb that coincides with one of the six levels within the cognitive domain. Refers to a subject Can be readily measured because it describes a specific outcome condition criterion or expected behavior Uses a verb for stating cognitive outcomes Includes a specific time frame 6. What are the major teaching methods and what are the advantages of each? a. Lecture: (A formal type of presentation) is the most efficient way to communicate general health information. Best used with adults. b. Discussion: Two-way communication is an important feature of the learning process. Whenused in conjunction with the other 3 methods listed, it improves their effectiveness. In group teaching, it enables clients to learn from one another as well as the RN. c. Demonstration: Often used for teaching psychomotor skills and is best accompanied by explanation and discussion, with time setaside for return demonstration by the client/caregiver. Gives clients a clear sensory image of how to perform the skill. Best to demonstrate in front of small groups or a single client. I deal method to use in a clients home as well as in. d. Role Playing: Having clients assume and act out roles maximizes learning. To prevent roleplaying from becoming a gamewith little learning, plan the proposed drama with clear objectives in mind. Can be used with staff, co-workers, young children, teens, and adults. 7. Why is literacy an important consideration in health education and health promotion 26

Many patients cannot read above a 6th grade reading level. A nurse should assess the appropriateness of materials used to teach patients, so that they are not misled or confused. Factors to consider include content, complexity, and reading level. If patients have learned English as a second language and require materials that have been translated, it is also important to make sure the meaning from the original has not been distorted or lost in the translation. Otherwise, the patient may not be able to understand the message the nurse is trying to teach. 8. What is SMOG testing and why is it done to evaluate the difficulty of health education materials? SMOG stands for Simple Measure of Gobbledygook. It is a crude measure of difficulty level of reading material. It may be used by the nurse to gain a quick approximation of reading difficulty level and as such is useful in evaluating client education materials. Our textbook states that according to SMOG, health education materials should be written at the 8th grade level or lower. It is performed to make sure patient materials are written at a level that they can understand. What teaching strategies are most effective for low literacy clients? The most effective teaching strategies include the above 4 Lecture, Discussion, Demonstration, or Role-Playing. Any situation where the nurse can teach the patient through hands-on experience or conversation. Also using tools such as visual images such as videos, pictures, powerpoints, posters, etc. can enhance learning. Television has both hearing and vision stimulation and is something most Americans are familiar with. What is pedagogy? Andragogy? How are these concepts related to the selection of appropriate teaching strategies? Pedagogy The method and practice of teaching, esp. as an academic subject or theoretical concept. Andragogy The methods or techniques used to teach adults Note: (*I dont know what to add to this for the last sentence) 11. Why is the assessment of client readiness critical in planning health education programs? If a nurse tries to push a patient too fast, or too strongly, it can backfire and the patient may not learn. It is important to know about the community that is being taught, and to use the correct type of teaching materials to help the patient to learn effectively. Patients cannot be forced to learn, so assessing the situation and planning accordingly is part of the nursing process as it relates to teaching.

9.

10.

9. Epidemiology 1. What is epidemiology? How is it related to health care research? Is a community health discipline Is a structure for systematic study Population focused (aggregate data) Studies: Health Disease Conditions related to health status 27

 Epidemiology investigates the distribution or the patterns of health events in populations and the determinants or the factors that influence those patterns. 2. Why is comparison of epidemiology rates critical in determining the significance of any specific rate? Because to make comparisons between populations epidemiologist often use a common base population in computing rates Because it the key to determine the extent of disease in a population, identify, patterns, and trends in disease occurrence, identify the causes of disease, and evaluate the effectiveness of prevention and treatment optionspatterns Determinants How does it occur ? Why are some people affected more than others? Factors involved? Individual Relational or social Communal Environmental

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3. How is the interaction of the agent, host, and environment used in the control of disease? Identify characteristics of agents, hosts, and environments? Infectious agents (bacteria, viruses, fungi, parasites) Agents: Chemical agents (heavy metals, toxic chemicals, pesticides) Physical agents (radiation, heat, cold, machinery) Genetic susceptibility Immutable characteristics: (age, sex) Acquired characteristics : (immunological status) Lifestyle factors : (diet, exercise) Climate (temperature, rainfall) Plant and animal life (agents or reservoirs or habitats for agents) Human population distribution (crowding, social support) Socioeconomic factors (education, resources, access to care) Working conditions (levels of stress, noise, satisfaction)

Hosts:

Environmental

3.

What are mortality rates? a. The relative death rate, or the sum of deaths in a given population at a given time

5. What are morbidity rates? The relative incidence of disease in a population, the ratio of the number of sick individuals to the to the total population -What does incidence mean? Refers to all new cases of a disease or health condition appearing during a given time You are looking for the number of new cases Number of new cases of disease population at risk in the time period under examination (usually mid-year population) X 1,000 (or 10,000, or 100,000-base rate may vary)

-What does prevalence mean? Refers to all of the people with a particular health condition existing in a given population at a given point in time 29

 You are looking for the number of new + old cases Number of existing cases (new + old) population at risk during the time examined (usually midyear population) X 1,000 (or 10,000, or 100,000-base rate may vary)

-How are they related to each other? They are used synonymously in health literature Numerator in prevalence rate: number of person with a characteristic per population Numerator in Incidence: number of person developing a disease per unit of population at risk 6. Why is the infant mortality rate the most important indicator of a communitys overall health status? KEY MARKER OF COMMUNITY HEALTH STATUS Number of infant deaths the number of live births X 1,000 (traditional base rate) 6. Identify the major epidemiology rates and work the sample problems provided under the epidemiology unit. You must know the following from memory for the exam: Crude birth rate: # of live births Estimated midyear population Crude death (mortality): Crude mortality: Number who died from any cause the total midyear population (remember everyone is at risk of dying) X base rate Infant death (mortality): # deaths under 1 year of age X 1,000=(rate per 1000) Number of live births Incidence Number of new cases of a disease in a given time period__ X 1, 000=(Rate Population at risk in the same time period per 1,000) Prevalence rates Number of existing cases in a population in a specific time X 1,000=(rate per Total population at the same specified point in time 1,000) X 1,000= (rate per 1000)

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You must know when the others are used but you do not need to memorize the rate formulas. Attack rate Number of new cases of disease number of people exposed to the disease X base rate (1,000 OR 10,000 OR 100,000) Age specific mortality rate: number of deaths in 20-24 year olds the total population of 20-24 year old X base rate Cause specific mortality rate: number of accidental deaths total midyear population (everyone is subject to accidents) X base rate Case fatality rate: number of deaths from lung cancer in a year the total number of cases of lung cancer X base rate Neonatal mortality rate: Number of infant deaths under 28 days old total number of live births X 1,000 (traditional base rate) Crude mortality rate for breast cancer Which population??? X base rate

8. Why are rates used on tables reporting health care data? How do rate tables differ from raw number and percentage tables? o Rate: a measure of the frequency of a health event in different populations at certain periods of time o Base rate used to equalize communities of unequal size for comparative purposes (1,000, 10,000, 100,000): Look for footnotes on a table: Relative to size of population being examined. o Population at risk: A population at risk is the population of persons for whom there is some finite probability (even if small) of that event occurring Valid percentages are presented after exclusion of missing values and raw numbers are easier to find base rate

10. Disaster Nursing 6. What are the steps of the START method of triage in your HESI book? To initiate the START Triage First clear the walking wounded using verbal instructions. Direct them to the treatment area(s) for detailed assessment and treatment. These patients are triaged MINOR for the purposes of START triage. Now Check your RPMs The START triage process takes place in the following order. RESPIRATIONS None? Open the airway Still None? Patient is triaged - DECEASED 31

Restored? Patient is triaged IMMEDIATE Present? Above 30? Patient is triaged IMMEDIATE Below 30? CHECK PERFUSION PERFUSION Radial Pulse Absent or Capillary Refill > 2 seconds. Patient is triaged IMMEDIATE Radial Pulse Present or Capillary Refill < or = 2 seconds - Check Mental Status MENTAL STATUS Cannot follow simple commands (Unconscious or altered LOC) - IMMEDIATE Can follow simple commands - DELAYED If the patient is IMMEDIATE upon initial evaluation attempt only to correct airway blockage or uncontrolled bleeding prior to moving on to the next patient. Remember, the goal is to take no longer than 30 seconds per patient. When things get hectic with multiple patients rev up your RPMs a. b. c. R - Respirations - 30 P - Perfusion 2 M - Mental Status - CAN DO

7. How is START different from the more contemporary SALT method of triage? a. The first step of SALT is sorting of patients. Global sorting involves determining (1) who can walk, (2) who can wave, and (3) who does not respond. - Anyone who does not walk and does not respond to simple instructions, such as wave! is assessed 1st. - Anyone who cannot walk, but can wave, or follow other simple instructions, is assessed next - Anyone who can walk to a pre-determined casualty collection point is last to be assessed b. The 2nd Step of SALT is patient assessment. Similar to START, SALT triage incorporates a few life saving interventions, but with the added directive of only if personnel, equipment, and/or other resources are readily available. This is one of the most advantageous additions, as it allows a resource evaluation for each individual patient, and for each overall scene. c. When a patient has been assessed as having a major traumatic injury, and given the current resources available, is not expected to survive, is it appropriate to allocate significant resources to this patient? In SALT triage, living patients that are not likely to survive are categorized as EXPECTANT. They are tagged with GRAY, and left, to be re-assessed and possibly managed at a later time, when other priority patients have been managed. This is another unique difference from START triage, and helps address some ethical challenges with triage, as well as address resource conservation Doing the most good, for the most people, in the least amount of time, with limited resources. 8. Learn the major sources of bio-terror and how these victims would be triaged (see your HESI book: would you tag these victims as red, yellow, green, or black? [grey is not in HESI 32

so may not be on exams-however, in current disaster management, grey would be the appropriate tag for many victims) 1. Anthrax, Ebola Virus, E. Coli, Botulism, Viral Hemorrhagic Fever, Smallpox, Tularemia, The plague 2. Victims would be tagged as RED??? (Not sure about this one)

4.

5.

What are the major tasks in disaster planning and management in each stage/phase of disaster management? A. Prevention/Mitigation/pre-impact/preparedness phaseplanning, mitigation B. Response/Impact phasesurvival C. Post impact phase/Recovery phaseEmergency intervention, rescue, first aid (burnout of workers, recovery What are the functions of the American Red Cross and how are these different from the role of government agencies? -Provides: -WORLDWIDE humanitarian care of war and disaster -Community services for the needy -Support and comfort for military members and their families -Collection, processing, and distribution of blood and blood products -Educational programs that promote health and safety -International relief and development programs -In Disaster: -Collaborates in formation of disaster plans -Is represented in emergency operations centers -Trains personnel as responders -Operates shelters -Provides feeding services -Provides individual and family assistance -Collects donations -The Red Cross attends to the whole world, where as government agencies give aid within the country

6.

What is the purpose of triage? What tagging system is used for triage of victims? -To sort victim based on the severity of their condition in order to treat the highest priority in the least amount of time -Red (immediate), Yellow (Delayed), Green (Minor), Black (Deceased/Dying)

7.

How can the nurse assist victims to recover from disaster? (see text, pages 465-467) -By providing psychological support/counseling to victims to manage their PTSD (including children)

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8.

What psychological problems must the nurse confront in the management of disaster victims? Why is PTSD a significant feature of emotional response to a disaster? (see text, pages 466-467) -Acute stress disorder, depression, and PTSD -PTSD is significant because it affects the way a person lives their lives after a disaster. The person may have restricted emotions, extreme phobias, and flashbacks. Physical problems can also arise as a result of PTSD.

9.

What primary, secondary, and tertiary interventions may the nurse use to respond to the threat of terrorism? (see text, 469-470) -Primary: -Can teach health educations classes in positive stress adaptation, positive ways of coping, self-efficacy, and resilience. Can be advocates for improving the social structure of the community including housing, work, and economic conditions for community members. -Secondary: -Crisis interventions, General support, debriefing -Tertiary: -Refer client for treatment by an advanced practice mental health nurse

Communication and Group Process 1. What are the 7 parts of the communication process? (text page 277) a. A message: expression of the purpose of communication b. A sender: person conveying the message c. A receiver: person receiving the message d. Encoding: the senders conversion of the message into symbolic form i. Involves how the send translates the message to the receiver ii. Can be accomplished through verbal and/or nonverbal means iii. Degree of success depends on senders communication skills, knowledge of the topic, attitudes & feelings r/t the message & the feelings, beliefs, values held by the sender e. A channel: medium through which the sender conveys the message i. Can be written, spoken, or nonverbal expression f. Decoding: receiver must translate the message into an understandable form i. Receivers can interpret message incorrectly when emotions cloud their perception g. A feedback loop What are the barriers to effective communication? a. Emotions: they can interfere with rational & objective reasoning i. Be aware of your own emotions when communicating ii. Know the emotional status of your client What are the three basic rules for sending verbal messages? (text pg. 280) a. Keep the message honest & uncomplicated 34

2.

3.

b. Use as few words as possible to state it c. Ask for reactions (feedbacks) to make certain that the message is understood 4. What are the components of nonverbal messages? a. Personal appearance, dress, posture, facial expression, gestures, and physical distance between receiver & sender b. Body language speaks louder than words c. Facial expression convey acceptance or rejection, interest or boredom etc. d. Eye contact or lack of it carries additional meaning and may be culturally indicated What techniques are used in active listening? (pg. 280-281) a. Reflective listening: assuming responsibility for & striving to understand the feelings and thoughts in a senders message i. Should actively work to discover what clients mean ii. This demands careful attention which arises from a genuine interest in what the speaker has to say iii. Sit forward, sustain eye contact, nod your head & ask occasional questions for clarification iv. Daydreaming or pretending to be listening block communication v. Mentally repeat to yourself words the client speaks to you to keep from straying during the conversation vi. Focus on listening and not forming your response vii. Ask questions that restate what clients have said to clarify their meaning Why is feedback critical in dealing with low literacy clients? (pg. 281) a. Because nurses have to make sure that their messages are understood; that their jargon/words havent gotten in the way Why is it essential that nurses understand the concept of health literacy? What must be included in health related communication to improve health literacy? (pg. 282-284) a. Health literacy: the ability to read, understand, and act on health information i. This is important for nurses to understand otherwise it will be a barrier to clients in maintaining their own health and increased costs ii. This can include: cultural or computer literacy b. Health related communication must include: i. Multiple communication channels: health messages, mass media etc. What are the stages of group process/development and what are the characteristics of each? a. Forming: Group dependent on facilitator; anxiety high, need safe environment, structure & avoid too much self-disclosure; agree on guidelines for group work/behavior; orient to task or purpose of group b. Storming: competition and conflict; need for structure; problem-solving; need to draw out quiet members continue to clarify group task or purpose c. Norming: group now more cohesive and creative; acknowledge others contributions; shared leadership; trust increases; work moves along more quickly d. Performing: not reached by all groups; true interdependence-can work as group, or as individuals, and in subgroups; most productive; least reliant on facilitator e. Adjourning: the termination phase; conclusion of activities and resolution of 35

5.

6.

7.

8.

relationships; formal acknowledgement of group work 9. What actions/behaviors are typical of the following: END (PG. 285) a. Task role behaviors: b. Maintenance role behaviors c. Nonfunctional group behaviors SEE ATTACHED TABLE AT

10.

How does the nurse working in a community setting foster collaborative partnerships? a. Collaboration has a goal that involves several parties assisting one another to achieve that coal w/ the goal being the benefit of the publics health. Because of that agencies, professionals, clients, and lay health workers must work together. b. The goal demands collaboration. What is contracting and what elements should be included in a contract establishing a collaborative relationship? a. Contracting: negotiating a working agreement between two or more parties in which they come to a shared understanding & mutually consent to the purposes and terms of the transaction i. Characteristics: 1. Partnership & mutuality: involves shared participation and agreement between team members, they become partners in the relationship 2. Commitment:involved parties make a decision that binds them to fulfilling the purpose of the contract 3. Format: involves outlining the specific terms of the relationship a. Client & professionals gain a clear idea of the purpose of the relationship, their respective responsibilities, and the specific limits within which they will work b. Expectations are clarified 4. Negotiation: nurse and other team members propose to accept certain responsibilities and then ask whether the clients agree

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