Community Health Nursing Kaplan PDF

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Kaplan Community Nursing ...

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Population-based nursing practiced in various community settings. Promotes and protects the health of the community. Nursing Focus & Concepts Community-Based Nursing (CBN) o Definition: ▪ Collaborative model of health care delivery. ▪ For individuals and families within a community. ▪ Addresses primary health needs for acute and chronic conditions in a variety of settings: • Community. • Nursing centers. • Institution-based facilities. Concepts: o Nursing Domain. o Managing Care. o Community Based Care. Assessment: o Current health status of client: ▪ Acute and chronic health conditions. ▪ Effectiveness of prescribed treatments and strategies of management. ▪ Capacity and level of client participation in self-care. o Access to services. o Need for referrals. o Safety concerns of the client and family members. o Client strengths. o Available resources. Diagnosis: Client and family needs related to physiological and psychological integrity and safety. Planning: o Identify client and family needs. o Advocate for client. o Collaborate with members of health care. o Manage and coordinate needed resources and services. Implementation: o Establish and maintain a ther therapeutic apeutic relationship with the cclient lient and family. o Enable client and family to view nurse as advocate in health care system. o Address needs that may impair access to health care services: ▪ Cultural. ▪ Financial. ▪ Social. ▪ Legal. o Make referrals as needed. o Provide direct care and teaching. Evaluation: o Nurse will determine effectiveness of interdisciplinary interventions. o Nurse will give attention to changing health needs. o Nurse will identify new health issues. Community Assessment o The act of becoming knowledgeable about the community. o Community has a location, a population, and a social system.

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Assessments: ▪ Familiarization assessment (windshield survey). ▪ Problem-oriented assessment.

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Community subsystem assessment. Comprehensive assessment.

Health Promotion • Purpose is to move individuals, groups, and communities closer to optimal well-being by educating. • Activities that assist a person to develop resources that improve quality of life. • Altering of personal habits, lifestyle, environment to reduce risks and enhance health and well-being. • Purpose: o Increase the healthy life span of all groups. o Achieve access to preventative services for all o Reduce health disparities among groups. groups. • Programs: o Health education. o Weight control. o Demonstrations. o Stress management. o General wellness. o Nutritional awareness. o Smoking cessation. o Work safety. o Exercise/physical conditioning. • Nursing Focus & Concepts o Health Promotion o Process of enabling people to increase control over and improve health. o Beyond focus on individual behavior. o Includes wide range of social and environmental interventions. o Concepts: ▪ Nursing Domain. ▪ Collaboration. ▪ Health Promotion. o Assessment: ▪ Alterations in: • Body mass index. • Blood pressure. • Cholesterol. • Blood glucose. ▪ Nutrition. ▪ Physical activity. ▪ Stress. ▪ Knowledge base. ▪ Readiness to learn. o Diagnosis: ▪ Poor health maintenance because of lack of knowledge. ▪ Poor health maintenance because of non-compliance with prescribed regimen. o Planning: ▪ Support family mobilization. ▪ Clarify client culture, values, and beliefs. ▪ Identify health and wellness resources. o Implementation: ▪ Activities vary based on client needs. o Teach: ▪ Nutrition management. ▪ Weight management.

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▪ Oral health promotion. ▪ Refer to smoking cessation program. ▪ Sleep enhancement. Discuss strategies: ▪ Increase high density lipids. ▪ Lower hemoglobin A1C. ▪ Decrease triglycerides. ▪ Encourage 30 minutes of moderate ▪ Decrease low density lipids. exercise at least 5 times per week. ▪ Lower blood pressure. Evaluation: ▪ Client will express desire to modify behavior and access resources to increase wellness. ▪ Client will express desire to engage in strategies and access resources to prevent chronic illness and infectious diseases. Process of enabling people to increase control over and improve health. Beyond focus on individual behavior. Includes wide range of social and environmental interventions. Physiology: Clients engage in activities and utilize available resources to improve health and prevent disease. Pathophysiology: ▪ Clients develop infections and diseases. ▪ Results in acute and chronic health conditions which can be life threatening. Caused by: ▪ Lack of knowledge. ▪ Lack of resources. ▪ Genetics. ▪ Lack of compliance. Risk Factors: ▪ Sedentary lifestyle. ▪ Secondhand smoke. ▪ Poor nutrition. ▪ High levels of stress. ▪ Family history. ▪ High total cholesterol. ▪ Obesity. ▪ Hypertension. ▪ Smoking. Signs & Symptoms: ▪ High blood glucose. ▪ Headache. ▪ Low energy. ▪ Dizziness. ▪ Sleeping poorly. ▪ Shortness of breath. ▪ Snoring. ▪ Chest pain. ▪ Bruising easily. ▪ Visual disturbances. ▪ Anxiety. ▪ High cholesterol. ▪ High blood pressure. Diagnostic Testing: ▪ Complete blood count. ▪ Biometric screening. ▪ Blood pressure measurement. ▪ Physical examination. ▪ Eye examinations. ▪ Blood glucose level. ▪ Blood chemistry. Expected Outcome: Client will engage in activities and utilize available resources to improve health and prevent disease.

o Population • All the people living within the boundaries of a community. • Variables: o Size. o Density. o Composition. o Rate of growth or decline.

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Cultural differences. Social classes. Mobility

Population-Focused Practice • Population: group of people sharing at least one characteristic such as age, gender, race, risk factor or disease. • Interventions for population-focused practice: o Advocacy. o Community organizations. o Screening. o Health teaching. o Disease and health event investigations. o Case management. Populations: Rural • Populations that live outside of urbanized areas and urbanized clusters. • Population characteristics: o Elderly persons - fastest growing population. o Generally less education. o Less racial diversity. o Lower per capita income. • Rural health issues: o Higher mortality rates due to cardiovascular disease. o More likely to smoke. o More machinery-related accidents. Populations: Vulnerable • Groups of people at increased risk of poor health outcomes. • Include: o Pregnant adolescents. o People with limited financial resources. o People who abuse drugs and alcohol. o Migrant workers. o Victims of abuse or neglect. o People with disabilities. o Untreated mentally ill. o People with communicable and chronic diseases. Research: Vulnerable Populations • Certain groups of people considered to be vulnerable in terms of research. • Groups: o Have or may have members with limited autonomy. o Cannot give fully informed consent to participate. o Might have strong likelihood of coercion to participate. o May be in circumstance where they have more than average risk of adverse effects - pregnant women. • If used as subjects: o Special care must be taken to ensure risks to subjects is low. o Protective measures are taken. o Examples: prisoners, the cognitively impaired, children. Infection Prevention: Levels oping. • Purpose of prevention is to prevent disease from developing. • Levels: • Primary prevention: o Precedes the development of disease. o Education about health promotion activities. o Immunizations. o Wear protective devices to prevent injury. • Secondary prevention: o Early detection and treatment of disease. o Screening. o Contact investigation. o Case-finding. • Tertiary prevention: o After disease has resulted in damage.

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o Limiting disability. o Rehabilitating clients to highest level of functioning. Risk factors: o Age – children are at higher risk due to immature immune systems. o Breaks in the skin such as surgery or insertion of IV devices. o Injury or illness – limits the physical resources available to combat an infection. o Smoking – interferes with normal respiratory function. o Substance abuse – may interfere with intake of a healthy diet. o Multiple sex partners – increases the risk of sexually transmitted diseases. o Environmental factors such as work, situations like healthcare settings, chronic disease – decreases the ability to fight off infection. o Medications – some reduce the immune response. o Nursing and medical procedures such as insertion of an indwelling urinary catheter. Nursing Focus & Concepts Illness Prevention o Primary prevention: ▪ Activities that promote health and prevent illness. ▪ Example - giving immunizations. o Secondary prevention: ▪ Identify health issues at earliest opportunity. ▪ Prevent complications. ▪ Example - screening for breast cancer. o Tertiary prevention: ▪ Restore individuals, families, or communities to highest level of functioning. ▪ Example - providing rehabilitation services. o Concepts: ▪ Nursing Domain. ▪ Illness Prevention. ▪ Managing Care. o Assessment: ▪ Health risks. ▪ Health history. ▪ Coping abilities. ▪ Physical examination. ▪ Emotional well-being. ▪ Lifestyle. ▪ Client motivation to change related to ▪ Physical fitness. identified health risks. ▪ Support systems. ▪ Barriers to change. ▪ Spiritual health. ▪ Health beliefs. o Diagnosis: ▪ Level of readiness for enhanced ▪ Health promotion. learning. o Planning: ▪ Health promotion/illness prevention education/activities based on: • Health needs. • Client goals. • Personal preferences. o Implementation: ▪ Provide education: • Various topics that promote health. • Illness prevention specific to the identified individual/family/community health risks. ▪ Assist clients in identifying specific health risks.

Help clients set realistic health goals. Provide needed support to meet goals: • Provide support to promote • Counseling. behavior changes. • Social services. • Support groups. Evaluation: Client will achieve goals related to promotion of health and prevention of illness. ▪ ▪

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Infection • Presence and growth of a microorganism that causes tissue damage. • Chain of infection: o Infectious agent - bacteria, virus, fungi, protozoa. o Reservoir where pathogen can live. o Portal of exit - skin, mucous membranes, respiratory tra tract, ct, urinary tract, GI tract, reproductive tract tract,, blood that allows the organism to exit one hos t. host. o Mode of transmission - contact, air, vehicles, vector. o Portal of entry - same as portals of exit into the new host. o Susceptible host. • Risk factors: o Age - children are at higher risk due to immature immune systems. o Breaks in the skin such as surgery or insertion of IV devices. o Injury or illness - limits the physical resources available to combat an infection. o Smoking - interferes with normal respiratory function. o Substance abuse - may interfere with intake of a healthy diet. o Multiple sex partners - increases the risk of sexually transmitted diseases or infections. o Environmental factors such as work, situations like healthcare settings, chronic disease - decreases the ability to fight off infection. o Medications - some reduce the immune response. o Nursing and medical procedures such as insertion of an indwelling urinary catheter. • Indications: o Localized - pain, tenderness and redness at o Systemic - fever, fatigue, nausea/vomiting, the wound site. malaise, enlarged, tender lymph nodes. • Treatment: o Obtain culture and sensitivity of wound. o Antibiotics/antifungal agents specific to organism/organisms. o Broad-based antibiotic/antifungal used until the results of culture and sensitivity are obtained. o Switched to the antibiotic/antifungal appropriate for the organism/organisms. • Nursing considerations: obtain culture and send to laboratory before starting medication. • Client education: take medication as prescribed and entire course of medication, return for follow-up. Disease: Prevention • Three levels of prevention: o Primary: health promotion and specific protection, dec decreasing reasing vulnerability to disease and harm. preventing ting spread of communicable o Secondary: early diagnosis and prompt treatment, including screenings and preven diseases diseases. o Tertiary: restoration and rehabilitation, to minimize effects of an already existing disease such as a chronic condition, prevent further disability disability. Disease: Progression • 4 stages: o Stage 1: susceptibility. o Stage 2: adaptation.

o Stage 3: onset. o Stage 4: culmination. • 2 phases: o Phase 1: ▪ Pre-pathogenesis. ▪ The first two stages. o Phase 2: ▪ Pathogenesis. ▪ Stages 3 and 4. • Primary prevention occurs during Stages 1 and 2. • Secondary prevention occurs during Stage 3. • Tertiary prevention occurs during Stage 4. Host-Agent-Environment Model • All interact to cause disease or conditions that harm the community. mal who nourishes the disease-causing agent Host: human or animal agent. • Host o Genetic susceptibility. o Immutable characteristics – family history, age, sex, etc. o Acquired characteristics – immunologic status, heart disease, obesity, etc. o Lifestyle factors – diet, exercise, drug use, intake of caffeine, use of tobacco products, etc. • Agent Agent: factor that causes or contributes to the illness or condition condition: o Infectious – bacteria, viruses, fungi, parasites, etc. o Chemical – heavy metals, toxic chemicals, pesticides, etc. o Physical – radiation, heat, cold, machinery, power tools, etc. • Environment Environment: external fa factors ctors that contribute to the hos host’s t’s susceptibility or resistance: o Climate – temperature, rainfall, number of days of sun, etc.. o Plant and animal life – agents or reservoirs or habitats for agents, types and numbers, etc. o Human population distribution – crowding, social support, apartments versus subdivisions, number of people per acre/block of land, etc. o Socioeconomic factors – education, sources, access to care, income, etc. o Working conditions – levels of stress, noise, satisfaction, factory inside air pollution, etc. Vaccines • VARICELLA VACCINE: o Nursing Considerations ▪ Both injections contain live, but weakened virus; immunization can cause a mild case of the disease ▪ Counsel patient to avoid contact with newborns, pregnant women, and immunocompromised individuals immediately after injection o Side Effects ▪ Soreness at injection site ▪ Rash (rare) ▪ Fever o Purpose ▪ prevention of varicella-zoster (chickenpox) infection • ROTAVIRUS VACCINE: o Nursing Considerations ▪ Contains the whole live virus; designed to trigger low-grade infection to create immunity ▪ Administer PO: oral liquid vaccine ▪ Infants: administer in 2 or 3 doses (depends on brand) o Side Effects ▪ Irritability ▪ GI upset

Purpose ▪ prevention of rotavirus infection POLIO VACCINE: o Nursing Considerations ▪ Contains whole but killed virus; cannot cause disease ▪ Children: administer in 4 doses o Side Effects ▪ Mild fever ▪ Extremely small risk of allergic ▪ Injection-site soreness reaction o Purpose ▪ prevention of polio infection PNEUMOCOCCAL CONJUGATE (PCV13) VACCINE: o Nursing Considerations ▪ PCV13 vaccine protects against 13 of the more than 90 types of pneumococcal bacteria ▪ PPSV23 vaccine (given to adults over age 65) protects against 23 strains of pneumococcal bacteria ▪ Contains only portions of the bacteria; cannot cause disease o Side Effects ▪ Children: drowsiness, anorexia, injection-site redness or tenderness (50%) ▪ Children: irritability (80%) ▪ Children: mild fever, swelling at injection site (33%) ▪ Adults: mild reactions o Purpose ▪ prevention of infections caused by Streptococcus pneumoniae MENINGOCOCCAL VACCINE: o Nursing Considerations ▪ Contains only portions of the ▪ Adolescents: 2 doses recommended bacteria; cannot cause infection ▪ Serious allergic reactions very rare o Side Effects ▪ Redness or pain at injection site (50%) o Purpose ▪ prevention of meningitis infection MEASLES, MUMPS, & RUBELLA (MMR) VACCINE: o Nursing Considerations ▪ Contains live but weakened viruses; can cause the actual diseases ▪ Serious allergic reactions in less than 1 in 1 million doses ▪ Children: administer in 2 doses o Side Effects ▪ Fever (17%) o Purpose ▪ prevention of infection with measles, mumps, and rubella (“German measles”) INFLUENZA VACCINE: o Nursing Considerations ▪ IM virus; cannot cause infection IM: injection contains the whole but killed virus ▪ Nasal spray spray: contains live, weakened viruses; designed to trigger a mild infection, inducing immunity ▪ Serious allergic reaction in less than 1 per 1 million doses o Side Effects ▪ Injection-site swelling, soreness ▪ Flulike symptoms (nasal spray) HUMAN PAPILLOMAVIRUS (HPV) VACCINE: o

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Nursing Considerations ▪ Contains only portions of the virus; cannot cause infection ▪ Cervarix recommended for girls age 1111––12 12; Gardasil recommended for girls and boys age 1111––12 • Cervarix ⎯ think CERVIX only girls can have a cervix. ▪ Given as 3-dose series o Side Effects ▪ Headache or fatigue (50% for ▪ Pain at injection site (90% for Cervarix, 33% for Gardasil) Cervarix, 80% for Gardasil) ▪ GI symptoms (25% for Cervarix) ▪ Redness or swelling (50% for Cervarix, ▪ Muscle or joint pain (50% for Cervarix) 25% for Gardasil) o Purpose ▪ prevention of infection with HPV types 6, 11, 16, and 18 18, which cause cervical cancer HEPATITIS A VACCINE: o Nursing Considerations ▪ Contains the whole, but killed virus; cannot cause infection ▪ 2 doses needed for lasting pr protection otection o Side Effects ▪ Soreness at injection site (50% in ▪ Headache (17% in adults, 4% in children) adults, 17% in children) ▪ Serious allergic reaction rare o Purpose ▪ prevention of hepatitis A infection HEPATITIS B VACCINE: o Nursing Considerations ▪ Contains only portions of virus; cannot cause infection ▪ Infants: administer in 3 doses o Side Effects ▪ Soreness at injection site (25%) ▪ Severe allergic reaction in 1 per 1.1 million doses o Purpose ▪ prevention of hepatitis B infection HAEMOPHILUS INFLUENZAE TYPE B (HIB) VACCINE: o Nursing Considerations ▪ Contains only portions of the bacteria; cannot cause infection ▪ Children: administer in 3 or 4 doses (depends on brand) o Side Effects ▪ Injection site redness, warmth (uncommon) ▪ Dizziness, shoulder pain (very rare) o Purpose ▪ prevention of Haemophilus influenzae type B infection DTaP VACCINE: o Nursing Considerations ▪ Contains only portions of the bacteria; cannot cause infection ▪ Control fever with aspirin-free pain reliever, esp. in child with seizures ▪ Children: administer in 5 doses o Side Effects ▪ Soreness at injection site (25%) ▪ Fever (25%) ▪ Fussiness (33%) ▪ Redness or swelling at injection site (25%) o

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Purpose ▪ prevention of diphtheria, tetanus, and acellular pertussis ( whooping cough) Immunizations: Adult o Influenza: ▪ Given yearly, preferably October to May. ▪ Recommended for all people age 6 months and older. o Contraindicated: ▪ Some persons who have had previous anaphylactic reaction to vaccine or eggs. ▪ Have had previous Guillain-Barrè Syndrome. ▪ Currently have a moderate or severe illness. o Tetanus-diphtheria (TD) or tetanus-diphtheria-acellular pertussis (TDaP): ▪ Tetanus and diphtheria toxoid (Td) administered to perso persons ns 7 years of age or older older. ▪ Provides protection for approximately 10 years. ▪ Tetanus toxoid - a booster dose of the toxoid given in case of a dirty wound. ▪ Tetanus immune globulin used for short-term passive immunity. ▪ One TDaP and then TD every 10 years. o Chickenpox (Varicella): 2 doses if not had as child. o Human Papillomavirus (HPV): 3 doses before age 26. o Shingles (herpes zoster): ▪ Shingrix. ▪ Age 50 and older. ▪ 2 doses 2-6 months apart. o Measles, Mumps, and Rubella (MMR): ▪ 2-3 doses before age 55. ▪ Adverse effects: fever, allergic reaction, arthritis, arthralgia, fever, encephalitis, burning and/or...