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community health lecture notes, Lecture notes of Community Health

community health lecture notes

Typology: Lecture notes

2022/2023

Uploaded on 06/29/2025

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HIV/AIDS QUIZ:
1. A student engages in unprotected sex under the influence of alcohol. Having an HIV test immediately afterward seems like the rational thing to do. Based on
known statistics, what will the student’s HIV test probably show?-- The test results won’t be reliable so soon after exposure.
2. A client was clearly very relieved when an HIV test came back negative. “Thank goodness. I’ve had sex several times without a condom, and when one of my
friends said he was sick, I think I panicked.” What is important to emphasize immediately before the client draws too many conclusions?-- The test would not
cover any recent infection, so if the client has had recent unprotected sex, the test should be repeated in 3 months.
3. A mother felt very guilty that her baby was born HIV-positive. When the nurse suggested the usual+DPT (DtaP)+and MMR immunizations, the mother was
extremely upset. “Don’t you know HIV children are immunosuppressed?” she exclaimed. What would be the nurse’s best response?-- “Being HIV-positive,
your child is more likely to catch an infection and be very ill if not immunized.”
4. A school nurse asks a class about the ways HIV can be transmitted. Which comment by a student indicates a need for additional teaching?—“I wouldn’t sit by
someone with HIV.”
5. In the United States, which demographic group has the highest risk for HIV infection?—African American homosexual male
6. What is the most common reason that people do not immediately seek medical treatment when they first become ill with HIV?—they don’t see their
symptoms as possibly being HIV.
7. Which individuals should routinely be assessed for their risk for a STD?—all sexually active adults.
8. Which body fluid is LEAST likely to spread HIV?—saliva
HIV/AIDS BASICS:
Transmission: how do you get it?
oBlood, semen (cum), pre-seminal fluid (pre-cum), vaginal fluid, breast milk.
oUnprotected sex with an infected person, from mother to child in uterus/during childbirth/breastfeeding, sharing syringes/tattoo needles.
oBlood transfusions—accounts for 9,000 out of every 10,000 transmissions.
oVertical transmission: from mother to child
oHorizontal transmission: between any two members of the same species
Epidemiology
oEvery 9.5 minutes someone in the U.S. is infected with HIV.
oMSM: men who have sex with men = population at high risk
oAfrican American males = highest rate of HIV diagnoses
Disease Progression: what happens when you’re infected?
o1. Primary infection : just had sex, you’re infected and don’t know it yet. ***MOST CONTAGIOUS DURING THIS TIME!!!!
o2. Window period : time between primary infection and seroconversion. Still won’t show up on a diagnostic test here.
o3. Asymptomatic chronic HIV : every time that you’ve had sex or shared a needle between 1-3, you’ve been infecting others. Still asymptomatic.
o4. Symptomatic HIV : usually 5 years down the road from the primary infection, usually have flu-like symptoms. **fatigue, HA, pain,
neuropathy, N/V, diarrhea, wasting, rashes, candidiasis.
o5. Advanced HIV
o6. AIDS
oCommon complications: diabetes, lipodystrophy (uneven fat deposits), and lactic acidosis.
Opportunistic Infections
oPneumocystis—lung fungus (they can’t breathe well)
oTB/Cryptococci meningitis
oKaposi’s sarcoma—cancer of the skin, mouth, and lymph nodes.
Commonly Used Laboratory Tests
oHIV Viral Load (PCR): the amount of HIV RNA in a blood sample. Reported as the number of HIV RNA copies/mL of blood. Treatment goal is <50
copies/mL. The higher the viral load, the faster the progression.
oCD4 Cell Percentage/Count : a measurement of the percentage of lymphocytes that are CD4 cells. <20% = immunosuppressed, <14% = AIDS. CD4
cells are helper T cells that fight infection and coordinates cell immune responses. It is the TARGET CELL FOR HIV.
oT-Cell Count: less than 200 = AIDS
oEnzyme Immunoassay (EIA/ELISA): standard HIV antibody SCREENING test.
oWestern Blot (WB): CONFIRMATORY HIV-antibody test.
oRapid HIV antibody screening test : detects HIV antibodies in less than 20 minutes—Expensive.
oHIV RNA test: directly detects genetic material (RNA) of the virus. Can be detected 6-12 days after exposure and 2 weeks before antibodies are even
made—Expensive.
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HIV/AIDS QUIZ:

  1. A student engages in unprotected sex under the influence of alcohol. Having an HIV test immediately afterward seems like the rational thing to do. Based on known statistics, what will the student’s HIV test probably show?-- The test results won’t be reliable so soon after exposure.
  2. A client was clearly very relieved when an HIV test came back negative. “Thank goodness. I’ve had sex several times without a condom, and when one of my friends said he was sick, I think I panicked.” What is important to emphasize immediately before the client draws too many conclusions?-- The test would not cover any recent infection, so if the client has had recent unprotected sex, the test should be repeated in 3 months.
  3. A mother felt very guilty that her baby was born HIV-positive. When the nurse suggested the usual DPT (DtaP) and MMR immunizations, the mother was extremely upset. “Don’t you know HIV children are immunosuppressed?” she exclaimed. What would be the nurse’s best response?-- “Being HIV-positive, your child is more likely to catch an infection and be very ill if not immunized.”
  4. A school nurse asks a class about the ways HIV can be transmitted. Which comment by a student indicates a need for additional teaching?— “I wouldn’t sit by someone with HIV.”
  5. In the United States, which demographic group has the highest risk for HIV infection?— African American homosexual male
  6. What is the most common reason that people do not immediately seek medical treatment when they first become ill with HIV?— they don’t see their symptoms as possibly being HIV.
  7. Which individuals should routinely be assessed for their risk for a STD?— all sexually active adults.
  8. Which body fluid is LEAST likely to spread HIV?— saliva HIV/AIDS BASICS:Transmission: how do you get it?

o Blood, semen (cum), pre-seminal fluid (pre-cum), vaginal fluid, breast milk.

o Unprotected sex with an infected person, from mother to child in uterus/during childbirth/breastfeeding, sharing syringes/tattoo needles.

o Blood transfusions —accounts for 9,000 out of every 10,000 transmissions.

o Vertical transmission: from mother to child

o Horizontal transmission: between any two members of the same species

Epidemiology

o Every 9.5 minutes someone in the U.S. is infected with HIV.

o MSM: men who have sex with men = population at high risk

o African American males = highest rate of HIV diagnoses

Disease Progression: what happens when you’re infected?

o 1. Primary infection: just had sex, you’re infected and don’t know it yet. ***MOST CONTAGIOUS DURING THIS TIME!!!!

o 2. Window period: time between primary infection and seroconversion. Still won’t show up on a diagnostic test here.

o 3. Asymptomatic chronic HIV: every time that you’ve had sex or shared a needle between 1-3, you’ve been infecting others. Still asymptomatic.

o 4. Symptomatic HIV: usually 5 years down the road from the primary infection, usually have flu-like symptoms. **fatigue, HA, pain,

neuropathy, N/V, diarrhea, wasting, rashes, candidiasis.

o 5. Advanced HIV

o 6. AIDS

o Common complications: diabetes, lipodystrophy (uneven fat deposits), and lactic acidosis.

Opportunistic Infections

o Pneumocystis —lung fungus (they can’t breathe well)

o TB/Cryptococci meningitis

o Kaposi’s sarcoma —cancer of the skin, mouth, and lymph nodes.

Commonly Used Laboratory Tests

o HIV Viral Load (PCR): the amount of HIV RNA in a blood sample. Reported as the number of HIV RNA copies/mL of blood. Treatment goal is <

copies/mL. The higher the viral load, the faster the progression.

o CD4 Cell Percentage/Count: a measurement of the percentage of lymphocytes that are CD4 cells. <20% = immunosuppressed, <14% = AIDS. CD

cells are helper T cells that fight infection and coordinates cell immune responses. It is the TARGET CELL FOR HIV.

o T-Cell Count: less than 200 = AIDS

o Enzyme Immunoassay (EIA/ELISA): standard HIV antibody SCREENING test.

o Western Blot (WB): CONFIRMATORY HIV-antibody test.

o Rapid HIV antibody screening test: detects HIV antibodies in less than 20 minutes—Expensive.

o HIV RNA test: directly detects genetic material (RNA) of the virus. Can be detected 6-12 days after exposure and 2 weeks before antibodies are even

made—Expensive.

 OTHER STUFF

o Serodiscordance: when one partner has HIV and the other doesn’t. Tell them to use latex condoms and have full disclosure with partners.

o HIV + Pregnant Women— should take HIV meds by the second trimester, should take them during L&D, and the newborn should receive meds

within 6-12 hours of delivery through 6 weeks of life.  Vaginal delivery possible IF— the mom took her HIV meds during pregnancy, L&D, and after giving birth/as long as the mom’s viral load (PCR) is less than 1,000 copies/mL.  Cesarean delivery needed IF— the mom is noncompliant with meds, or has a viral load >1,000 copies/mL or an UNKNOWN viral load near time of delivery.  NEVER BREASTFEED IF HIV+ EnvironmentalEnvironmental Assessment: “I PREPARE”

o I: Investigate potential exposures. “Have you ever felt sick when you’ve come into contact with a substance/chemical?”

o P: present work. “ What are you exposed to at work? What equipment do you work with? Are your clothes worn home? Similar health issues

among your co-workers?”

o R: residence. “When was your home built? ”

o E: environmental concerns. “What does your water look like? Farms/industries nearby? Live close to a landfill?”

o P: past work. “Where have you worked in the past?”

o A: activities. “What do you do in your spare time, do you hunt/fish/garden?”

o R: referrals and resources

o E: educate

Factors/Risks of Cancer:

o Diet: 20-60% of all cancer deaths, tobacco: 30-33%, natural hormones 10-20%, infections 5-15%, radiation 5-10%, alcoholic beverages 2-6%,

occupational exposure 2-6%, environmental pollution <1-4%.  OTHER Environmental:

o Environmental health —the study of environment-related illnesses or disorders and their prevention.

o Lillian Wald— coined the term “public health nurse”

o Differences b/w now and a century ago?— cleaner air, cleaner water, and more regulations.

o Food Quality Protection Act of 1996— protected infants and children from pesticide exposure from multiple sources.

o Biological influences— disease organisms in water/food. Chemical influences— air pollutants, chemicals, toxic wastes, VOCs, and food

additives. Physical influences —noise, light, radiation. Socioeconomic influences— safe neighborhoods, adequate healthcare.

o Toxicology: study of the causal mechanisms between exposure and disease. “The dose makes the poison”—example of water poisoning.

o MSDS: material safety data sheet; tells you what the substance is, what it is used for, what to do if it gets in your eyes, ears, nose, etc.

o Three R’s: reduce, reuse, recycle = primary PREVENTION

o Prevention: secondary = screening for exposure, tertiary = preventing complications after exposure has occurred.

DeGravellesBasic Epidemiology Concepts

o Epidemiology: the study of the distribution and factors that determine health-related states or events in a population.

 Descriptive: a form of epidemiology that describes a disease according to its person, place, and time.  Analytical: looks at the etiology (causes) of the disease and deals with determinants of health and disease. How does it occur?  Determinants of health: factors, exposures, characteristics, behaviors, and contexts that influence the patterns of diseases. Who is affected/where are they?

o JOHN SNOW = FATHER OF EPIDEMIOLOGY

o Morbidity Measures

Incidence proportion (attack rate): number of new cases of disease / total population.  ATI says attack rate is the number of people exposed to a specific agent who develop the disease / number of people exposed? ??Incidence rate: number of new cases of disease / average population.

o Response to bioterrorism: emergency PH measures such as quarantine, isolation, closing public places, seizing property, mandatory vaccination,

travel bans, disposal of deceased.

o Protecting HCPs from exposure—standard precautions.

o Patterns of occurrence:

 Common source: group exposed to same thing (gas, chemicals, radiation)  Point source: all persons became ill at one time during incubation period (potato salad)  Mixed outbreak: common source + person to person contact (typhoid mary)  Intermittent source: exposed over days or weeks (occupational)  Propagated source: no common source; gradually from person to person (TB).  Biological Agents

o Anthrax, plague, smallpox, botulism, tularemia, and hemorrhagic viruses.

Virulence: strength of a disease; how long will it take to kill me? Will I recover? Smallpox (Variola) Chickenpox (Varicella) Incubation Period 7–17 days 14–21 days Prodrome Fever and malaise for 2–4 days before onset of rash Minimal to none Pock Distribution Centrifugal; usually on palms and soles Centripetal; seldom on palms and soles Pock Appearance Vesicular—> pustular—> umbilicated—>scab Vesicular on erythematous base—>pustular—>scab Evolution of Pocks Synchronous Asynchronous Scab Formation 10–14 days after onset of rash 4–7 days after onset of rash Scab Separation 14–28 days after onset of rash Within 14 days after onset of rash Infectivity From onset of exanthem until all scabs separate From 1 days before rash until all vesicles scab  OTHER STUFF FOR DR. D SLIDES o Modes of transmission  Vertical transmission: mother to child  Horizontal transmission: person to person o Agent: bacteria, fungi, parasites, viruses that CAUSE disease. o Host: human or animal that becomes infected  Herd immunity: the idea that if enough people are vaccinated, the agents may not be strong enough to penetrate the population. o Environment: physical, biological, social, and cultural. o Emerging infectious disease: any disease which the incidence has actually increased in the past two decades or has the potential to increase in the near future. Examples: HIV/AIDS, H1N1, WNV. o Hep A: the best known waterborne disease outbreak pathogen o Universal Precautions: steps taken to prevent exposure to blood-borne diseases. o JOHN SNOW = father of epidemiology o Syphilis: can cause dementia in its tertiary stage; Chlamydia: most common STI in the U.S. o EBP Info comes from the CDC, WHO, and Human Genome Project. o Louis Pasteur = germ theory and pasteurization / Joseph Lister = antiseptic surgery (Listerine) / Robert Koch = discovered TB, anthrax, and cholera organisms. Chickenpox on the hand Notice the simultaneous occurrence of lesions in different stages of development: macules, papules, vesicles, pustules, and crusts. Smallpox close-up Notice that all lesions are in the same stage of development and that they are umbilicated.

o Steps of the epidemiological process:  1. DIAGNOSIS: Determine the nature, extent, and possible significance.  2. DESCRIPTIVE: Using the data gathered, formulate a hypothesis.  3. INVESTIGATIVE: Gather information from various sources to narrow possibilities.  4. ANALYTICAL: Make a plan  5. INTERVENTION: Put it into action  6. DECISION MAKING: Evaluate the plan  7. MONITORING: Report/follow-up o Population at risk: certain portion of the population who is much more exposed to dangers or harm in comparison to the general population. o Natural Hx of a Disease: the course of the disease process from onset to resolution. o Primordial prevention: prevent the development of risk factors (discuss sanitation, fluoridated water, etc.) o Subclinical: you may feel bad, but your labs are normal and you don’t show any signs of the disease. Faith Community NurseHP 2020 and faith community nursing o BP screenings/nutrition counseling??  Models of Faith Community Nursing o Congregational Model: the nurse is autonomous. The development of a parish nurse/health ministry program arises from the individual community of faith. The nurse is accountable to the congregation and its governing body. o Institutional Model: includes greater collaboration and partnerships than the congregational model. The nurse may be contracted to a hospital, med center, long-term care facility, or educational institution.  Central role of the parish nurse o To act on the spiritual dimension of care.  What is it? o Faith community: groups of people that gather in churches, cathedrals, synagogues, or mosques and acknowledge common faith traditions. o Parish nurses: respond to health and wellness needs of populations of faith communities and are partners with the church in fulfilling the mission of health ministry. o Health ministries: activities and programs in faith communities that are organized around the health and healing to promote wholeness in health across the lifespan. o Functions of the parish nurse include personal health counseling, health education, liaison, facilitator, and spiritual support. o Confidentiality is of the utmost importance to parish nursing. o Professional/therapeutic relationships are maintained at all times.  Advocacy/Reporting o Faith nurses act as advocates for client and group rights. o The nurse must personally and professionally abide by the parameters of the nurse practice act of the jurisdiction and maintain an active license in that state. If you don’t know—call the state board. o MUST REPORT SUSPECTED/CONFIRMED REPORTS OF ABUSE and NEGLECT. Cultural DiversityFirst step in working with immigrants o Consider your own values and beliefs. Know yourself.  Definitions to know o Culture : a set of beliefs, values, and assumptions about life that are widely held among a group of people and that are transmitted intergenerationally. “a learned process that is transmitted by the family, ethnic group” o Race: a social classification that relies on physical markers (skin color). May be of the same race, but different cultures. o Ethnicity: the shared feelings of peoplehood among a group of individuals. Represents the identifying characteristics of culture. EXAMPLE: skin color = race, race = a part of ethnicity. o Cultural competence: having respect for all individuals from different cultures and seeing the value in diversity.  Helps nurses use strategies that respect patient values and expectations without diminishing the nurses’ own values and expectations.  Failure to be culturally competent causes increased barriers to equitable access to care, inhibits effective communication between the patient and nurse, and creates obstacles in gathering assessment data thus limiting the development and implementation of effective treatment plans. o Cultural awareness: self-examination and in-depth exploration of one’s own beliefs and values as they influence behaviors. o Cultural sensitivity : use last names, unless given permission. Introduce self and explain position. Be authentic and honest of what you do/do not know about a culture. Explore what the client knows about health and treatments. Show respect. o Cultural encounter : the process that permits nurses to seek opportunities to engage in cross-cultural interactions.  Can be direct (face to face) or indirect. o Cultural Brokering: advocating, mediating, negotiating, and intervening between the patient’s culture and the biomedical health care culture on behalf of the patients. o Prejudice: the emotional manifestation of deeply held beliefs (stereotypes) about a group. o Racism: a form of prejudice that occurs through the exercise of power by individuals and institutions against people who are judged to be inferior. o Environmental control: the way in which individuals view their relationship with nature. Ex) some cultures think imbalances with nature = illness will occur. o Refugee: a person who has been forced to leave their country in order to escape war, persecution, or natural disaster.