NURS 475 COMMUNITY FINAL EXAM STUDY GUIDE WITH COMPLETE SOLUTIONS, Exams of Nursing

Download NURS 475 COMMUNITY FINAL EXAM STUDY GUIDE WITH COMPLETE SOLUTIONS and more Exams Nursing in PDF only on Docsity! Community Final Exam Objectives TB- SHORT ANSWER AND ESSAY 1. What is the difference between TB disease and latent TB? • Latent TB : upon breathing in the TB bacteria the body succeeded in fighting the bacteria to stop it from growing. So.. the person carries the disease, but does not show symptoms and cannot infect others. Only sign of infection is a positive rxn to the tuberculin skin or special TB blood test, but negative chest x-ray. o Many w/ latent will never develop TB disease, some develop it in weeks, some in years when their immune system weakens d/t another reason ▪ Those w/ weak immune systems (such as those w/ HIV) are much more likely to develop TB disease • Transitions from latent to active when the immune system can no longer fight off the bacteria and it multiplies • TB disease : (aka active & multiplying TB) patient can infect others and shows symptoms (bad cough w/ hemoptysis, chest pain, fever, chills, night sweats, and no appetite). Patient will have a positive skin test, blood test, and chest x-ray. 2. How is TB spread? • Airborne : person w/ active TB of the lungs or throat coughs, sneezes, speaks or sings  nearby person breathes the TB bacteria in and becomes infected o Not by shaking hands, touching a toilet seat, kissing, or sharing food/drink or toothbrushes 3. What is the treatment regimen for latent TB? • Needed to prevent the bacteria from becoming active and turning into disease. o Isoniazid (INH) ▪ Up to 300 mg QD for 6 or 9 months ▪ Up to 900 mg twice-weekly for 6 or 9 months Rifampin (RIF) ▪ Up to 600 mg QD for 4 months ▪ Isoniazid & rifampin QD for 3 months o Rifapentine (RPT) ▪ Up to 900 mg isoniazid & rifapentine once-weekly for 3 months 4. What is the treatment regimen for TB disease? • Drug treatment for total of 6-9 months. The initial phase of meds is taken for 2 months to eliminate the active infection, then the second phase is 4-7 months on a few different drugs to eliminate any other pathogens in the body. o Isoniazid (INH) ▪ Contraindication : HIV, pregnant, children < 2, liver disease. Use cautiously in older adults, & pts w/ DM or alcohol use d/o. ▪ Administration : 1 hr before or 2 hrs after meals. Take w/ Pyridoxine o Rifampin (RIF) ▪ Turns body fluids red/orange. Given in combo w/ one other anti-tb med to prevent antibx resistance. ▪ Avoid : alcohol ▪ Monitor : ALT/AST ▪ Notify HCP : anorexia, fatigue, malaise, o Ethambutol (EMB) ▪ Decreases visual acuity, loss of red-green colors o Pyrazinamide (PZA) ▪ Risk of hyperuricemia & hepatoxicity 5. What are the most common medications used to treat TB disease and what education would the nurse provide regarding these medications? • Finish all meds as prescribed to prevent bacteria from becoming resistant or from getting sick again ▪ Avoid : tyramine foods, alcohol, & taking isoniazid, rifampin, and pyrazinamide together (all increase risk of hepatoxicity) ▪ Monitor : ALT/AST and phenytoin levels • Medication effectiveness: o Treatment completion determined by the # of doses ingested over a given period of time o 3 negative sputum cultures (usually takes 3-6 months to achieve) o Clear breath sounds, no night sweats, increased appetite, and no afternoon rise in temperature • TB vaccine: o Bacilli Calmette-guerin  not widely used in US but commonly given to infants and small children in other commons where TB is more common. It does not always protect people from getting TB Chapter 5 – Epidemiology 1. Identify epidemiological models used to explain disease and health patterns in populations. a. Epidemiology: i. Organized study of distribution, determinants, and disease, in a population b. Epidemiologic triad: i. Agent: 1. Etiology, such as infectious agent or chemical agent (strep, flu) ii. Host: 1. Susceptibility or response (age, sex, immunity) iii. Environment: 1. Extrinsic factors influencing the existence, exposure, or susceptibility to the agent (biologic, socioeconomic & physical) c. Descriptive epidemiology: i. Study of frequency & distribution of disease in a population (patterns may lead to cause) d. Ecosocial epidemiology: i. Study disease in context of social, political & economic forces e. Analytic epidemiology: i. Cause & effect  why is disease rate lower in one population compared to another 1. 1st aid training 2. Emergency disaster kit 3. Decide pre-determined meeting place outside of home 4. Develop family communication plan ii. Community: 1. Plan must include authority, communication & coordination of  a. Supplies/equipment, HR, evacuation & rescue 2. Must be able to change PRN 3. Must be tested in different disaster scenario drills 3. Describe the stages of a disaster and disaster management. 4. Describe the roles of federal, state, local, and volunteer agencies involved in disaster management. 5. Identify potential bioterrorist chemical and biological agents. 6. Describe the role and responsibilities of nurses in relation to disasters. Chapter 30 – School Health 1. Identify and discuss the eight components of a comprehensive school health program. Overall Purpose: a coordinated system ensures a continuum of care from school  home  community health provider & back • Health education : o National health education standards: ▪ promote personal, family & community health in students and targets grades 2, 5, 8 & 12 o youth risk behavior surveillance system: ▪ initiated by CDC, started in 1990. Surveys of high school students every 2 years throughout the US o focuses on 6 high risk behaviors: ▪ Alcohol use ▪ Substance/drug use  most common illicit drug use in US is marijuana (an increasing problem for school nurses as it is legalized some places) ▪ Tobacco use  use has declined but it is still high ▪ Nutrition ▪ Physical activity ▪ Sexual behavior  prevention of pregnancy, STDs & HIV (a focus of healthy ppl 2020). many young are sexually active • pregnancy has declined but is still high  US teen birth rate is one of highest among developed countries (black & Hispanic highest here) • teen mothers: less likely to complete high school, more likely to be single parents & live in poverty • 7 fundamental topics in a comprehensive sex education curriculum: o Anatomy & physiology o puberty & adolescent development o identity or sexual orientation o pregnancy & reproduction o STDs & HIV o Healthy relationships & personal safety ▪ Injury & violence  prevention • Tattoos & body piercings: poor sterile technique resulting in Hep C & MRSA. Educate that if they’re going to do it, there are safe ways • Dental health: good nutrition, proper teeth brushing, & regular dental checkups are emphasized throughout February • Physical education: o Focus: ▪ improving knowledge, positively change behaviors & attitudes, and promote lifelong physical activity • Health promotion for staff: o School nurse also available for staff & can  improve productivity, increase staff morale, decrease absences, reduce health insurance costs & peak an interest in teachers to teach health related topics to students • Healthy school environment: o Physical healthy environment: safe playgrounds, safe classrooms, light circulation of air, good hygiene & cleanliness, safe spaces that don’t put kids playing at risk for injury o Psychological health risks to react to: ▪ Violence  armed intruder ▪ Terrorism ▪ Tornado safety  safe rooms & tornado/fire drills • Health services: o Health screenings  vision, hearing, scoliosis, BP, autism o Emergency care  falls, breaks, cuts, scrapes, CPR, lead school district in developing an emergency plan o Care of the ill child  chronic or acute, symptom screening to determine when to send child home or keep at school ▪ Chronic: • Asthma (& allergies)  #1 encountered by school nurses o Students should have immediate access to rescue inhaler, be able to have it with them at all times o Education of staff & other students on the condition • Diabetes  typically type 1, but increased type 2 (with school age) o Know how well they manage their diabetes by themselves  help them becomes autonomous with it & keep them in the classroom as much as possible (so they aren’t singled out) • ADHD  commonly medicated & classroom behavior management issue, so help teacher develop a management plan • Seizure disorder  know which classrooms have these kids & educate teacher & students o Medication administration  increased o Special needs  increased (tube feeding, suction, catheterization, ventilators, wheelchairs  create individual health care plan for these students) ▪ family is expert on child’s condition ▪ ratio: 1:250  1 school nurse for every 250 students w/ special needs (1:750 for healthy students) ▪ 1976 d/t public law giving all students including the severely handicapped the right to education ▪ 1990 individuals w/ disabilities act advanced the previous one, mainstreamed disabled in public schools o Record keeping (immunizations)  tracking history of screening & exam results • Nutrition services: o Work w/ dieticians to teach students & help plan school lunches o Eating disorders ▪ Female athlete triad: eating disorders, amenorrhea, and osteoporosis o Obesity  increased • Counseling, Psychological & social services: o Increased • Family & community involvement: o School is just one component of kids lives, so have an integrated approach: ▪ Advisory councils  parents & community members can serve ▪ Coalitions  health education in the community o NEEKC foundation: ▪ Looked at key needs of school children & their families ▪ Kids count index (promotes 4 domains that kids need in order to thrive) • Economic well-being, education, health, family & community 2. Recognize the major stressors that can negatively affect an adolescent’s mental and physical health. a. Injury prevention : Motor vehicle safety (including risks of distracted driving), sports safety (prevention of sports related injuries, proper use of equipment, hydration, frequent rest periods, effective warm up & cool down exercises i. Sports physical is a good time for school nurse to council at risk students b. Tobacco use : in adolescents is closely correlated to use of alcohol & other drugs. Smoking in young can cause heart disease, chronic lungs disease, and cancers of lungs, pharynx, esophagus & bladder. i. Vaping : vaping education for adolescents! risks are vast and is much more dangerous than smoking. Develop micro abrasions on lungs increasing susceptibility to systemic infections (sepsis). Formaldehyde & some other substances have very dangerous cancerous effects c. Drug abuse: anabolic steroids (decreased among high schoolers, but still in use & school nurses need to be aware) 3. Identify common physical and mental health concerns of school-age children and associated health interventions. ii. workers compensation acts (vary from state to state state mandated): 1. OHN needs to be aware of the act in her state & the documentation needed to support or refute a workers compensation claim iii. Americans with disabilities act (ADA): 1. Requires employers to adjust facilities & practice to make reasonable accommodations to enhance opportunities for individuals with disabilities 5. Describe a multidisciplinary approach for resolution of occupational health issues. a. Nursing science : provides context for healthcare delivery & recognizes needs of individuals, groups & populations within a framework of prevention, health promotions, illness & injury care management b. Medical science : related to the tx & management of occupational health illnesses & injury integrated w/ nursing health surveillance activities c. Occupational health sciences: i. Toxicology  routes of exposure, examines relationships bw those exposures & the workplace, and health challenges that they could present ii. industrial hygrines  identification & evaluation of workplace hazards to control them iii. safety  prevent injury through active safeguards & worker training/education programs iv. ergonomics  matching the job to the worker & emphasizing the capabilities & minimizing the limitations d. epidemiology: to study health & illness trends & characteristics so that preventative measures can be taken & issues can be mitigated e. business & economics: related to the strategic & operational planning of the occupational health services f. social & behavioral sciences: help explore the various environments, relationships, and lifestyle factors that could influence worker health g. environmental health: systematically examine interrelationships bw employees & the environment h. legal & ethical issues: 6. Understand the elements of a work site survey. Chapter 32 – Forensic and Correctional Nursing *identify the healthy people 2020 goals r/t forensic nursing (2:30) *box 32.3 (tips for testifying at a deposition or in court) 1. Define forensic nursing. a. Forensic : pertaining to the law or legal, refers to instances, activities, or information used in or suitable to law b. Forensic nursing : the application of the nursing process to public or legal proceedings, and the application of forensic health care in the scientific investigation of trauma and/or death r/t abuse, violence, criminal activity, liability, and accidents i. Where health care & the legal system intersect ii. Forensic nurses may work w/ both victims & perpetrators 2. Describe the specialties of forensic nurses. a. First recognized by ANA in 1995  fairly new specialty* i. Both physicians and nurses recognize the need for RNs to work in this area of specialty* b. International association of forensic nurses: i. professional organization that recognizes the need to provide accurate & reliable knowledge, skills & scope of practice & education for new forensic nurses c. subspecialties: i. Sexual Assault Nurse Examiner (SANE): 1. Very valuable in ED & community clinics 2. Most widely recognized subspecialty 3. Can get certified as either an adult or pediatric SANE  requirements = a. Must have RN license & at least 2 years experience b. Must complete 40 hours of lecture or academic course equivalent c. Must demonstrate competency in sexual assault examinations (through supervised clinical hours) 4. Roles: a. Physical exam, history (in a sensitive manner), collect evidence, documenting 5. Evidence: a. History of assault, photos & written descriptions of injuries, all clothing worn, trace evidence, biological evidence, fingernail swabs, swabs & smears from genitals anus & mouth, pubic hair combings, evidence disbursement sheet ii. Death Investigator: • Forensic nurse death investigator role  evaluate crime scene from nursing perspective 1. Medicolega l: (most common) a. Clarify the sudden/unexpected (& often unnatural) circumstances in which death occurred b. Issue the official death certificate  document presenting cause & manner of death i. Medical examiner: 1. Must be licensed physician certified in anatomic & forensic pathology 2. Can be appointed for a term & serve at county, region or state level ii. Coroner/justice of peace: 1. Elected layperson w/ little med/science training 2. Conduct investigation & certify cause & manner of death 2. Institution-based: a. Someone on staff at hospital or nursing home that looks into the deaths that occur there 3. Private: a. Consultant hired by the family to help answer questions about the death 4. Public: a. Works in cooperation w/ medicolegal when the understanding of the death is in the best interest of the public as a whole i. Nurse Coroner: 1. Ensure death investigations (must be certified in DI too) & certify death certificates ii. Legal nurse consultants & legal nurse attorneys: 1. Analyze & give opinions about health care delivery & outcomes by looking at medical record & patient charts (not so much face- face patient care nursing) a. Did the pt receive the standard of care? 2. Certified through American legal nurse consultant certification board iii. Nurse examiner in emergency and critical care: 1. Examine people that are somehow associated with the legal system  evaluating living survivors of trauma, physical/mental toxicology emergencies, violence, MVAs, and those detained by the police 2. Collect evidence & document iv. Organ tissue donation & transplant nurse 1. Called in if patient is near death in hospital & is potential organ & tissue donor 2. They assess patient, collect evidence, review records, and work with agencies to get release to obtain organs v. Care of vulnerable populations: 1. Child abuse & neglect (know these state definitions from chapter 32*) a. *Neglect: failure of a parent, guardian, or caregiver to provide basic needs (needs can be medical, educational, or emotional) i. Dressed inappropriately, poor hygiene, school absences, stealing b. *Physical abuse: intentional physical injury including: striking, kicking, burning, and biting i. Unexplained in various stages of healing, wary of adult contact, cries when its time to go home c. *Sexual abuse: range of activities from i. non-contact indecent exposure ii. production of pornographic materials iii. incest, rape, fondling, and genital contact 1. rape drugs: gamma-hydroxybutyrate (GHB), flunitrazepam (Rohypnol), ketamine, alprazolam, clonazepam, carisoprodol, alcohol b. Religion provides things that are good for health & well-being such as social support, existential meeting (a sense of purpose, coherent belief system & a clear moral code) i.  faith communities contribute to the well-being of their members through support, prayer & providing a sense of hope 2. Define the roles, functions, and education of the faith community nurse. a. Roles : i. Health educator ii. Personal health counselor iii. Referral agent iv. health advocate v. coordinator of volunteers vi. facilitator (facilitate activities but maybe not do them all) vii. developer of support groups (grief counseling, recovery groups) viii. integrator of health & healing b. education: i. BSN, experience in clinical & community-based nursing practice ii. There is specialized faith community nursing training to expand c. Issues: i. Providing care to vulnerable populations 1. Homeless & poor ii. End of life issues: grief & loss iii. Family violence prevention 1. need to understand risk factors, cycle of abuse, and id those at risks 2. intimate partner violence  imbalance of power is main issue 3. child abuse & neglect  reportable in all 50 states 4. elder abuse  physical, psychological neglect w/ or w/o verbal threats, violation of personal choices/rights, financial threats & failing to provide basic needs 5. confidentiality & accountability a. volunteers are held to the same degree of accountability as payed employees b. doctrine of separation of church & state does not exempt churches from discrimination laws c. ministers both ordained & not ordained may be required to disclose confidential information in court (could be community nurses title) 3. Discuss faith communities as clients of the community health nurses. a. Clients are members of the faith community or whoever the faith community determines could be clients (outreach into neighborhood) b. Services encourage members to be self-sufficient & capable of handling their own health w/ just a little support & empowerment from faith community nursing 4. Discuss the five practices of caring. Things all nurses can do for their patients. C on the circle model. a. Knowing (know their patients) b. Being with (be with their patients) c. Doing for (when they cant do for themselves) d. Enabling (in a positive sense, empowering them to take charge) e. Maintaining belief (helping them to maintain belief at whatever level that is) 5. Describe the role of the faith community nurses in the spiritual health and wellness of faith communities. a. Spiritual health: i. Motivating factor in seeking wellness care, participating in education, and enhancing self-care capabilities b. Spirituality: i. Human desire for a sense of meaning, purpose, connection, and fulfillment through intimate relationships and life experiences c. Spiritual distress: (what faith community nurse is usually dealing with) i. Disruption in life principle that provides a person’s entire being and impacts them in a biological & psychosocial nature  causing illness ii. Spiritual care is an indicator of quality care (TJC, ICN, NCSBN, NCLEX) 1. If you aren’t comfortable providing this care, find someone who is (chaplain, co-worker) d. Prayer: i. Commonly used spiritual intervention that can provide comfort & support (pre- written, poem, personal) 6. Models: a. The model for healthy living: i. Faith life: building a relationship w/ God, neighbors & yourself ii. Movement: discovering ways to enjoy physical activity iii. Medical: partnering w/ your healthcare provider to manage your medical care iv. Work: appreciating your skills, talents, and gifts v. Emotional: managing stress and understanding your feelings towards better self- care vi. Nutrition: making smart food choices & developing healthy eating habits vii. Family & friends: giving & receiving support through relationships b. HOPE model: i. H: sources of hope, strength, comfort, meaning, peace, love, and connection ii. O: the role of organized religion for the patient iii. P: Personal spirituality & practice iv. E: effects on medical care & end-of-life decisions c. Circle model of spiritual care: i. C: caring ii. I: intuition  instinct iii. R: respect for religious beliefs and practices iv. C: caution  avoid using your role to preach religion to clients v. L: listening vi. E: emotional support Chapter 34- Home Health and Hospice 1. Discuss the purpose of home health services. a. focus is on individual, as well as educating the family i. maximizes the level of independence ii. patients must be homebound or disabled to qualify b. before visit: i. review referral form, contact client by telephone ii. let coworker know where you’re going iii. environmental assessment before entering, create comfortable atmosphere, beware of surroundings 2. Define home health care. a. Hospice: i. Improves end-of-life care, supports pts & whole family (family w/ grief support) ii. Main priority = pain control (regular schedule) 1. Can help manage n/v, constipation, diarrhea, fatigue iii. Dx has to be < 6 months to live to qualify iv. pt does not have to be homebound 1. Allowed to go into nursing homes (home health cannot)