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Curing/diagnosing a disease or pathologic process |
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how do individuals deal with health and illness in the context of day to day life? |
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looking at ways to prevent disorders in health |
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Advocacy in community health |
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for populations; ex: public policy or transportation issues |
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Examples of Community health nurses |
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Public health nursing
Community health nursing
TB Surveillance nurse |
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Example of nurses in the community |
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School nursing
Adult day health centers
Home care
Community health centers
Homeless shelters |
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A community with geographic boundaries and structures that support a community. Example: The City of Boston, Boston College, Assistive Living facility |
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Phenomenological Community |
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Community that has no geographic place. It does have struture, though. Ex. Gay and Lesbian Alliance; Haitian Americans |
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Meet the needs of members
Shared values, beliefs and institutions
Persue common goals
Provide structure for living and working with others; for sharing resources
preserve history, culture and identity
to educate and socialize the young
to care for the vulnerable |
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Looking at a community. What can you see? Things like parks; grocery stores; gyms, sidewalk quality. Are they there? What's missing? |
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Can tell you air quality. |
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Unemployment rates (if increased, increase crime, decrease incidence of health insurance, and there's less money for healty food, childcare and transporatation) |
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Rates of disease (flu, stroke, falls) |
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quality of water, which has significant health implications |
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interventions to prevent disease and injury. Ex: vaccine, seat belt laws, bicycle helmet laws, sex ed (esp STD teaching), condom distribution |
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aimed at early detection and treatment of disease. Ex: breast cancer screening, pap smear, bp screenings, diabetes screenings, child hearing/vision screenings, colonoscopy |
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aimed at treatment of a disease; occurs when people actually have an illness. |
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rate of new cases. Tells you how much the disease is growing, or whether it's been affected by interventions |
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rate or pre-exisiting conditions or health events. Example the rate of diabetes in Dorchester from 2000-2005 |
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Frequency of an illness in a given population in a given time |
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death rates of a population in a period of time |
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The rate of death among infants born alive but that die within the first year of life. |
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Name the things that resulted from Lillian Wald's work |
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Definition
Henry Street Settlement
School Nursing
Play grounds in the lower east side and theater programs for adults at the Henry Street Settlement
"Milk Stations" in LES so that mothers would have access to pasturized milk
Rural Nursing (Town and Country by the American Red Cross)
Factory Reform and Child Labor Laws (with the help of Jacob Reece who took compelling pictures of factory life)
Brownsille Clincal: Margaret Sanger gae birth control info to poor women. |
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What do hospitalization rates tell us? |
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Info about the burden of chronic illness (diabetes, COPD)
Lack of access to preventative/primary care (maybe lack of insurance?) |
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What do infant mortality rates tell us? |
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Definition
How a community is able to care for their most vulnerable. It is a bell weather for the heath of a community
Def: Death of a live birth within the first year of life
*When infant mortality was controlled for SES and education there was still a higher rate in black populations. This is tied to the stress of enduring discrimination/racism |
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Black women are more than 10X as likely to have HIV/AIDS than white women. Black men are 2X as likely to have HIV/AIDS as white men. |
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Why are diabetes rates so high for minorities? |
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Definition
They often are not being diagnosed early enough. They are often not diagnosed until they come in with complications
They don't have the resources to control their BS
lack of concistency with PCP (the poor end up going to clinics where residents rotate) |
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Why is obesity a bigger problem for minorities? |
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Definition
Less access to healthy foods (placement of grocery stores)
healthy food costs more
It's difficult to transport groceries |
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What are factors that lead to increased rates of asthma in minorities? |
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air quality (Dorchester has the poorest air quality)
housing conditions: mold/cochroach droppings
money for medicines
health illiteracy: how to use medicines |
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1 Person $9570/year
3 people $19350/year
If somone worked full time, 52 weeks per year at minimum wage they would not reach the federal poverty rate |
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How does education relate to health? |
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Definition
Education relates to income and access to employment (health insurance)
Relates to health literacy. The ability to understand verbal and written instructions |
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Why are there desparities in exercise among minorities? |
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Definition
No time--working too much
No $$ for the gym
Less access to open spaces
devaluing exercise
Saftey in neighborhoods |
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Stair dangers, and how to improve them |
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Definition
Dangers: falls especially with impared gate Improvement: slipper socks, stair tread, 100W light bulbs (40W is too low!); night lights |
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Cords, dangers and how to improve them |
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Definition
Danger: tripping, use duct tape, or bright green glow in the dark tape |
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Toilets, danger and how to improve |
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Danger: hips and back problems. Getting up multiple times in the night, in the dark
Improve: nightlights to get to the bathroom (especially light sensing ones that don't need to be turned off/on). Bedside commode for continuous falls during the night; Raised seat or backless commode for the toilet |
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Tubs, danger and how to improve |
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Definition
Danger: Slips and falls; burns, esp for peripheral neuropathy
Improve: non-slip stickies for the tub; tub chair, especially with transfer bench to ease in; turn down hot water tank |
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Ovens, dangers and how to improve |
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Danger: burns; leaving gas on; fire, especially with hoarders
Improve: get them to use the microwave; take knobs off the stove |
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Rats/Roaches, dangers, how to improve |
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Danger: rat bites, dandriff from mice/rats and cochroach droppings are major asthma triggers
Improve: proper garbage disposal |
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In the community, what are the major causes of medication errors? |
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Definition
*The further from the hospital we are, the less control we have of heath care
forgetfullness: taking multiple times or not taking at all
noncompliance: dislike SE
health literacy: they don't know how to take them, have vision problems, dexterity problems
can't afford meds
Feel fine on maintence meds, so they stop taking them
Transportation to pharmacy, and whether pharmacy carries the medications |
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Definition
List of meds that you should use caution with when perscribing to the elderly |
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Checking for orthostatic hypotension |
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Definition
Assess BP/P when supine
Then again after going from supine to sitting or standing
Then at 1-3 minute intervals over the next 10 minutes
Patient is orthostatic if there is a SUSTAINED drop in SBP of 20mmHG and for DBP of 10mmHg or acccompanied by an increase in the HR of 20bpm or more. |
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Three things you need for fall prevention to work |
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Definition
Lower extremety strength and balance exercises
Environmental changes
Comprehensive medication review |
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What is a chronic illness? |
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Definition
Irreversable illness one must live with for the remander of his or her life
Illness where there MAY be no treatment to manage symptoms but for which there is NO cure
Illness characterized by ambiguity and uncertainty-by periods of control and episodes of exacerbation |
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Activities of daily living
Very basic activities
ex: thinking, toileting, communicating, bathing, grooming, dressing, eating
Deficits in ADLs make people eligable for subsidized programs |
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Instrumental Activities of Daily Living
less basic than ADLs. You need access ability ot engage in these and manage them independantly (or make adaptive changes) or have support system to help with these
ex. food/meal preparation, shopping, driving/taking public transportation, doing laundry, using the telephone |
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How low does glucose need to be for healing? |
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Definition
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What are HTN guidelines for people with diabetes? |
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Definition
BP higher than 130/80 is HTN
130-140/80-90 can try to be managed with lifestyle changes for 3mo before trying a med
140/90 and above should be put on anti hypertensive |
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Recommended norms for glycemic control |
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Definition
FBS: 90-130
PP <180mg/dl
HgbA1C: <7 |
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sweating, shaking, dizziness, hard time concentrating |
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Person doesn't know that they're exhibiting hypoglycemic symptoms
This occurs often in the elderly, and with Beta blockers |
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Characteristics of diabetic foot ulcers |
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Definition
Usually have a callus ring; a ring of white callus which makes it difficult to heal. |
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If they can't feel 3/5 places they have "loss of protective sensation" and should be referred to a podiatrist (which is covered by medicare if they have this)[image] |
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Positive PPD (and need for chest x-ray)
bacteria is in the body, but the immune system is strong enough to wall off the bacteria.
not contageous; not sick.....
but if the immune system becomes comprimised, it can lead to TB disease |
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Definition
Exhibits the signs and symptoms of TB including: cough, chest pain, coughing up blood tinged sputum, weakness/fatigue, anorexia/wasting, fever, night sweats
high risk for TB: HIV+, homeless, Asia community (TB is more common in Asian countries) |
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Definition
Screen for TB antibodies
Positive: a whiel the size of a pencil eraser or larger
Negaitive: clear skin at site of injection
False positive: reaction to the serum
Who should be screened? healt care workers; if you think you've been exposed, immunocomprimised patients
w/exposure you should have a PPD shortly after, and then serial testing for 6 months |
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INH (Izoniazid).
Rifampin and streptomycin are also new antibodies to deal with resistant strains
You need to stay on meds for 6-9 months and compliance/adherance is difficult....stoping the drugs leads to resistant strains |
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Diagnostic related groups: Hospitals are paid a lump sum based on diagnosis, reguardless of how much care the patient requires. Lead to shorter hospital stays and a spike in homecare for post-acute care. |
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provides personal care: bathing, dressing, toileting |
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does meal prep, shopping, errands...but NOT personal care |
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Requires the skills, educatoin and knowldege of a nurse to perform.
NOT skilled: DSD; prefilling med boxes
Skilled WTD; injections, catheters, colostomy care |
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Can not be 24h, 7day care. Most frequent is twice daily, least frequent is 2X/month. |
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leaving home is a considerably taxing activity. The patient can leave for MD appointments and church. |
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Federal program from the department of health and human services.
Insurance for people 65 and over and for some people with disabilities
Pays for ACUTE illness, not for care after stabilization or prevention and maintence
Does not payed for "non-skilled" work |
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Definition
Federal and State monies for insurace, administered by the state
For low income populations
Much more generous tha medicare. Covers acute illness AND chronic care. Covers things like filling med boxes and syringes, to see someone with a chronic illness, and some adaptive equiptment (wheelchairs, scooters ect)
Prevention and Promotion |
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