Ch 6. Environmental Health: prevents human injury and illness by promoting well-being Ch.
Ch. 14: Disaster Mngmt: mitigate(prevent), preparedness, response and recovery
by identifying and evaluating environmental sources and hazardous agents, limiting Recovery is expensive, Goal: lessen the impact , Have a concise, realistic, well-rehearsed exposures to hazardous, physical, chemical, biological agents disaster plan-preparedness Toxicology: study of toxic harmful effects of chemical exposure associated with adverse Need to be trained as volunteer to respond, reduce or avoid potential losses from health outcomes (e.g. cancer, birth defects) Potency: the ability to cause injury/disease hazards, assure prompt and appropriate assistance to victims, and achieve rapid and (determined by dose, exposure time, port of entry). Epidemiology: uses information to effective recovery study links between disease and personal risk factors. Box 6-1: Gen environ comp for Nurse should prepare: before disaster occurs nurses: understand rel btw ind/pop & env. Exp to health hazard, prevention, control Mitigation (prevention): primary prevention to reduce individual or property. Nurses strategy, effective interven, role of research. Perform env health hx, recog envir role: Awareness and Education holding or attending community meetings on disaster hazards/illnesses, make referrals & give info. Advocacy, ethics, risk communication. preparedness, Organizing and participating in mass prophylaxis and vaccination Understand policy framework Env. & elderly: preex LD/CV, long exp to pollu, age, host campaigns, Advocacy: Identifying environmental hazards, serving on panels that def, meds contribute to mitigation work, Ex: Supporting efforts for enhancing building codes, or First step in assess comm env risk: windshield survey. Env & Child: more susceptible reporting unsafe equipment in hospitals (educational programs/trainings) Prevention: to env toxins d.t size structural measures, improved surveillance, security, immunizations Prim prev: education on exposure. Second prev: screenings for toxins. Tert prev: referral Preparedness: have a plan for you and your family. RN license, ID company, drivers to doctors license, pocket references for emergencies, PPE, stethoscope, first aid, mask, meds, cell Consumer confidence report: right to know report reports drinking water conditions phone etc (prepare kits). Family: 3days food/water (disaster emergency plan) IPREPARE(environmental health assessment/history): investigate potential exposures, Volunteering: American Red Cross: local, Certified Emergency Response Team (CERT): present work, residence, environmental concerns, past work(longest job), activities, local, Disaster Medical Assistance Teams (DMATS): national and state, Medical Reserve referrals/resources, educate. Corps (MRC: local and national, Salvation Army: local and national, FEMA: countywide, Environmental justice: goal of campaigns seeking to improve the unequal burden of levels are not determined by number of casualties, but by the amount of resources environmental risks borne by impoverished and minority communities (live near needed hazardous waste site/incerator, kids with lead poison and asthma) Recovery: restore normalcy, proper hygiene to make sure immunization records are Air pollution: vehicles, burning of fossil fuels, waste incineration, natural (lighting, current, make referrals to mental health professionals, be alert for environmental volcanoes, forests, wildfires), livestocks, cities, airplanes, stationary hazards, case finding and referral, OSHA: worker and workplace safety(environ free of health hazards-chem, excess noise, Stress response: child regresses and wets bed after house fire Primary prevention: mech dangers, heat/cold, unsanitary), establish standards preparing disaster plan Environmental healthcare assessment: assessing the environment or assessing a Triage guidelines: Assess needs assistance: priority- life-threatening ab injuries Black: setting(ask questions that cover environmental causes- Look at what you see) head injury with GCS<8, burns >85% BSA, multisystem trauma, signs of impending death Lead Poisoning symptoms: abd/joint pain, constipation, N/V, learning disability, slow (nothing you can do) Red: Airway obstruction, cardiorespiratory failure, significant growth, fatigue, loss of app, hyperactivity, irritability, baby colic, H/A, insomnia, mem loss external hemorrhage (priority) Risk Assessment: uses available information to evaluate and estimate exposure of Ch. 26 Infectious Disease: number one cause of death worldwide individuals and communities to a substance and the adverse health effect it may produce Healthy People 2020: related to comm diseases, inc immunization rates reduce Risk management: Selecting most appropriate action to eliminate or mitigate the risk infectious disease (Resp,hep, TB, diar disease) Advocacy in community: ask questions at policy meetings, serve as source of info, serve Surveillance: incidence of school absenteeism on health related committees, inform local media about environmental hazards Community concern of disease: hold educational campaign Ch. 9 Epidemiology: the study of the occurrence and distribution of disease, goal to Increase in infectious disease: d/t activities or behavior of human, changes in prevent, limit consequence of disease, disability, and to maximize their state of health environment endemic. Epi Nurse: surv/monitoring disease trends/# of ind with similar disease, symp, Reduce childhood infectious disease: no shots no school legislation patterns Communicable disease goal: to get rid of specific infectious disease Primary prevent: health ed/training daycare about health hygiene, immunizations, Epidemiological Triangle: Host: recipient of the organism, Environment: vaginal seatbelt ed,folic acid ed environment change. Resistance (ability to withstand the infection) Immunity (natural or Secondary: health screenings (mamm, pap smear, colonoscopy), education (ex. teach acquired and active or passive) Natural immunity: innate resistance to an infectious asthmatic client to recog/avoid triggers, replace carpets, keep air sys. (BP, cholest agent (Ex. Opossums) Active immunity: resistance you get after you’ve been exposed (Ex. training, weighing obesity) Flu-wont get same strain again, measles) Active immunization: admin of antigen Tertiary: clinics, hospitals, rehab, med treatment, PT/OT, education to decrease/prevent infectious agent/vaccine which produces antibodies. Passive immunization: antibody worsening (OSP-nutrients) transfer (Mother to child) immunoglobin HEP a, rabies, tetanus. Herd immunity: Analytic Epi: determinants of patterns observed-how/why factors, characteristics, Immunity to a group or a community, Inc vacc gives greater herd immunity-kids being exposures, behaviors (factors to certain disease (DM, obesity) immunized stops epidemics. Agent: ability to cause the disease (bacteria, fungi, parasites, Descriptive Epi: examines occur/distrib of disease in a pop in terms of time, place, viruses). Infectivity: the ability to enter the host. Pathogenicity: the agent’s ability to person. produce a specific clinical reaction. Virulence: ability to produce a severe Epi triangle: factors as agent, host, environment, examines all factors that lead to disease pathological/physical reaction. Toxicity: ability to produce a poisonous reaction. Agent: animate/inanimate factor that’s present or lacking for disease to occur Invasiveness: ability to penetrate and spread throughout the host. Antigenicity: ability to (bac, virus, fungi, parasites, chemicals, radiation, heat, cold) stimulate an immunological response. Environment: Physical, biological, social, cultural Host: humans, animals factors that are external to the host. Ex. Antibiotics change the environment within the Environment: internal or external to a given host or agent that is influenced and hose causing thrush, cdiff, yeast infection. How to stop mosquito born illness (nets, influences the host or agent (climate, plant/animal life, human pop, spraying, clothes, antimalarials, bug spray, avoid standing water) Vectors: anthropoids socioeconomic, working conditions) like ticks/mosquitos (Ex. Lyme disease) Prospective study: subjects who do not have the outcome under investigation are Incubation period: actual invasion of the microorganism before clinical S&S appear. Can classified on the basis of the exposure of interest at the beginning of the follow-up last from hours-weeks-years (Ex. Food poisioning vs. viral, HIV test next day wont be period. reliable Retrospective study: rely on existing records to define a cohort that is classified as having Prodromal period: few S&S begin to appear, malaise been exposed or unexposed (reviewing) Active period: full S&S appear from mild-severe—fatal Ch. 15: Survelliance: Ongoing, systematic collection, analysis, and interpretation of Convalescent phase: S&S begin to subside individual begins to feel better, still carrier health-related data essential to the planning, implementation, and evaluation of public CDC: responsible for programs to prevent/control communicable disease health practice, closely integrated with the timely dissemination of these data to those Measles: highly contagious, respiratory disease affects child-adults, may also get ear responsible for prevention and control. Monitor emerging infections and bioterrorist infection or pneumonia, aerosol droplets (coughing, breathing, sneezing) or contact, S&S: outbreaks, monitor disease trends to reduce morbidity and mortality and improve fever, sneezing, cough, conjunctivitis, small white inside cheese, red blotchy rash over the health(determine local baseline and see change), important to be up to date and attend body, MMR 2 dose immunization (measles epidemic) conference-usually first to recognize/respond to a problem. Reviews data for mortality Salmonella(bacterial disease): onset 48 hrs, S&S: H/A, abd pain, diarrhea, N/V, fever, Survellience: whats the problem risk factor: what is the cause intervention: what dehydration, fecal-oral transmission,, From an infected animal or worker – on veggies works implementation: how do you do it? from animal run off onto the food, pooping in the fields (Reptiles, iguanas, turtles, Passive: case reports are sent to local health depart by HCP/labs, summarized and poultry, cattle, swine, rodents, dogs, cats may carry the disease) forwarded to the state health department, national government, or organizations E. Coli: enterohemorrhagic strong toxin, eating undercooked meat, Beef, alphalpa responsible for monitoring the problem sprouts, apple cider, melons, lettuce, municipal water, unpasteurized milk, ready to eat Active surveillance, the health department nurse may begin a search for cases through salads, cheese, packaged cookie dough, pizza, flour, and tacos, S&S: Bloody diarrhea, adb contacts to determine the magnitude of the problem(ex. children become ill with GI at cramps, can cause ARF, Children and older adults at highest risk – can cause ARF school (hamburger, soft eggs) Syndromic surv: trips to ER/doc, increase in pharm meds, increase in absenteeism Lyme Disease: vector borne (tick, deer, mice, raccoons, opossums), Seasonal affective: affects during winter months-normal-no action require northeast/Minnesota/Wisconsin/midatlantic state/pacific, late spring, summer, early fall, Interpret data impact: reviewing the incidence (has it decreased) outdoor activity in wooded area increase risk, S&S: flu like, stiff neck, muscle pain, may Purpose: evaluate effectiveness, monitor/reduce chronic disease, note/help prevent develop arthritis, lymphedema, Treatment: tetracycline, PCN (10-14days) Prevention: occup exposure/disease avoid ticks, wear protective clothing, deet sprays (avoid under 2) reapply q2hrs, inspect immediately, permethrin sprayed on clothing, know how to remove Malaria: blood borne, human-human (drug users can develop from sharing needles, other-infant), travels to liver-reporoduce and enter bloodstream and infect rbc, risk children and travelers, S&S: chills, fever, H/A, muscle pan, anemia, hepatomegaly, splenomegaly (most common world wide), antimalarial treatment-prophylactic, 1-3 wks prior to travel then 4-6 weeks after Primary prevention: receiving immunizations(ex. tetanus), Secondary prevention: screenings(ex. tb test, xray) Ch. 27 TB: Not easy to catch: must breathe same air for hours, HIV & TB correlated (get tested for TB if + HIV) At risk expose: contact with infected ppl, born in high risk areas, elderly, low income, healthcare, prisons At risk develop: HIV, cancer, previous infection, IV substance, diabetes, severe kidney disease S&S: serious cough, pleurisy, coughing up blood/phlegm, weakness, fatigue, loss of weight/appetite, chills fever, blood in urine, back pain, night sweats (THINK kidney) Elderly: mental status change, anorexia, may need 2 step PPD Screening: hospitals, prisons, nursing homes, homeless TB tests: PPD/Mantoux- admin 2-4 in below elbow, wheel 6-10mm, read 48-72hrs, >5mm facilities, AIDS facilities +, >15 no risk factors +, if + chest xray Treatment: make sure they take all their meds with active TB(teach about importance of taking med to avoid resistance), latent doesn’t have to take. 6-9 month therapy. INH therapy can cause peripheral neuropathy is common side effect: take Vitamin B6, take all meds same schedule, don’t cancel appt, ade rest, nutrition, avoid alc, DOT-watch pt swallow med, must be specially trained to observe. Tertiary prevention: DOT for TB treatment. >10 mm induration + TB Ch. 27 HIV, Hep, STI HIV: Primary infection/acute HIV infection (within 1 month): blood tests are usually not a reliable for recent exposure, wait 3 months. Can be transmitted w.o symptoms. Most people don’t recog symp as HIV & don’t seek treatment. TB & HIV linked S&S: Lymphadenopathy, myalgia, sore throat, lethargy, rash fever. Antibodies occur 6-12 weeks. Can be asymptomatic. Highly active antiretroviral therapy (HAART). Aids can take up to 10 years w.o intervention, at risk for infections. Transmitted through blood, semen , seminal fluids, rectal fluids, vaginal secretions, breast milk(not by sitting next) young black gay/bi men. HIV testing: antibody test blood or oral fluids(EIA, ELISA), can test anonomously d/t possible drug use/scared. AIDS: diagnosis CD4 T-lymphocytes drop to less than 200/ml. HIV prevention PrEP (Truvada): oral med, must be HIV –, effectiveness dependent on adherence. HIV children: cant control body secretions, chickenpox STI’s: High risk factors: <25 y.o, minority group, urban setting, impoverished Bacterial: usually treatable with antibiotic; however, antibiotic-resistant forms of STDs are emerging (e.g., gonorrhea, syphilis, chlamydia) Viral: cannot be cured (e.g., herpes simplex virus; human papillomavirus infection; genital herpes) Chlamydia: genitourinary tract, rectum, conjunctivitis in babies. Via vaginal, anal, oral transmission, mostly unaware of symptoms, recommended annual testing, most common report STI. Can cause problems in infants born to infected mothers Gonorrhea: highest incidence in AA, person in southern us, 15-25 y.o, dysuria, white yellow discharge, epididymis swollen, women asymptomatic-can lead to PID infertility. Obtain sex hx, inform partners, obtain cultures, report to CDC. Yellow, green discharge penis. Syphilis: infects moist mucosal or cutaneous membranes spread through direct contact (mother-fetus) Primary-bacteria produce infection (chancre) at site of contact (lasts 3-6 weeks), Canchre - usually single lesion begins as a macula progresses to a papule then ulcerates, Genital, vaginal, anal, oral. Secondary-organism enters the lymph system and spreads throughout the body – (non-itchy rash body), palms, feet. Fever, swollen lymph nodes, sore throat, muscle aches, fatigue. Tertiary-can lead to blindness, congenital damage, cardiovascular damage, or syphilitic psychosis, Lesions of the mucus membranes, difficult coordination, paralysis, numbness, blindness, dementia. Congenital- transmission through the placenta (stillbirth, blindness, deafness, deformities, death- signs jaundice, skin rash, hepatomegaly, pseudoparalysis of an extremity) HPV (genital warts): clustered cauliflower like lesions. Need to inform that there is no safe sex, asymptomatic, can clear on it owns within a few years, HPV and cervical cancer link, Prevention: vaccines, three shots, 11-12, can still be given 13-26, condoms are not full proof- don’t cover entire area. Incurable and chronic. Herpes Simplex Virus (HSV-2): infect genital/nongenital sites, 14-49, no cure, direct exposure, can remain latent, S&S: painful lesions ulcerate and crust within 1-4 days, itching, pain, dysuria, Can spread when lesions are active or when asymptomatic, can Rifampin: turns urine orange, Seasonal affective disorder: effects people in winter months more, can spread to other areas, can lead to miscarriage, premi. make depressed. INH: active TB, Vit B6 for peripheral neuropathy” Hep A: most risk travelers, kids in areas with high rates, IV drug users, men-men Rubella (German Measles): worldwide, risk to travelers, moderately infective through intercourse, caregivers of HAV. Who lives with you, where are you employed, sexual inhalation/contact person, incubation average 14 days, S&S: lymphadenopathy, fever, rash(fine/pink), contacts? Hep B: decrease due to vaccine but no treatment if contracted, risk same as A, malaise, treatment is supportive, MMR vaccine STDS’s, georgraphic areas prevelant, health care works, hemo pts, inmates/prisoners, Pertussis (Whooping cough): risk in infants, travelers, highly contagious through inhalation/contact, Acute: flu like symptoms, jaundice, N, fever, joint pain, Chronic: lifelong, risk S&S: milk URI-paroxysmal cough, vomiting, treatment: mycins, prophylactic treatment for fam mem, other contacts, 5 doses dTaP, school nurses need be on lookout immunocompromised, S&S: anorexia, hepatomegaly, jaundice. Vaccine: 3 series, birth- Influenza: viral, airborne survives on inanimate surfaces for hours, mortality in immunocompromised 6months-1. Hep C: most common chronic blood borne, leading cause liver disease, at elderly/children, types: A (worldwide-mutates and can be hard for immunization), B (regional), C risk-HCW, infants born to infect moms, drug users, sex w. multiple part, hemodialysis, (epidemic, but less common/mild), vaccines are educated guesses, Oct-Mar, 6 months of age >, donor recipients. Primary prevention: screening blood products. Secondary: screening pregnant women, people >50, suspected pt. S&S: fatigue, anor, malaise, weight loss, right-sided pain, jaundice, elevated Rocky Mountain Spotted Fever: southeast/Midwest, caused by dog ticks, S&S: mod-high fever, severe ALTS-lead to cirrhosis H/A, chills, deep muscle pain, malaise, 50% have rash Zika Virus: spread like dengue, west nile, chikungunya, mosquitos, S&S: fever, muscle aches, eye pain, a/w Guillain-Barre, pregnant can be born with microcephaly, no vaccine, antiviral treatment Rabies: animal-humans, very serious spread to brain/spinal cord, no treatment, S&S: fever, cough, sore throat, restlessness, hallucinations, seizures/coma/death, prophylactic treatment: post exposure immunoglobulin vaccine series of IM injection