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community health lecture notes
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Epidemiology
Disease Progression: what happens when you’re infected?
neuropathy, N/V, diarrhea, wasting, rashes, candidiasis.
Opportunistic Infections
Commonly Used Laboratory Tests
copies/mL. The higher the viral load, the faster the progression.
cells are helper T cells that fight infection and coordinates cell immune responses. It is the TARGET CELL FOR HIV.
made—Expensive.
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+ Environmental Environmental Assessment: “I PREPARE”
among your co-workers?”
Factors/Risks of Cancer:
occupational exposure 2-6%, environmental pollution <1-4%. OTHER Environmental:
additives. Physical influences —noise, light, radiation. Socioeconomic influences— safe neighborhoods, adequate healthcare.
DeGravelles Basic Epidemiology Concepts
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?
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.
travel bans, disposal of deceased.
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
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 Nurse HP 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 Diversity First 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.