FINAL EXAM REVIEW
Office of Emergency Management (OEM)-The Office of Emergency Management involves
representatives from all official and unofficial agencies in developing the community disaster plan,
developing scenarios to test the plan through drills, and assessing the scope, intensity, and number of
casualties (once an incident has occurred) in order to initiate the proper response. For those events that
are not within the abilities of the local community or in the event of a terrorist-type incident, higherlevel agencies and resources must be requested and will become involved. When a disaster overwhelms
the local community’s resources, the state’s Department or Office of Emergency Management is called
for assistant.
Federal Emergency Management Agency (FEMA)-became part of DHS in 2003. FEMAs mission is to
support citizens and first responders to ensure that as a nation, everyone works together to build,
sustain, and improve the capacity to prepare for, protect against, respond to, recover from, and mitigate
all hazards, In 2006, a law passed that significantly reorganized FEMA, giving it substantial new authority
to remedy gaps that became apparent in response to Hurricane Katrina in 2005
American Red Cross (ARC)-is not a governmental agency. It is charted by Congress to provide disaster
relief. The ARC works in partnership with FEMA, DHS, and CDC, and other local state, and federal
agencies to provide and manage needed services. Primarily a volunteer organization. Places a great
emphasis on preparedness and participates with communities in developing and testing their disaster
plans, maintaining and training personnel for disaster response, and responding during an actual
emergency or disaster. Publishes many pamphlets and educational materials (prepare for potential
disaster). The key actions the agency recommends are 1. Identify potential disaster events. 2) create a
disaster plan for sheltering in place or for evacuation. 3) assemble a disaster supplies kit and 4) practice
and maintain the plan.
U.S. Department of Homeland Security (DHS)- est in March 2003 to realign the existing federal
departments, agencies, groups, and organizations into a single department focused on protecting the
American people and their homeland. Mission of DHS is 1) lead the unified national effort to secure
America, 2) prevent and deter terrorist attacks, and 3) protect against and respond to threats and
hazards to the nation. Goal: “vision for nationwide preparedness and identifies the core capabilities and
target necessary to achieve preparedness across five mission areas (prevention, protection, mitigation
response, and recovery).”
Environmental Protection Agency (EPA)
Smallpox(variola virus) as a bioterrorism threat- Category A: highest priority; easily transmitted with
high mortality and social disruption.
Botulism as a bioterrorism agent- Category A highest priority easily transmitted with high mortality and
social disruption
Anthrax signs and symptoms and treatment: manifestations; headache, fever & chills, muscle aches,
chest discomfort, severe dyspnea, shock. Treatment: antitoxin and IV antibiotics are administered if
manifestations of an anthrax infection are present.
Triage of mass casualty patients- Triage is identifying and separating individuals quickly according to
injury severity and treatment needed. START stands for “Simple triage and rapid treatment.” This
system describes what to do when first arriving at a mass casualty incident.
Pneumonic plague and isolation-fever, headache, weakness, pneumonia w/ SOB, chest pain, cough, and
bloody or watery sputum. PREVENTION: Vaccine no longer available in the U.S. Contact precautions till
decontaminated. Droplet precautions till 72 hour after antibiotics.
How to tag patients according to the tag colors- Green on the triage tag is for the walking wounded or
those with minor injuries (e.g., cuts and abrasions) who can wait several hours before they receive
treatment. Yellow is for those with systemic but not life-threatening complications who can wait 45 to
60 minutes (e.g., simple fractures); Red is considered top priority or immediate and is for those who
have life-threatening conditions but who can be stabilized and have a high-probability of survival (e.g.,
amputations.); Black is for decreased or for those whose injuries are is so extensive that nothing can be
done to save them (e.g., multiple severe injuries).
Education on biological weapons of mass destruction- weapon of mass destruction refer to any
weapon that is designed or intended to cause death or serious bodily injury through release,
dissemination, or impact of toxic or poisonous chemicals, or their precursors; any weapon involving a
disease organism; or any weapon that is designed to release radiation or radioactivity at a level
dangerous to human life. Biological organisms considered to be potential weapons of mass destruction
are shown in Box 28-2, and chemicals that are potential weapons of mass destruction are listed in Table
28-1. Chemical warfare agents are classified as nerve agents, vesicants, pulmonary agents, and cyanides
(formerly “blood agents”). These tables also include information about the lethality, treatment, and
impact related to each.
Environmental pollutants and what disease processes they affectModifiable risk factors for different disease processes- Coronary Vascular Disease and Metabolic
Syndrome: cigarette smoking, obesity, diet high in (fats, cholesterol, refined carbs, sodium) glucose
intolerance, elevated serum lipid values, sedentary lifestyle, personality type, hypertension, stress,
alcohol.
Reportable diseases to the CDC- Anthrax, arboviral neuroinvasive and nonneuroinvasive diseases;
California serogroup virus disease, Eastern equine encephalitis, Powassan virus disease, St. Louis
encephalitis, West Nile Virus disease, and Western equine encephalitis, Babesiosis, botulism, brucellosis,
chancroid, chlamydia trachomatis (genital infections), cholera, coccidiodomycosis, cryptosporidiosis,
cyclosporiasis, dengue virus infections, diphtheria, ehrliciosis/anaplasmosis, giardiasis, gonorrhea,
haemophilus influenzae, hansen’s disease(leprosy), hantavirus pulmonary syndrome, hemolystic uremic
syndrome post-diarrheal, hepatitis acute(hepatitis A/B/C, perinatal), hepatitis chronic (Hep b/C), HIV,
influenza-associated pediatric mortality, legionellosis, listeriosis, lyme disease, malaria, measles,
meningococcal disease, mumps, novel influenza A virus, pertussis, plague, poliomyelitits(paralytic),
poliovirus (infection, nonparalytic), psittacosis, Psittacosis, Q fever (acute and chronic), Rabies (animal
and human), Rubella, Rubella, congenital syndrome, Salmonellosis, Severe acute respiratory syndrome–
associated coronavirus (SARS-CoV) disease, Shiga toxin–producing Escherichia coli (STEC), Shigellosis,
Smallpox, Spotted fever rickettsiosis (formerly Rocky Mountain Spotted Fever), Streptococcal toxicshock syndrome, Streptococcus pneumoniae, invasive, Syphilis (all stages), Syphilis, congenital, Tetanus,
Toxic shock syndrome (other than streptococcal), Trichinellosis (trichinosis), Tuberculosis, Tularemia,
Typhoid fever, Vancomycin-intermediate Staphylococcus aureus (VISA), Vancomycin-resistant
Staphylococcus aureus (VRSA), Varicella (morbidity and death), Vibriosis, Viral hemorrhagic fevers
(Crimean-Congo hemorrhagic fever virus, Ebola virus, Lassa virus, Lujo virus, Marburg virus, New World
Arenaviruses [Guanarito, Machupo, Junin, and Sabia viruses]), Yellow fever
Characteristics of analytic assessments:
Primary, secondary, and tertiary prevention- Primary: prevention of the initial occurrence of disease or
injury(nutrition education, family planning and sex education, smoking cessation education,
communicable disease prevention education, education about health and hygiene issues to specific
groups, safety education, prenatal classes, providing classes, providing immunization, advocating for
access to health care, healthy environments. Secondary: early detection and treatment of disease with
the goal of limiting severity and adverse effects(community assessments, disease surveillace, screenings,
cancer, DM, hypertension, hypercholesterolemia, sensory impairments, tuberculosis, lead exposure,
genetic disorder/metabolic deficiencies in newborns, control of outbreaks diseases. Tertiary prevention:
Maximazation of recovery after an injury or illness (rehab), nutrition counseling for management of
Crohn’s diasese, exercise rehab, case management(chronic illness, mental illness) physical and
occupation therapy, support groups, exercise for a client who has hypertension (individual).
Ten Greatest Public Health Achievements:
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Vaccine preventable diseases.
Prevention and control of infectious diseases
Tobacco control
Maternal and infant health
Motor vehicle safety
Cardiovascular disease prevention
Occupational safety
Cancer prevention
Childhood lead poisoning prevention
Public health preparedness and responses
Public health nursing practice standard: obligation for the greater good for all people
Community Health Nursing & Main Focus: Definition: The synthesis of nursing practice and public
health practice applies to promoting and preserving the health of populations. Main Focus: Disease
nursing, home health. Directs care to individuals, families, or groups.
Standards of Nursing Practice: Population focused with the goals of promoting health and preventing
diseases and disability for all people through the creation of conditions in which people can be healthy.
Identifying environmental evidence-based practice for a community: Evidence-based practice involves
using best practices, expert opinion, and client preferences to change the delivery of client care. The
goal is to improve client outcomes.
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Data: The nurse should appraise data collected from research to measure whether bias was
minimal (quality), the number of studies, participants, or strength of effect (quantity) and
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whether the results are repeatable (consistency). The nurse then analyzes the data for
application to practice.
In the community: Evidence-based practice improves public health as nurses develop policies to
improve the health of specific groups. The public health nurse can use evidence to provide new
solutions for groups of people (assessment), provide information to communities (policy
development) and evaluate the effectiveness of the health care environment for groups
(assurance). An example of evidence-based practice in community health includes the use of
high levels of evidence to support media campaigns regarding immunization guidelines.
Scope of practice of community health nurse in community health fairs
Asthma education from a community health nurse perspective
Lillian Wald’s teaching in a community health fair setting: Established House on Henry Street. Kept
notes on sick children teachers excluded from school. Wald convinced nurses to go out into schools. She
got Metropolitan life insurance to provide home nursing. First president of National Organization for
Public Health Nursing. Her vision shaped by feminist values. Driving force behind development of
Children’s Bureau.
Using the Theory of Reasoned Action to educate patients: Attempts to predict a person’s intention to
perform or not to perform a certain behavior. Based on assumption that all behavior is determined by
one’s behavioral intentions. Intentions are determined by one’s attitude regarding a behavior and the
norms associated with behavior. Attitude determined by one’s beliefs about the outcomes of
performing the behavior, weighed by one’s assessment of the outcomes. One’s norm is determined by
normative beliefs.
Pender’s Health Promotion Model: Similar to Health Belief Model. Does not consider health risk as a
factor that provokes change. Examines factors that affect individual actions to promote and protect
health: Personal factors(biological, psychological, sociocultural), behaviors, abilities, self-efficacy.
Feelings, benefits, barriers, and characteristics associated with the action. Attitudes of others, and
competing demands and preferences.
Healthy People 2020 and diabetic education
What is the purpose of Healthy People 2020: Healthy People serves as a measure for quality of health.
The national health goals guide the nurse in developing health promotion strategies to improve
individual and community health. Healthy People initiatives have shown that implementing health
promotion and disease prevention strategies leads to decrease expense for healthcare and improves the
length of the client’s lifespan.
1. Attain high-quality, longer lives free of preventable diseases, disability, injury, and premature death.
2. Achieve health equity, eliminate disparities, and improve the health of all groups.
3. Create social and physical environments that promote good health for all.
4. Promote quality of life, healthy development, and healthy behaviors across all life stages.
Purpose: Promotion of healthy behaviors, promotion of healthy and safe communities, improvement of
systems for personal and public health, and prevention and reduction of diseases and disorders.
Under what Sojourner Truth was known for: Advocate for abolishing slavery and supporting women’s
rights. Lobbied for funds to help train nurses and physicians
OSHA (Occupational Safety and Health Act of 1970): Focuses on the health needs and risks in the
workplace and environment. Provides critical programs important to the workplace and community.
Medicare: A health insurance program for people who are older than 65 years of age, are disabled or
have end-stage renal disease.
Prospective payment system (PPS): is a method of reimbursement in which Medicare payment is made
based on a predetermined, fixed amount. The payment amount for a particular service is derived based
on the classification system of that service (for example, diagnosis-related groups for inpatient hospital
services).
Assessment of homes or buildings prior to 1960’s
Major accomplishments of the Romans during the classical times for improving health in the
community: Constructed aqueducts, bathhouses, and sewer systems
Innovations implemented during the 19th century in Germany regarding community health nursing:
Improved economic, social, and environmental conditions. Virchow argued public responsible for the
health of the people; that social and economic conditions heavily affected health and disease; that
efforts to promote health and fight disease must be social, economic, and medical; and that the study of
social/economic determinants of health and disease would yield knowledge to guide appropriate action.
all dangers to health, and the control of disease.
Epidemiology triangle: Epidemiology involves the study of the relationships among an agent, host, and
environment (known as the epidemiological triangle). Their interaction determines the development
and cessation of communicable diseases, as they form a web of causality, which increases the risk for
disease.
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The agent: the physical, infectious, or chem factor that causes the disease.
The host: is the living being that an agent or the environment influences
The environment: is the setting or surrounding that sustains the host.
Methodological design of studies
Prevalence rate and other types of rates: Number of all cases of a specific disease or condition in a
population at a given point in time relative to the population at the same point in time. AKA point
prevalences. Period prevalences represent the number of existing cases during a specified period or
interval of time and include old cases and new cases that appear within the same period of time. Rates
influenced by the number of people who experience a particular condition and the duration of the
condition.
What type of community is MADD an example of Mothers Against Drunk Driving: Strategies to reduce
substance use disorders and it is a PRIMARY PREVENTION: assist in the formation of parental action and
awareness groups.
Using summative evaluation data to educate the community
What is the Patient Protection and Affordable Care Act (purpose, goals, etc.) Intended to expand
insurance coverage for those uninsured. Encourages prevention and wellness incentives. Passed in 2010.
Implemented in 2014. Requires all citizens and immigrants to have insurance.
1. Establishes high risk pools to provide health coverage to individuals with preexisting conditions.
2. Prohibits insurers from placing lifetime limits on the dollar value of coverage
3. Prohibits insurers from disallowing coverage due to preexisting conditions
4. Requires health plans to provide some types of preventative care
Creates: programs to foster nonprofit, member-run health insurance companies
National Health Planning and Resources Development Act of 1974: Assigns responsibility for health
planning to the states and local health systems agencies. Requires health care facilities to obtain prior
approval from the state for expansion in the form of a certificate of need.
What factor has the greatest impact of the community :
House on Henry Street: District nursing service. Later called Visiting Nurse Association of NYC. Nurses
provided home visits and patients paid a service fee. Families could arrange a visit through nurse or
physician.
Florence Nightingale’s work: Highlights the relationship b/w an individuals environment and health.
Depicts health as a continuum. Emphasizes preventative care.
Define community health nursing: Community health nursing is a population-focused approach to
planning, delivering, and evaluating nursing care. Community health nursing is a broad field that allows
nurses to practice in a wide variety of settings. Community health nurses promote the health and
welfare of clients
Cultural competency: Cultural competence involves respecting personal dignity and preferences, as well
as acknowledging cultural differences. The provision of culturally competent care requires nurses to be
responsive to the needs of clients from different cultures. Culturally competent care is guided by 4
dimensions:
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Cultural preservation: allowing preservation of the clients traditional values.
Cultural accomodations: supporting and facilitating the client’s use of cultural practices that are
beneficial to the clients health
Cultural repatterning: assisting the client to modify cultural practices that are not beneficial to
the clients health
Cultural brokering: advocating, mediating, negotiating, and intervening b/w the clients culture
and health care culture on behalf of the client’s
Nurse leaders can use cultural competency in creating and working with a diverse workforce that can
meetthe needs of a diverse client population.
Faith Community Nursing and their roles: Faith community nurse works with individuals, families, and
faith communities who share common faith traditions. Most religions have practices that are important
to health and healing, and many follow specific practices when caring for an ill or dying member.
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Members of faith communities (congregants) represent the entire lifespan and all family types.
This offers nurses the opportunity to work with a diverse population within the same setting.
Faith community nurses provide interventions to individuals and groups in homes,
congregational meeting places, acute or long-term care facilities or through schools.
The practice of faith community nursing is governed by each state’s nurse practice act and
standards of practice.
Nursing interventions are based on spiritual, physical, emotional, and social dimensions.
Faith community nurses must be aware of faith and belief practices of the congregants served.
Caring and spirituality are central among faith-based organization
CIRCLE Model of Spiritual Care: C: Caring, I: Intuition, R: Respect for religious beliefs and practices, C:
Caution, L: Listening, E: Emotional support.
Primary prevention for child abuse: Public service announcements that encourage positive parenting.
Parent education programs and support groups that focus on child child development, age-appropriate
expectations, and the roles and responsibilities of parenting. Family support and family strengthening
programs that enhances the ability of families to access existing services and resources to support
positive interactions among family members. Public awareness campaigns that provide information on
how and where to report suspected child abuse and neglect.