COMMUNITIES EXAM 1

*********Identify & explain primary, secondary, and tertiary prevention*******

Primary Prevention: Includes measures taken to keep illness or injuries from occurring
and precedes disease of dysfunction. Also involves anticipatory planning and action on the
part of community health professionals, who must protect themselves into the future,
envision potential needs and problems, and then design programs to counteract them so
they never occur
Secondary Prevention: Involves effort to detect and treat existing health problems at
the earliest possible stage when disease/impairment already exist. It attempts to discover
a health problem at a point when intervention may lead to its control or eradication
Tertiary Prevention: Attempts to reduce the extent and severity of a health problem to
its lowest possible level, so as to minimize disability and restore or preserve
function, prevent recurrence of problems and prevent complications of acute or chronic
conditions. This is used to minimize the effects of an existing unhealthy community
condition or eliminating/preventing additional injury to those experiencing tragedy
(disasters/hurricanes/earthquakes/fire)
Environmental & Global Health: Chapter 9/16
1. Apply the ecological perspective to human and environmental relationships.
Ecology: can be defined as the study of the interactions and relationships between
living organisms and their environments
The scientific study of ecosystems provides the science to understand the synergistic
relationship between humans and the environment and why knowledge of
environmental health is so important for nurses. The term ecomedicine refers to the
adverse human impact upon the environment that in turn creates new patterns of
disease and poverty
2. Discuss concepts of prevention & upstream approaches to health impact and
environmental health.
Upstream focus: approach that identifies root causes of disease and manufacturers of
the illness. Considers socioeconomic factors and also the environmental origins of
disease and health problems.
Public health nurses work in prevention and health promotion areas, but an upstream
approach moves our thinking to those factors that are at the institutional and system
level rather than looking solely at healthy lifestyle issues.
For example, a program to improve heart health in a community using a lifestyle
approach would promote healthy diets, increased physical activity, and smoking
cessation. An upstream focus looks at the social factors such as secondhand smoke in
public places, unhealthy food choices available in schools and other public places, and
how the built environment promotes or impedes safe outdoor physical activity.
3. Describe environmental issues affecting health.
Overpopulation: Effects: food scarcity, water shortages, depletion of other vital
resources
Air pollution: One of the most hazardous sources of chemical contamination; adverse
effects including costs to property, productivity, quality of life, and human life
Acid precipitation: Air contaminants + precipitation = sulfuric and nitric acid (acid rain)
Ozone depletion and global warming: Effects: increased risk for skin cancer and
cataracts; indirectly damaging food chain, increasing exposure to vector-borne
diseases, raising of ocean levels, and negative impact on crop production
Water pollution: Effects: cause of disease, contamination of streams, lakes, and wells,
contamination of fish, upset of ecosystem
Deforestation, wetlands destruction, and desertification: Effects: upset of ecosystem;
gases contributing to ozone depletion; geographic changes/landslides; drought, famine,
starvation
Energy depletion: Nonrenewable sources primarily used today; nuclear energy still
controversial, including building of plant and disposal of nuclear waste

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8.

COMMUNITIES EXAM 1

Unhealthy or contaminated food

Waste disposal: Issues involving disposal of human waste, garbage, hazardous waste
Inset and rodent control: Effects: irritation/discomfort; direct threat to health via attack;
contamination of food; vectors for disease transmission (mosquitoes, flies, ticks,
roaches, fleas, rats, mice, and ground squirrels)
Safety in home, worksite, and community: Exposure to toxic chemicals, radiation, noise
pollution, biologic pollutants; injury hazards; psychological hazards
Define risk management & risk assessment.
Risk assessment: is a process that uses scientific information by identifying and
evaluating adverse events to aid in judgments about hazards in the environment. The
process uses hazard identification, the dose response assessment, and exposure
assessment to characterize risk.
Risk management: requires that judgments be made about the significance of those
risks
Discuss key characteristics of upstream focus.
Use of an Upstream approach challenges the public health nurse to address factors that
are at the institution and system level rather than looking solely at the healthy lifestyle
issues
Strategic actions that can be considered as part of an upstream framework are to include:
Using an environmental health history in nursing assessments in order to create better
tracking of environmental exposures
Embedding environmental health information into nursing practice settings
Increasing educational efforts to inform individuals and families of environmental
health hazards
Knowing information
Engaging in environmental health research to advance our understanding of etiology
and prevention
Advocating for individuals and groups who are at specific risks
By using an upstream approach, public health nurses can impact the prevalence of
disease by intervening where the root causes exist
Define & discuss ecology & ecosystems.
Ecology can be defined as the study of the interactions and relationships between living
organisms and their environments. Ecosystems are dynamic communities of plant, animal,
and microorganisms as well as the nonliving environments in which they live. No organism
including humans can live removed from their ecosystem or other species. Ecosystems
help regulate water, gases, waste recycling, nutrient cycling, pollination, infectious
disease, climate, and biology as well as provide recreational and cultural opportunities for
human use.
Identify pollutants & types of toxic/hazardous materials. 299
Types of Toxic Exposures:
Air: Carbon monoxide, lead, ground level ozone, nitrogen dioxide, sulfur dioxide,
particulate matter
Water: microbial, gasoline stations, nitrogen derivatives, arsenic, lead, fluoride,
cadmium, mercury, organophosphates, phthalates
Food: food additives, microbial outbreaks, pesticides, fertilizers, dyes, thickening
agents
Toxic waste: solvent wastes, dioxins, and wastes from electroplating and other
metal finishing operations, wastes from oil refineries, organic chemicals, pesticides,
explosives, lead processing materials, and wood preservatives.
Radiation: radon gas, infrared, microwave, and radio wave radiation
Identify & describe the framework (3 Ps) for delivering care globally.
Population

COMMUNITIES EXAM 1

Procedure
Provider
In community health nursing, our focus is on populations rather than individual patients.
The provider refers to the health care team, which may include a community health nurse,
a physician, a midwife, an injector (someone who is trained to only give injections), or a
community health worker (CHW). The procedure refers to the interventions health care
providers implement for or with populations.
9. Identify major infectious diseases that persist globally. 508
Measles
Tuberculosis
Poliomyelitis
Malaria
Pandemic influenza
West Nile Virus
Diarrheal diseases
Leprosy
Acute respiratory tract infections
Guinea Worm Disease
HIV/AIDS
10.

Define universal imperatives of care.

The universal imperatives of care is one useful paradigm. When we ask the question,
how many nurses a community needs, part of the answers have to do with these
imperatives.
These imperatives include mortality, morbidity, daily functioning, decision-making, and
cost of and access to health care.
This paradigm underscores the notion of first things first. That is, one must be alive and
well before interventions can focus on functioning or decision making
11.
Discuss role & significance of the World Health Organization.
The leading global agency that focuses specifically on health.
Provides technical support and advises member states on strategies to meet their
health care needs.
Serves as a catalyst to mobilize the resources of national governments, financial
institutions and endowments, and bilateral partners for health developments.
6 point agenda: promoting development, fostering health security, strengthening
health systems, harnessing information/evidence/research, enhancing partnership, and
improving performance through its ongoing reforms
Providing leadership on matters critical to health and engaging in partnerships
where joint action is needed;
Shaping the research agenda and stimulating the generation, translation and
dissemination of valuable knowledge;
Setting norms and standards and promoting and monitoring their implementation;
Articulating ethical and evidence-based policy options;
Providing technical support, catalysing change, and building sustainable institutional
capacity; and
Monitoring the health situation and assessing health trends.
12.
Define eradication, elimination, & control of communicable diseases.
Eradication: interruption of person-to-person transmission and limitation of the
reservoir of infection so that no further preventive efforts are required; it indicates a
status whereby no further cases of a disease occur anywhere.
Elimination: when a disease has been interrupted in a defined geographic area.
Control: indicates that a specific disease has ceased to be a public health threat.
Control programs are aimed at reducing the incidence and prevalence of communicable
and some noncommunicable conditions.
13.
Older Adult & Dementia (LOOK AT KIMZEYs DEMENTIA POWERPOINT)
1. Describe characteristics of healthy older adults.

COMMUNITIES EXAM 1

Better educated, higher income, better health, more wealth, higher standard of living in
retirement
Their ability to function is a key indicator of health and wellness and is an important
factor in understanding healthy aging. Good health in the older adult means
maintaining the maximum possible degree of physical, mental, and social vigor. It
means being able to adapt, to continue to handle stress, and to be active and involved
in life and living. In short, healthy aging means being able to function, even when
disabled, with a minimum of help from others.
2. Identify & define interventions for caregiver burden.
14.Respite care: It provides time off for caregivers, including family members, who care for
someone who is ill, injured, or frail. Respite care can take place in an adult day center, in
the home of the person being cared for, or even in a residential setting such as an assisted
living facility or nursing home.
3. Identify & explain primary, secondary, and tertiary intervention practices.
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4.
Identify
interventions to
prevent polypharmacy.
Many of these health problems associated with old age are preventable to some extent,
and early diagnosis and treatment of some conditions can minimize their adverse
effects
Thoroughly examine all the meds the patient is on (make sure there are no duplicate
medications, wrong person, over the counter)
5. Describe various types of older adult living environments.
Aging in place- seniors who choose to remain in their own homes
Continuing Care Retirement Community (CCRC)- total life centers; allows seniors to
age in place with flexible accommodations designed to meet their health and housing
needs as these needs change over time. They provide all levels of living, from total

COMMUNITIES EXAM 1

independence to the most dependent, and are designed to meet the continuous living
needs of older aging adults
Skilled Nursing Facility- provide skilled nursing care along with personal care that is
considered non-skilled or custodial care (bathing, dressing, feeding, and assisting with
mobility and recreation)
Adult day care: day care services offer a place where older adults can go during the
day for social activities, nutrition, nursing care, and physical and speech therapies
Home care services: provides services, such as skilled nursing care, psychiatric nursing,
physical and speech therapies, homemaker services, social work services, and dietetic
counseling. These services are useful for families who are caring for an older per-son,
especially if the caregivers work and no one is at home or available during the day.
Independent living: general term for any housing arrangement designed exclusively for
seniors. Types of independent living facilities include subsidized senior housing,
retirement communities, and senior apartments restricted to those who are older
(usually 55+). These facilities provide minor assistance with ADLs and maintenance for
the housing facility.
o The Village Concept- older adults live in their own homes in a village, giving
them access to services such as transportation and grocery shopping or helping
with household chores provided by the village
Assisted living: or assisted living facilities (residences) provide supervision or
assistance with ADLs, coordination of services by outside health care providers, and
monitoring of resident activities to help to ensure their health, safety, and wellbeing.
Assistance may include the administration or supervision of medication, or personal
care services pro-vided by trained staff.
6. Describe difference between hospice and palliative care.
41.Hospice: Hospice is an option for people with a projected life expectancy of 6 months or
less and often involves palliative care (pain and symptom relief) as opposed to ongoing
curative measures.
42.
Palliative: consists of comfort and symptom management and does not provide a
cure. Palliative care should be viewed as any care primarily intended to relieve the burden
of physical and emotional suffering that often accompanies the illnesses associated with
aging.
7. Identify types of elder abuse.
43.Elder abuse is defined by the National Center on Elder Abuse as intentional or neglectful
acts by a caregiver or any other person that causes harm or a serious risk of harm to a
vulnerable adult.
Physical abuse
Verbal abuse and threats
Neglect
Financial abuse and exploitation
Emotional or psychological
Sexual abuse
abuse
Abandonment
8. Identify chronic conditions common to the older adult.
Alzheimers Disease
Arthritis
Cardiovascular disease
Depression
Diabetes
Osteoporosis
9. Identify differences between ADLs & IADLs.
Activities of Daily Living (ADLs) are activities in which people engage on a day-to-day
basis. These are everyday personal care activities that are fundamental to caring for
oneself and maintaining independence.
Instrumental Activities of Daily Living (IADLs) are activities related to independent
living and are valuable for evaluating persons with early-stage disease, both to assess

COMMUNITIES EXAM 1

the level of disease and to determine the persons ability to care for himself or herself.
10.
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Disaster Health
1. Define & discuss role of FEMA.
12.The FEMA, established in 1979, is the federal agency responsible for assessing and
responding to disaster events in the United States. It also provides training and guidance
in all phases of disaster management.
2. Identify role of RN in disaster intervention.
13.
PRIMARY
Keeping disaster from ever happening by taking actions to eliminate the possibility
of its occurrence
Anticipatory guidance: disaster drills, anticipatory exercise
Teach community members how to protect themselves from the effects of a natural
disaster
14.
SECONDARY
Focuses on earliest possible detection and treatment
Corresponds to immediate and effective response
Triage: process of sorting multiple causalities in the event of a war or major disaster
Provide treatment on-site at emergency treatment stations, at mobile field
hospitals, in shelters, and at local hospitals and clinics
On-site interventions might include arranging for transport once survivors are
stabilized and managing the procurement, distribution, and replenishment of all
supplies
The nurse often must also arrange for psychological and spiritual care of survivors
of disasters.
15.
TERTIARY
Tertiary disaster prevention involves reducing the amount and degree of disability or
damage resulting from the disaster
Follow-up care for injuries
Follow-up care for psychological problems
Recovery assistance
Prevention of future disasters and their consequences
3. Identify colors used in disaster intervention.
16.(1) Red: Urgent/Critical. Victims in this category have injuries or medical problems that
will likely lead to death if not treated immediately (e.g., an unconscious victim with signs
of internal bleeding).
17.(2) Yellow: Delayed. Victims in this category have injuries that will require medical
attention; however, time to medical treatment is not yet critical (e.g., a conscious victim
with a fractured femur).
18.(3) Green: Minor/Walking Wounded. Victims in this category have sustained minor injury
or are presenting with minimal signs of illness. Prolonged delay in care most likely will not
adversely affect their long-term outcome (e.g., a conscious victim with superficial cuts,
scrapes, and bruises).
19.(4) Black: Dead/Nonsalvageable. Victims in this category are obviously dead or have
suffered mortal wounds because of which death is imminent (e.g., an unconscious victim
with an open skull fracture with brain matter showing).
4. Identify & discuss phases of disaster management.
Prevention: no disaster is expected or anticipated. The tasks during this phase are to
identify community risk factors, to develop and implement pro-grams to prevent
disasters from occurring or mitigate their impact, and to train personnel and educate
citizens.
Preparedness: involves improving community and individual reaction and responses,
so that the effects of a disaster are minimized. Disaster preparedness saves lives and

COMMUNITIES EXAM 1

minimizes injury and property damage. It includes plans for communication,

evacuation, rescue, victim care, and recovery.
Response: response phase begins immediately after the onset of the disastrous event.
Preparedness plans take effect immediately, with the goals of saving lives and
preventing further injury or damage to property. Activities during the response phase
include rescue, triage, on-site stabilization, transportation of injured, and treatment at
local hospitals and clinics. Response also requires recovery, identification, and
refrigeration of bodies, so that notification of family members is possible and correct,
even weeks after a disaster.
Recovery: the community takes actions to repair, rebuild, or relocate damaged homes
and businesses and restore health, social, and economic vitality to the community.
Psychological recovery must also be addressed.
5. Define disaster planning.
20.Essential for a community, business, or hospital. It involves thinking about details of
preparation and management by all involved, including com-munity leaders, health and
safety professionals, and lay people.
6. Identify POD.
Point of Distribution- specific locations that can be opened for the purpose of dispensing
medications or giving vaccinations to large populations in a public health emergency
7. Define terrorism & identify types of terrorism.
21.
Terrorism: as the unlawful use of force and violence against persons or property to
intimidate or coerce a government, the civilian population, or any segment thereof, in
furtherance of political or social objectives
22.Types:
Nuclear warfare: involves the use of nuclear devices as weapons and can take several
forms.
Chemical warfare: involves the use of chemicals such as explosives, nerve agents,
blister agents, choking agents, and incapacitating or riot-control agents to cause
confusion, debilitation, death, and destruction
Biologic warfare: involves using biologic agents to cause multiple illnesses and deaths.
Biological agents are graded as Category A, B, or C by the CDC. These agents could be
used to contaminate food, water, or air.
8. Identify psychological impact of disasters.
23.People affected by a disaster can also suffer from psychological consequences, such as
acute stress disorder, depression, and PTSD.
24.Psychological support is often required after a disaster, both for survivors and for relief
workers. Some individuals may experience posttraumatic stress disorder (PTSD). Many
survivors, especially elderly persons displaced from their homes, may quietly lose their will
to live and drift into apathy and malaise. Individuals whose belief in God was unshakable
before the incident may now question their faith, wondering how a loving God could have
let this happen, especially if they lost a loved one. These survivors often require not only
empathetic listening but also long-term skilled spiritual counseling.
25.
26.
School Health & Screening
1. Define & describe required screenings for school age students. (Look at
powerpoints)
2. Describe visual screening process for young school age students. (Look at
powerpoints)
3. Identify interventions for obesity, ADHD, & suicide prevention.
27.
Obesity:
Treating hypertension and high cholesterol, stopping tobacco use, control-ling
diabetes, reducing obesity, and improving physical activity are all helpful in reducing
CVD.
Preventive measures and early management of cardiovascular risk factors is now

COMMUNITIES EXAM 1

considered a more effective form of treatment than just clinical treatment of the
disease complications after the fact.
28.
ADHD:
A multimodal treatment approach is recognized as most effective. This includes:
Medication, usually methylphenidate (Ritalin, Metadate, or Concerta),
dextroamphetamine (Dexedrine or Dextrostat), or combined dextroamphetamine and
amphetamine (Adderall)
School accommodations for learning problems
Social skills training for the child with ADHD (NIMH, n.d.).
Family and individual counseling, parent support groups, and training in behavior
management techniques, as well as family education about the condition, are also
essential features of this treatment method.
29.
Suicide prevention:
Community health nurses and community mental health counselors may serve as
consultants to schools in the development of sound prevention programs.
Hallmarks of good prevention programs include student education on suicide
awareness and intervention; coping and problem-solving skills training; skill building
by reinforcement of strengths/protective factors while dealing with risk-taking
behaviors; teaching about the association between suicide and mental health
(especially depression).
Suicide screening is often thought to be effective in reducing suicidal ideation
4. Identify common vaccinations among school age kids.
Tetanus, diphtheria, pertussis
Hepatitis A
(TDAP)
Hepatitis B
Human papillomavirus
Inactivated poliovirus
Meningococcal
Measles, mumps, rubella
Influenza
Varicella
Pneumococcal

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Community as Client
Describe community, community assessment, & community diagnoses.
Community: refers to a collection of people who interact with one another and whose
common interests or characteristics form the basis for a sense of unity or belonging. It
can be a society of people holding common rights and privileges (e.g., citizens of a
town), sharing common interests (e.g., a community of farmers), or living under the
same laws and regulations (e.g., a prison community).
Community assessment: process of determining real or perceived needs of a defined
community
Community diagnoses: occurs after analysis; portray a community focus; include
community response and related factors that have potential for change via CHN;
logically consistent; response and factors logically linked; include statements narrow
enough to guide interventions; use a community response instead of a risk, goal or
need statement
o Risk of identified problem among aggregate/population related to etiology
Identify & define public health nursing.
Community health nursing: combines nursing science with public health science to
formulate a community-based and population-focused practice
During the first 70 years of the 20th century, community health nursing was known as
public health nursing. The PHN section of the American Public Health Associations
definition of a public health nurse is a nursing professional with educational,
preparation in public health and nursing science with a primary focus on populationlevel outcomes and notes the primary focus for public health nursing is to promote
health and prevent disease for entire population groups. The later title of community
health nursing was adopted to better describe where the nurse practices.
Discuss how the core functions of public health can be applied to public health
nursing.291
The core functions: assessment, policy development, and assurance will be applied to
the important aspects of environmental health for public health nursing. Assessment
includes the investigation of health hazards, surveillance of health issues such as
disease or injury, examining causes, and assessing needs.
Public health nurses fulfill these functions but extend them by their strong emphasis
upon education for health promotion, disease prevention, as well as advocacy by
integrating nursing knowledge and practice into these functions. In addition, public
health nurses work collaboratively with others in the community to promote health for
the people they serve.
Define Public Health Nursing Practice Model.
The LAC PHN Practice Model provides a conceptual framework that assists in clarifying
the role of the public health nurse and presents a guide for public health practice
applicable to all public health disciplines
The LAC PHN Practice Model promotes the concepts of an interdisciplinary public health
team working together, with an emphasis on primary prevention. It also recognizes the
importance of active participation of the individual, family, and community.
Describe population- focused care & relationship-based care.
Community-oriented, population-focused: care employs population-based skills and is
shaped by the characteristics and needs of a given community. Public health nurses
provide community-oriented, population-focused care when they count and interview
homeless people sleeping in a park and, based on these data, help develop a program
to provide food, clothing, shelter, health care, and job training for this population.
Relationship-based care: incorporates the value of establishing and maintaining a
reciprocal, caring relationship with the community. It is a necessary and feasible aspect
of public health nursing practice and is foundational to caring effectively for the
communitys health. A reciprocal, caring relationship with the community involves

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listening, participatory dialogue, and critical reflection, and it may also involve
sociopolitical elements of practice such as advocacy, community empowerment, and
movement to action
Identify genetics, genomics, & genetic engineering.
Genetics: the science of heredity
Genomics: the identification and plotting of human genes and the study of the
interaction of genes with each other and the environment. The study of the entire
genome
Genetic engineering: the group of applied techniques of genetics and
biotechnology used to cut up and join together genetic material and especially DNA
from one or more species of organism and to introduce the result into an organism in
order to change one or more of its characteristics
Discuss migration & effects on health.
Migration is the act of moving from one region or country to another, temporarily,
seasonally, or permanently.
The health care needs of migrants and migrant refugees are enormous.
Environmental factors are a primary reason for compromised health, and include
inadequate waste disposal, crowded and often unsanitary living conditions, lack of
access to healthful foods, and air pollution from an increased concentration of vehicles
used for moving refugees.
Compounding these problems are language and cultural barriers, as well as distrust
and fear that may interfere with meeting the needs of these vulnerable populations.
Identify types of community needs assessments.
Familiarization/Windshield survey: involves studying data already available on a
community, then gathering a certain amount of first-hand data in order to gain a
working knowledge of the community.
Problem oriented assessment: begins with a single problem and assesses the
community in terms of that problem. This type of assessment is responsive to a
particular need.
Community subsystem assessment: the community health nurse focuses on a single
dimension of community life. For example, the nurse might decide to survey churches
and religious organizations to discover their roles in the community
Comprehensive assessment: seeks to discover all relevant community health
information. It begins with a review of existing studies and all the data presently
available on the community. A survey compiles all the demographic information on the
population, such as its size, density, and composition.
Community assets assessment: focuses on the strengths and capacities of a
community rather than its problems. The type of assessment depends on variables
such as the needs that exist, the goals to be achieved, and the resources available for
carrying out the study.
Describe health continuum.
Because health involves a range of degrees from optimal health at one end to total
disability or death at the other, it often is described as a continuum. This health
continuum applies not only to individuals, but also to families and communities. The
health of an individual, family, group, or community moves back and forth along this
continuum throughout the lifespan.

10.

Describe the 3 dimensions of a community.

Status/People: is the most common measure of the health of a community. It typically
comprises morbidity and mortality data identifying the physical, emotional, and social
determinants of health (SDH).
Structure: of a community refers to its services and resources. Community
associations, groups, and organizations provide a means for accessing needed
services.
Process: reflects the communitys ability to function effectively. It includes processes
within the community (collaboration between subsystems of education and health, for
instance) and between the community and the state or national levels.
Three features of a community: physical location, population, and social system
11.
Identify 8 principles of Public Health Nursing.

1. Focus on the Community. The client or unit of care is the population

2. Give Priority to Community Needs. The primary obligation is to achieve the

greatest good for the greatest number of people or the population as a whole

3. Work in Partnership With the People. The processes used by public health
nurses include working with the client as an equal partner

4. Focus on Primary Prevention. Primary prevention is the priority in selecting

appropriate activities

5. Promote a Healthful Environment. Public health nursing focuses on

strategies that create healthy environmental, social, and economic conditions in which
populations may thrive

6. Target All Who Might Benefit. A public health nurse is obligated to actively
identify and reach out to all who might benefit from a specific activity or service

7. Promote Optimum Allocation of Resources. Optimal use of available

resources to ensure the best overall improvement in the health of the population is a key
element of the practice

8. Collaborate with Others in the Community. Collaboration with a variety of

other professions, populations, organizations, and other stakeholder groups is the most
effective way to promote and protect the health of the people