N327 Final - Dr. Kimberly McClellan PDF

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Dr. Kimberly McClellan...

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1 What are Nerve agents? Muscarinic agents What are adverse effects of nerve agents? Sludgem syndrome - can develop cholinergic crisis Salivation: stimulation of the salivary glands Lacrimation: stimulation of the lacrimal glands (tearing) Urination: relaxation of the internal sphincter of urethra, and contraction of the detrusor muscles Diaphoresis: stimulation of the sweat glands GI upset: Smooth muscle tone changes causing gastrointestinal problems, including diarrhea Emesis: Vomiting Miosis, muscle spasms How do you treat sludgem syndrome? Treatment: atropine What is bioterrorism? deliberate release of viruses, bacteria, etc. used to cause illness/death in ppl, animals, or plants. What is the Strategic national stockpile? biodefense program - part of the federal medical response infrastructure - supplements medical countermeasures needed by states, tribal nations, territories and large areas during public health emergencies. The supplies for lifesaving care can be used as a short-term, stopgap buffer when the immediate supply of these materials isn’t available or sufficient. How are bioagents classified? Bacterial agents, Viruses, Toxins: categorized A,B,C based on level of risk and disruption caused What is Category A? High-priority agents including organisms that pose a risk to national security because they easily disseminate or transmit from person to person - result in high mortality rates and have the potential for major public health impact might cause public panic and social disruption require special action for public health preparedness What is Smallpox’s incubation period? Incubation period 7-17 days (asymptomatic, not contagious) What are symptoms of smallpox? fever, malaise, aches, (2-4 days) sometimes contagious Early rash: small red spots on tongue and mouth if break open virus spreads, MOST contagious time, Rash spreads to body on extremities, Pustular rash through scabs and recovery, Contagious until scabs have fallen off, mainly on face and extremities Lesions differ from chicken pox: Smallpox lesions develop at the SAME rate (all are small, then all become pus filled, then all start to scab) How is smallpox treated? Contact FBI if considered a bioterrorist attack Routine vaccines stopped after last case - the only prevention, effective within 3 days of exposure, US has stockpile of vaccine How is smallpox transmitted? Direct and prolonged face-to-face contact, contact w infected bodily fluids, or w fomites

2 What was the response to the smallpox outbreak? Required mass vaccinations set up by school districts. supplies provided by pub health dept Vaccination stations - Crowd control, Patient flow Record keeping and prioritization Dealing with emotions - Educate patients about vaccine, answer questions

What is Category B? 2nd highest priority: moderately easy to disseminate w mod morbidity rates & low mortality rates require specific enhancements of CDC's diagnostic capacity & enhanced disease surveillance. What is Category C? Third highest priority agents include emerging pathogens that could be engineered for mass dissemination in the future because of availability, ease of production and dissemination; and potential for high morbidity and mortality rates and major health impact Emerging infectious diseases such as Nipah virus and hantavirus, SARS, H1N1, HIV/AIDS What is Care of the patient with radiation exposure? don PPE specified by Wireless Information System for Emergency Responders (WISER) Remove patient from the scene Must treat life threatening injuries first Establish background radiation levels (50-200CPM) Assess patient for level of radiation exposure (Geiger counter) Remove all clothing and items exposed to radiation from patient Wash patient Reassess radiation level Repeat cleaning process until pt radiations read lower than 3x the background radiation level What is Treatment for radiation exposure? Potassium Iodide (KI) - Distributed by health depts for residents within 25 mile radius of a nuclear power plant - protects thyroid against cancer Prevent various types of radiation from being absorbed: Prussian Blue, DTPA What are symptoms of radiation exposure? N/V/D, HA, fever, dizziness and disoriented, weakness fatigue, hair loss, hematemesis, hematochezia What is Start triage? All walking wounded - minor If no respirations: position airway If no respirations after repositioning - deceased If respirations after repositioning - immediate If respirations: If respirations > 30/min - immediate If respirations < 30/min - check pulse: if pulse present - check mental status - if can follow simple commands - delayed, if cannot follow simple commands - immediate If pulse not present check cap refill:

3 If cap refill less than 2 sec - check mental status - if can follow simple commands - delayed, if cannot follow simple commands - immediate If cap refill greater than 2 sec - control bleeding - immediate What are the levels of disease occurrence? Endemic: a disease/event that is found to be present in a population. Oubreak: a sudden inc in the # of cases above what is norm expected in pop for a given area. Epidemic: outbreak with higher attack rate, involves larger geographic area, may cross borders. Pandemic: an epidemic that has spread over several countries or continents What is part of the Epidemiological triangle? Environment, host, agent (inside vector/time) How do we fill in triangle? Who: Patient 0 (if known); # of persons affected? deaths? Additional clusters of occurrences What: Agent?; Reservoir?; Mode of transmission?; Vectors or fomites (if applicable)? When: Time frame of the first case and the duration of outbreak Where: Location of outbreak; Environmental conditions that were favorable for the outbreak S/S of the Disease Identify preventative strategies and strategies for nursing care the patient What is Passive acquired immunity? Vertical transmission from mother to baby, Immunoglobulin treatments What is Active acquired immunity? Natural or vaccine What is Herd immunity? Requires 95% of the population What is the Natural history of disease? Incubation, prodromal, acute, convalescence What is part of the Chain of Infection? Agent: pathogen that causes disease Reservoir: carrier on which agent depends for survival Portal of exit: avenue by which agent leaves reservoir Mode of transmission: mechanism by which agent moves to host: Air, water, insects, fomite Portal of entry: avenue by which agent enters susceptible host Susceptible host What are Attributes of an Effective Screening test? Reliability Validity - Sensitivity, Specificity Innocuous, Ethical and effective High yield Capable of large group administration Results: Pos: true+(disease), false+(no disease), Neg: false- (disease), true-(no disease) Too sensitive: too many false positives Too specific: not enough correct or positive results What are the 4 principles of bioethics, principlism? Autonomy, nonmaleficence, beneficence, justice What is autonomy?

4 Individuals have the right and freedom to make decisions for themselves that fulfill their life plans – without coercion or influence Ex. A patient leaves AMA What is Nonmaleficence? “do no harm” – act according to standard of care, guidelines, and policy Ex. Pt with communicable disease who requires quarantine What is Beneficence? “do good” – obligation to perform actions that maintain or enhance the dignity of others – actions should not cause undue burden on providers Ex. Staying up to date on latest practice guidelines What is Justice? Everyone has an equal opportunity – eliminate discrimination in biological studies and healthcare, Ex. Access to basic health care for all What is Social justice? fair and equal society in which each person matters What is Distributive justice? fair distribution of benefits and burdens in society – a minimal level of goods and services should be available to its members Ex. Welfare rights What is Restorative justice? repairing harm caused by criminal behavior: Mediation between school bully and student victim What are the goals of Health for All in the 21st century? WHO, 1997 Social justice focused Increase life expectancies Universal access to quality care between and within countries Policy directions Embracing values of Health For All Making health central to development Developing sustainable health systems What is a population pyramid? A graphical illustration that shows the distribution of a population Age distribution: Pre-reproductive (0-14y), Reproductive (15y-44y), Post –reproductive (>45y) Sex ratios - Male vs Female Dependency ratio: working age population (15-64) to dependents (Children, Elderly) What is Information that can be extrapolated from population pyramids? Gender differences in trends Prediction of population growth overtime - Rapid, slow, stagnant Level of industrialization - Recent, developing, advanced Life expectancy of the population, Infant mortality rate Record of past events

5 What is Child maltreatment? Affects 742,000 children/teens: Neglect, physical, sexual, psychological abuse, medical neglect What are Risk factors of child maltreatment? Familial financial restraint, Lack of social support, IPV between parents, Substance use What is Nursing care for child abuse? Recognize signs and symptoms of abuse PA ChildLine 1-800-932-0313 What are signs of child abuse? burns, fractures, subdural hematoma, poor hygiene, unkempt clothes, unusual fear of people in authority, malnutrition/developmental delays, vague physical complaints, incontinent, hyper, withdrawal, Low self-esteem/poor school performance/absenteeism, hx of running away What is Unintentional injury? Injury to a person without predetermined intent to injure another or one self Motor vehicle collisions, Accidental drownings, Unintentional poisoning (food, chemical), Falls What is Intentional injury? occur as a result of deliberate act that causes harm either to one self or others => VIOLENCE What are resources for injuries? CDC National Violent Death Reporting System (NVDRS) Web-based Injury statistics query and reporting system (WISQARS) What are Public health consequences of violence in the community? Mortality, Disability, Health-care costs, Need for emergency care What is the Cycle of change? upward spiral Pre contemplation - no intention of changing behaviors Contemplation - aware prob exists but w no commitment to action Preparation - intent on taking action to address problem Action - active modification of behavior Maintenance - sustained change, new behavior replaces old Relapse - fall back to old patterns of behavior What are individual factors that influence planned behaviors? Age, gender, education, income, personality, mood/emotion, values, stereotypes, knowledge What are social factors that influence planned behaviors? Religion, race, ethnicity, culture, laws, economy, geography, media, intervention What are behavioral beliefs? Attitude toward the behavior What are normative beliefs? Subjective norm What are control beliefs? Perceived behavioral norm What influences intention? Individual and social factors, behavioral, normative, and control beliefs What influences behavior? intention What is Anticipatory guidance?

6 Common strategy used in health promotion & disease prevention across the lifespan Anticipate problems and provide guidance to cope or prevent Given by HCP to assist patients in understanding what to expect. In peds, it helps parents understand the expected growth and development of their children. For adults, it helps pt see what to expect w life stage changes, onset of illness, disease progression Allows time for planning & preparation for possible outcome Informing people about what may occur & support problem solving strategies Places individuals in positions where they may make choices that will best support the individual, family &/or community. What are Categories of anticipatory guidance? Family structure and dynamic Development and behavior: Cognitive, Social-emotional Nutrition, Routine care, Safety What are Examples of anticipatory guidance? Infant, 2months: Keep hand on infant when on bed or changing on table/couch Toddler, 2years: provide nutritious 2 meals and 2 snacks; limit sweets/high fat foods School-aged, 7 years: Establish tooth brushing routine twice daily; floss daily. Adolescent, 15 years: Teach self-safety at friend’s house/car, and how to exit situation Young Adult, 20 years: Transition to adulthood for health, social, and work matters. Encourage independent decision skills/problem solving. Prenatal care: Limit amount if seafood that contains mercury. Take prenatal vitamins that have at least 400 micrograms of folic acid. Bicycling safety: Wear a properly fitted bicycle helmet. Driving safety: Always wear seatbelt. Do not drive under the influence of alcohol or other substances or get in a car with a driver who is under the influence Firearm safety: Store firearm in locked cabinet, safe, gun vault, or storage case when not in use. Make sure it is in a location not accessible to children, and where others cannot access the firearm without permission. Limit total entertainment screen time to fewer than 2 hours a day Avoid screen time for babies younger than 2 years old Encourage careful selection of programs to view. Co-view and discuss content with children and adolescents. Be a good medial role model Emphasize alternative activities Avoid use of media as an electronic babysitter Avoid watching TV during family meals What are comprehensive assessments? Public health agencies mandated to perform regularly Systematically collect, analyze, and report on the community health status Primary data: Windshield survey, demographics, focus groups, surveys, etc. Secondary data: census, public health dept mortality and morbidity What are Population focused assessments? A group of persons who share at least one characteristic; age, gender, location What are Setting specific assessments? Identifies strengths and weakness of an organization (community) and the workers (population)

7 Requires a clear purpose for assessment; stressors at work What are Problem or health issue based assessments? Specific such as diabetes management, reducing risk for heart disease What is a Health impact assessment? combination of procedures, methods, tools a policy, program, or project may be judged as to its potential effects on health of a population, and distribution of those effects within the population What are Rapid needs assessments? Used in emergency or disaster setting - Establish extent and evolution of emergency and measure the present and potential public health impact Determine response capacity and Identify additional immediate needs What are Characteristics of an effective community partnership? Equity, Inclusion Trusted relationships, Community power, Strategic collaboration and alignment Data and community informed action Flexible, Continuous What is Body burden? total amount of naturally occurring or synthetic chemicals present in the body at a given time. also useful to consider the body burden of a single chemical, like, lead, mercury, or dioxin. What is Environmental justice? Fair treatment and involvement of all regardless of race, national origin, or income, w respect to development, implementation, and enforcement of environmental laws, regulations, and policies Everyone have the same protection from environmental and health hazards Everyone has = access to decision-making to have a healthy environment to live, learn, work. How is the Federal Poverty Level used? Medicaid/CHIP: States determine eligibility by income and family size, Net vs. gross income ACA Marketplace: To qualify for premium subsidies, between 138 and 400% on FPL What is the ACA – Affordable Care Act? upstream approach - attempt at universal health care implemented in 2014 What public health measures were made to promote the ACA? Mandatory funds for early childhood home visitors CDC national diabetes prevention program Loan repayment programs to increase public health workforce Nurse managed clinics/school-based health centers What are Conditions to the ACA? No denial of coverage based on existing conditions Young adults may stay on parental insurance until age 26 Employers >50 employees must provide employer sponsored insurance Medicaid expansion to adults under 133% of federal poverty level Preventative health care provided at no additional costs To qualify for premium subsidies,...