Community Final Exam Study Guide
The final exam is cumulative with the exception of chapter 24 * (new content, not on quiz #2) and will cover the following chapters: 1, 2, 3, 4, 5, 8, 10, 11, 12, 18, 19, 20,
21, 23, 24, 25, and 26. There will be a total of 50 questions.
The break out is as follows
Chapter 1,2,3 8 questions
Chapter 4, 5, 8 8 questions
Chapter 10, 11, 12 8 questions
Chapter 18, 19, 20 8 questions
Chapter 21, 23 5 questions
Chapter 24, 25, 26 13 questions
Chapter 1
1.
Understand Public Health and its philosophy on care of communities and populations.
Community-Based Nursing: focus on “illness care” of individuals and families
(not groups), goal: to manage acute/chronic health conditions in the community. Family-centered care. A PHILOSOPHY that guides care in all nursing specialties.
Community Oriented Nursing: focus on “health care” in the community OR populations.
1. Public Health Nursing (community or populations)
2. Community Health Nursing (individuals/families/groups) in a community
Some call Community Oriented Nursing – (Community Health
Nursing)
(1) Public Health Nursing – community/populations
 Focus: Health Care of communities and populations
NOT I/G/F.s
 Goal: Prevent disease, preserve, promote, restore, and protect health for the community and population.
 Public health ethic of “greatest good for the greatest number”
 Blends Nursing & discipline of Public Health communities
(2) Community Health Nursing – individuals/family/groups in the
Community Based Nursing:

(Philosophy): illness care of individuals and families across the life spans
Goal: manage acute/chronic conditions
Clients: usually ill
Community Oriented Nursing:
Philosophy: Primary focus is on “health care” of individuals, families, groups and community or populations
Goal: Preserve, protect, promote, or maintain health and Prevent disease.
Clients: at risk, usually healthy. Health care to promote QOL.
Public Health is best described as what society collectively does to ensure that conditions exist in which people can be healthy. Public health is a
Community-Oriented, population-focused specialty area. Use scientific and technical knowledge to prevent disease and promote health.
Overall mission: organize community efforts that use scientific and technical knowledge to prevent disease/promote health.
PH Core Functions:
Assessment: data collection
Policy development: policies that support the health of the population
Assurance: CO services + competent PH and personal Health care workforce available
2.
Define aggregate: a population group. A population or aggregate is a collection of people who share one or more personal or environmental characteristics. Subpopulations.
Chapter?
3.
Know all levels of prevention.
Primary: Prevention of Health Problems before they occur
Focuses on generalized health promotion and protection against specific problems. It precedes disease and is applied to generally healthy individuals or groups. Ex:
 Risk assessment for specific diseases.
 Health education about preventing diseases
 Immunization against specific diseases (in the book it says secondary p12)
Secondary: Pathology is involved and is aimed at early detection and treatment. (screening)
Focuses on early IDENTIFICATION of health problems and prompt interventions to alleviate health problems.

Ex:
 Screening for specific illnesses such as developmental disabilities, cancer, or hypertension.
 Nsg interventions designed to prevent complications such as administering medications.
 Initiating dietary changes to promote elimination
Tertiary: Rehabilitation when a permanent, irreversible condition exists.
Focuses on: restoration and rehabilitation with the goal of returning an individual to an optimum level of functioning.
 Referring a person who has had a stroke to rehabilitation
 Teaching someone with diabetes how to identify and prevent complications
Examples from the game:
Primary: A PHN provides vaccine to clients at an immunization clinic.
Tertiary: pt referred to cardiac rehab after coronary bypass surgery.
Secondary: nurse teaches breast self examination at a woman’s fair
Secondary: Annual physical, nurse provides info on how to collect a specimen for occult blood to check for colon cancer.
Secondary: Monthly cholesterol screenings offered to the public by a hospital.
Secondary: going to clinic for annual Pap.
Primary: provide information on risk factors to PTA.
Secondary: LTC facility directs a nsg assistant to turn and reposition a bedridden pt every 2 hours.
Tertiary: Nurse teaches group of recently diagnosed diabetic clients how to recognize hypoglycemic and hyperglycemic reactions.
Secondary: BP screening provided at a local bank.
Here is the link to that game: http://www.wisconline.com/Objects/ViewObject.aspx?ID=NUR3403
Chapter 2
4.
Review Florence Nightingale
 An English Nurse who is credited with establishing Nursing as a discipline.
 Her vision of trained nurses and her model of nursing education influenced the development of professional nursing and indirectly, public health nursing in the US.
 1851 – visited Kaiserwerth, Germany, for 3 months of nurse training.
 There she studied nursing “system and method” at the School for
Deaconesses. (Lutheran deaconesses provided home visits)

 Systems of district nursing later led her to promote nsg care for the sick in their homes.
 Worked in Scutari during Crimean War 54-56 – was sent to Asia Minor with
40 ladies, 117 hired nurses, and 15 servants.
 Improved the soldier’s health using a population-based approage (improved environmental conditions & nursing care.)
 She used epidemiology to document decreased mortality rate from
415/1000 to 11.5/1000.
 Organized hospital nsg practices and nsg education in hospitals to replace untrained lay nurses with Nightingale nurses.
 She thought the nsg should promote health and prevent illness.
 She emphasized proper nutrition, rest, sanitation, and hygiene.
 1860 Florence Nightingale Training School for Nurses established at St.
Thomas Hospital in London
 The first nursing schools based on the nightingale model opened in the US in
1870’s.
 Florence Nightingale designed and implemented the first program of trained nursing, and her contemporary, William Rathbone, founded the first district nursing association in England.
Chapter?
5.
What is taken into consideration when funds are allocated to communities for initiatives
 One example of effective use of technology is the funding provided by the US Dept of Health and Human Services, Health Resources, and
Services Administration to fund health centers so they can adopt and implement EHRs.
Chapter 3
6.
What would be ideal primary care?
 Low cost, easily accessible, quality care.
 Personal health care that provides first contact and continuous comprehensive and coordinated care – deals with most common needs of community members by providing preventative, curative, and rehab services.
 Community health center o 1. located in or serve a medically underserved area o 2. Provide comprehensive primary care services and supportive services such as translation and transportation o 3. Be available to all residents of their service area and adjust o fees based on the client’s ability to pay
7.
Review current social trends that impact communities.

Demographic Trends:
 World population growth
 Baby Boomers
 Hispanics outnumber Blacks
 US household composition is changing
 Mortality for M/F has declined
Social/Economic:
 Lifestyles
 QOL appreciation
 Composition of families and living patterns
 Household incomes – income inequality, per-person income increasing
Health Workforce:
 Nursing shortage
 Increase number of minority nurses
Chapter 4
8. Review the steps on making an ethical decision.
1.
Identify ethical issues and dilemmas: because persons cannot make sound ethical decisions if they cannot identify ethical issues and dilemmas.
2.
Place them within a meaningful context: because the historical, sociologica, cultureal, psychological, economic, political environmental, and demographic contexts affect the way ethical issues and dilemmas are formulated and justified.
3.
Obtain all relevant facts: facts affect the way ethical issues and dilemmas are formulated and justified
4.
Reformulate ethical issues or dilemmas if needed: the initial issues and dilemmas may need to be modified or changed on the basis of context and facts
5.
Consider appropriate approaches to actions or options: nature of issues and dil. Determines specific ethical approach used
6.
Make decisions and take action: professional persons cannot avoid choice and action in applied ethics
7.
Evaluate decisions and action: evaluation determines whether the ethical decision-making framework used resulted in morally justified actions r/t the ethical issues and dilemmas.
9. Understand what advocacy is and what it looks like.
 Advocacy – the act of pleading for or supporting a course of action on behalf of a person, group, or community.
 A powerful ethical concept in nursing

 2 definitions:
1. advocacy is the application of information and resources (finances, effort, and votes) to effect systemic changes that shape the way people in a community live - QOL of individuals in a community
2. Public Health Advocacy – advocacy that is intended to reduce death or disability in groups of people…such advocacy involves the use of info and resources to reduce the occurrence or severity of public health problems.
- QOL for aggregates, or populations
 3 codes and standards of practice address advocacy
1.
ANA’s code of Ethics for Nurses with Interpretive Statements:
“The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the pt.”
2.
Public Health Leadership Society’s Code of Ethics
“Public health should advocate and work for the empowerment of disenfranchised community members, aiming to ensure that the basic resources and conditions necessary for health are accessible to all.”
3.
ANA’s Public Health Nursing: Scope and Standards of Practice:
Public health nurses have a moral mandate to establish ethical standards when advocating for health care policy
Components of Advocacy:
Public Health Advocacy = Products and Processes
Products:
End Products: decreased morbidity and mortality
Intermediate Products: individual/family level & family/community level
Ex. Healthy diet, stress reduction, prenatal care
Ex: pollution, school-based services
Processes:
Problem ID
Research and data
Pro clinical education including media coverage
Development and promotion of regulations and legislation
Endorsement of regs & legislation
Enforcement of effective policies
Policy process and outcome evaluations
Conceptual Framework
Informational Stage
Gather data
Strategy stage

Objectives, etc
Action stage implementation
Practical Framework
-places advocate’s skills: litigation, legal knowledge, self-management, negotionation, assertiveness/force, interviewing within the context of the 6 princials.
6 Ethical Principals for Advocacy client’s best interest act with client’s wishes keep client informed diligence/competence impartially, frank advice client confidentiality
Chapter 5
10. Know ethnocentrism, stereotyping, prejudice and racism.
 Inhibitors to developing cultural competence:
These and similar issues can inhibit delivery of culturally competent care and may result in nurse behaviors such as stereotyping, prejudice and racism, ethnocentrism , cultural imposition, cultural conflict, and cultural shock.
Stereotyping: means attributing certain beliefs and behaviors about a group to an individual without giving adequate attention to individual differences. An example of a stereotype is “All Asian people are hard-working.”
Prejudice: Prejudice refers to having a deeply held reaction, often negative, about another group or person. For example, a person may be viewed negatively because of skin color, race, religion, or social standing with no regard for the worth of the person as an individual.
Racism: is a form of prejudice and refers to the belief that persons who are born into a particular group are inferior, for example, in intelligence, morals, beauty, or self-worth
Ethnocentrism: belief that one's own group or culture is superior to others.
a type of cultural prejudice at the population level, is the belief that one's own group determines the standards for behavior by which all other groups are to be judged. Ethnocentric nurses are unfamiliar and uncomfortable with anything that is different from their culture. Some American nurses may think that the way we do it is the best (or only) way to provide this care

11. What is cultural competence?
Combination of culturally congruent behaviors, practice attitudes, and policies, that allow nurses to work effectively in cross-cultural situations
care is designed for the client
care based on uniqueness of person’s culture and includes cultural norms and values
care includes self-employment strategies to facilitate client decision making to health behavior
care is provided with sensitivity and is based on cultural uniqueness of clients
Dimensions of Cultural Competence:
Cultural Preservation: support cultural practices
Cultural Accommodation:
Support home practices such as burying the placenta
Cultural Re-patterning:
Nurse will assist the individual to change their beliefes when practices are harmful
Cultural Brokering:
Nurse acts as an advocate
Chapter 8
12. What factors can lead to poor health?
- There is strong evidence to suggest that poverty can be directly related to poorer health outcomes.
-Poorer health outcomes lead to: reduced educational outcomes for children, poor nutrition, low productivity in the adult workforce, unstable economic growth in a population/community/nation.
- Uninsured, socioeconomic status, access, rationing.
Chapter 10
13. Understand EBP, what needs to be included when you incorporate EPB in your practice?
EBP: The best available evidence from a variety of sources, including research studies, evidence from nursing experience and expertise, and evidence from community leaders.
EBP includes: clients and communities in decisions, presenting evidents to them in an understandable fashion, informing of pros and cons, and basing decsions on the values of clients.
Implementation:

1.
ask clinical question
2.
relevant and best evidence
3.
critically appraise the evidence
4.
clinical decision by integrating all evidence
5.
evaluate clinical decision
14. What are the levels of evidence?
A systematic review is done by more than one person.
A well-designed systematic review can provide stronger evidence than a single randomized controlled trial which is considered the gold standard of research.
1. Systematic Reviews
2. RCT: ranks as the highest level of evidence
Other RCTs
Nonrandomized clnical trials
3. Prospective cohort studies
4. Case-control studies
5. Case Series, Case reports
6. Editorials, Expert opinions
Chapter 11
15. Review healthcare teaching and adult learning principals.
Cognitive Domain – memory, recognition, understanding, reasoning, application, problem solving
Affective Domain – changes in attitudes
Psychomotor Domain – neuromuscular coordination required
Community Health Education:
1.
Gain attention
2.
Inform the learning of the objectives of instruction
3.
Stimulate recall of prior learning
4.
Present the material
5.
Provide learning guidance
6.
Elicit performance
7.
Provide feedback
8.
Assess performance
9.
Enhance retention and transfer of knowledge
Teaching/Leaning Style:
Pedagogy vs Andragogy
Others decide vs decide themselves
Accept as is vs validate and evaluate

Limited past experience vs lifetime experience
Future use vs immediate use
Focus on facts
Teacher authority vs teacher-learner collaborate
Teacher plans vs shared planning
Passive vs active
16. What is readiness to learn?
Individuals learn best when they are physically, mentally, and emotionally ready to learn, and do not learn well if they see no reason for learning. Getting students ready to learn, creating interest by showing the value of the subject matter, and providing continuous mental or physical challenge, is usually the instructor ’s responsibility. If students have a strong purpose, a clear objective, and a definite reason for learning something, they make more progress than if they lack motivation . In other words, when students are ready to learn, they meet the instructor at least halfway, simplifying the instructor’s job.
Chapter 12
17. What is the purpose of a community assessment and what are the steps?
Community Assessment is the process of critically thinking about the community and involves getting to know and understand the community client as partner.
Assessments help identify community needs, clarify problems, and identify strengths and resources.
A short and simple assessment is a windshield survey
Comprehensive community assessment is the necessary initial phase of the nursing process in community health with community client as partner.
Assessment community health requires the following three steps.
1.
Gathering relevant existing data and generating missing data
2.
Developing a composite database
3.
Interpreting the composite database to identify community problems and strengths.
 Data collection and Interpretation
Data Gathering
Data Generation
Composite Database analysis (problems/strengths)
 Data-Collection Methods
Informant Interviews
Participant observation
Windshield surveys
Secondary analysis of existing data
Surveys

Collection of Direct Data
Informant Interviews
Participant observation
Windshield surveys are the equivalent of simple observation
Collection of Reported Data
Secondary analysis
Surveys
Chapter 18
18. Define resilience the ability to withstand many forms of stress and deal with several problems simultaneously without developing health problems.
Family resilience is to withstand and rebound from adversity (when situation works against you)
19. Know the Family Theory Frameworks
Theoretical Frameworks for Family Nursing:
Structure-function theory: families are examined in terms of their relationship with other major social structures (institutions)
Systems theory – encourages nurses to view clients as participating members of a family
Developmental theory – looks at family system over time through different phases that can be predicted with known family transitions based on norms
Interactional Theory – views family as a unit of interacting personalities and examines the symbolic communications by which family members relate to one another
4 Approaches to Family Nursing:
Context, or Structure – individual first, and family second
Client – family first, individuals second
System – the whole is more than the sum of its parts, individual and family member focus as a whole
Component of society – seen as one of many institutions
Chapter 19
20. Review risk reduction. health risk reduction application of selected interventions to control or reduce risk factors and minimize the incidence of associated disease and premature mortality. Risk

reduction is reflected in greater congruity between appraised and achievable ages.
Health risk reduction is based on the assumption that decreasing the number or the magnitude of risks will decrease the probability of an undesired event.
Ex: likelihood of adolescent substance abuse: parents not drinking, alcohol, etc.
Voluntary risks are tolerated better than those imposed by others.
Risks that scientists debate are more feared than ones they agree upon.
Risks of natural origin such as hurricanes are less threatening than ones humans create.
Community Oriented Nursing Approaches to Family Health Risk Reduction
 Home visits – rather than clinical visits…. More accurate assessment of family structure, natural home environment, behavior in that environment
Initiation
Previsit
In-home
Termination
Postvisit
 Contracting with families involves a shift in responsibility and control toward a shared effort by the client and the professional, rather than by the professional alone
Contingency contract – specific reward for the client after completion
Noncontingency contract – does not specify a reward
Empowering families –
 building nurse-family partnerships
 Emphasizes health risk reduction and health promotion
Chapter 20
21. Know what the risks across a lifespan are.
Health Risks Across the Life Span
Children’s Health:
Obesity – r/t obesity in parents, if both are obese, 80% chance.
70% of obese children will become obese adults
Consequences:
Hypertension
Respiratory problems
Hyperlipidemia
Bone and joint difficulties
Hyperinsulemia

Injuries and Accidents
Menstrual problems
-most preventable cause of disease, disability, and death
-MVC’s are leading cause of death among children and teenagers.
Infants –
-small size increases possibility for injurty
- small airway may be occluded
-head may get trapped, high surfaces = falls
- MVA – small size of infant’s body increases the risk of being crushed, light weight, becoming airborne
- immature motor skills – no escape
-SHAKEN BABY SYNDROME – 1 st week of life highest incidence -> leading cause of
Blunt head trauma).
Toddlers and Preschoolers –
Large number of falls, poisonings, and MVA’s.
School-Age Children –
Pedestrian and bicycle accidents
Adolescents –
Risk-taking, among males.
Adolescents are at the highest risk for MVA, drowning, and intentional accidents.
Suicide leading cause of death among 15-24 years.
Gang violence, drugs & weapons
Abuse and Neglect - 2001, 3.1 million children abused/neglected
-under age 6, 85% of fatalities
-underreported, difficult to prove
Alterations in Behavior – ADD/ADHD
Tobacco Use – ½ of all teens who smoke regularly will die from
Asthma – 8.9 million children have asthma
- 75% increase 1980-2003
- low income AA/Hispanics more likely to be hosp./die
-educate families
-assess homes/environments
-educate on second-hand smoke
**Lead poisoning is the most common environmental health hazard for children’s health**
-pesticides, poor air quality, indoor air pollutants
Adult Health –
Women’s healh:
Birth Control

Roe v Wade
Reproductive
Menopause
Osteoperosis
Breast cancer -2 nd leading cause of cancer deaths in women
Female genital mutilation
Disparities: AA, incarcerated, lesbians, disabled, older women
Men’s Health: they won’t seek primary care
Prostate cancer – most frequently dx in men
Testicular Cancer
•
Shared Health Concerns:
Mortality
• Diseases of the heart #1 COD for both males and females
• Cardiovascular disease
• Heart disease one of the most significant public health concerns
• Risk factors for CHD
• Smoking, Increased lipids, HTN
• Stroke
• AA males 2x the stroke incidence of white males
• Diabetes mellitus
• 20.8 million people have DM
• 11% of all men over age 20 have DM
• Mental health
• Women experience certain conditions more than men. Psychosocial factors such as life stress, trauma, interpersonal relationships have been cited as causing depression among women
• Cancer
• Second leading cause of death in the US
• HIV, AIDS, STDs
• HIV infection is the leading cause of death for AA males age 35-44
• Accidents and injuries
• Young men are more prone to injury RT risk taking behaviors
• Weight control
Older Adults
• The population of Americans 65 years of age and older is steadily growing, accompanied by an increase in chronic conditions, greater demand for services, and strained health care budgets
• Most older adults live in the community
• Nurses address the chronic health concerns of older adults with a focus on maintaining or improving self-care and preventing complications to maintain the highest possible quality of life

• Assessing the older adult incorporates physical, psychological, social, and spiritual domains
Chapter 25
22. Who are victims* what are some characteristics, who are abusers?
 Abused women and rape victims
 Persons living in areas with high rates of crime and violence are more likely to
 become victims than those in more peaceful areas.
Whereas more males than females are victims of homicide and assault, women are more likely to be victimized by a relative, especially a male partner
 Victims may engage in negative health behaviors such as smoking, abusing alcohol, or drugs, or engaging in risky sexual behaviors.
 73% of victims of family violence were female and about 75% of their attackers were male.


Victims of child abuse and individuals who saw their mothers being battered are at risk of using violence toward an intimate partner, whether one is male or female
Young women who have been victims of dating violence experience low selfesteem, depression, anger, and irritability
 As children, abusers were often beaten or saw siblings or parents beaten.
 Both men and women who witnessed abuse as children were more likely to abuse
 their children
As children, abusers were often beaten or saw siblings or parents beaten.


Severe wife abusers may commit other acts of violence, especially child abuse.
Families who are verbally aggressive in conflict resolution (e.g., using name
 calling, belittling, screaming, and yelling) are more likely to be physically abusive.
Adults whom children and parents are inclined to trust, such as coaches, scout
 leaders, and even priests, have been reported sexual abusers .
Parents with low social support, a tendency toward depression, multiple stress factors, and a history of abuse are at risk for abusing their children
23. Know most common types of cancer.
Prostate
Breast
Lung
Colorectal
Melanoma
Bladder
Non-hodgkin lymphoma

Thyroid
Kidney (renal cell)
Chapter 23
24. Review care of the homeless
Health promotion activities are a luxury
for them not a part of their daily lives.
Homeless people often have the following health problems:
 •Hypothermia and heat-related illnesses


•Infestations and poor skin integrity
•Peripheral vascular disease and hypertension


•Diabetes and nutritional deficits
•Respiratory infections and chronic obstructive pulmonary diseases
 •Tuberculosis (TB)


•HIV/AIDS
•Trauma


•Mental illness
•Use and abuse of tobacco, alcohol, and illicit drugs
Nurses must be aware of the unique needs of homeless clients at every age.



Homeless pregnant women are at high risk for complex health problems.
Homeless adolescents living on the streets exhibit greater risk-taking behaviors including earlier onset of sexual activity.
Homeless older adults are the most vulnerable of the impoverished older-adult
 population.
Nurses have a critical role in the delivery of health care to poor, homeless, mentally ill, and other high-risk people.
 Create a trusting environment
 Show respect, compassion, and concern
 Do not make assumptions
 Coordinate a network of services and providers
 Advocate for accessible health care services
 Focus on prevention
 Know when to walk beside or behind
 Develop a network of support for yourself
Preventative Services
Primary – affordable housing, birth control, education, needle exchange, counseling, job training
Secondary – supportive and emergency housing meal sites, comprehensive services
Tertiary – drug and alcohol tx, emergency shelter, mental health services

Advocate for accessible health care services
Neighborhood clinics, mobile vans, and home visits can bring health care to people unable to access care. Coordinating services at a central location often improves client compliance because it reduces the stress of getting to multiple places. Many shelters and transitional housing units have clinics on site.
These multiservice centers provide health care, social services, day care, drug and alcohol recovery programs, and comprehensive case management.
Chapter 21
25. Know Vulnerable Populations and at risk groups
• Poor and homeless persons
• Pregnant adolescents
• Migrant workers and immigrants
• Severely mentally ill individuals
• Substance abusers
• Abused individuals and victims of violence
• Persons with communicable disease and those at risk
• Persons who are human immunodeficiency virus (HIV) positive or have hepatitis B virus (HBV) or sexually transmitted disease
Social and economic factors predispose people to vulnerability.
- Poverty is a primary cause of vulnerability… poverty in its relative sense causes vulnerability because uninsured and underinsured people are less likely to seek preventive health services due to the cost. They are then more likely to suffer the consequences of preventable illnesses.
- Age – infants of substance abusing mothers, elderly
- Human capital – strength, knowledge and skills to live happy!
- Education
- Lack of resiliency
- disenfranchisement – a sense of social isolation; a feeling of isolation from mainstream society.
Chapter 24
26. What is harm reduction? harm reduction
(also called harm minimization): a public health approach to substance abuse problems. This approach acknowledges, without judgment, that licit and illicit drug use is a reality, and the focus of interventions is to minimize these drugs’ harmful effects rather than to simply ignore or condemn them; also to facilitate responsible use of substances.

However, a new approach, the harm reduction model, is a health care approach to
ATOD problems.
Harm Reduction Model
 Addiction is a health problem.
 •Any psychoactive drug can be abused.
 •Accurate information can help people make responsible decisions about drug use.
 •People who have ATOD problems can be helped.
Model accepts that psychoactive drug use (ETOH & TOBACCO) is endemic and focuses on pragmatic interventions, especially education, to reduce adverse consequences of drug use and get treatment for addicts.
Harm reduction strategies such as having free water available and rooms for people to relax could help prevent such overdoses. (MDMA)
The harm reduction approach to substance abuse focuses on health promotion and disease prevention.
Primary prevention for ATOD:
1. Promotion of healthy lifestyles/resiliency
2. education about drugs and guidelines for their use
Harm reduction as a goal recognizes that people consume drugs and that they need to know about the use of drugs and risks involved to make decisions about their use.
Using the harm reduction model, the nurse should provide education on cleaning needles with bleach between uses and on needle exchange programs to decrease the spread of HIV.
27. Understand drug addiction vs. drug dependence. drug addiction a pattern of abuse characterized by an overwhelming preoccupation with the use
(compulsive use) of a drug and securing its supply, and a high tendency for relapse if the drug is removed. drug dependence physiological change in the central nervous system as a result of chronic drug use.
 Drug dependence and drug addiction are often used interchangeably, but they
 are not synonymous.
Drug dependence is a state of neuroadaptation (a physiologic change in the central nervous system [CNS] and alterations in other systems caused by the

 chronic, regular administration of a drug ). People who are dependent on drug s must continue using them to prevent symptoms of withdrawal
Drug dependence is both psychological and physical.
Psychological dependence includes feelings of satisfaction and a desire to repeat the drug experience or to avoid the discomfort of not having the drug . Craving and compulsion are part of this dependence .

Drug addiction
is a pattern of abuse characterized by an overwhelming preoccupation with the use (compulsive use) of a drug and securing its supply and a high tendency to relapse if the drug is removed. Addicts may be both physically and psychologically dependent on a drug and there may be a risk of harm and the need to stop drug use
28. Risk factors for alcoholism.
 Set
Individual using the drug, their expectations of the drug
Genetically predisposed to alcoholism
 Setting
Mood disorders/mental illness
Fast pace of life
Competition at school or in the workplace
Pressure to accumulate material possessions
Lower socioeconomic background/minimal education
29. Review the principals of smoking cessation
 Using an intervention is more successful.
 Medications/behavioral treatments are more promising
 4 types of nicotine replacement: gum, skin patches, spray, inhalers
(double the chances)
 cessation clinics
 hypnosis
 acupuncture
 most effective way to get people to stop involves multiple interventions
 18-24 price
 25+ smoking program expenditures more effective
Chapter 25
30. How is violence defined and why are some countries more prone to it?
 Non-accidental acts, interpersonal or intrapersonal that result in physical, emotional or psychological injury to one or more persons.
 Factors influencing social and community violence include changing social conditions, economic conditions, population density, community facilities, and

institutions within a community, such as organized religion, education, the mass communication media, and work.

Particularly those countries where there is a large difference in standard of living between rich and poor
31. Understand rape, family violence. rape sexual intercourse forced on an unwilling person by threat of bodily injury or loss of life.
 An alarming aspect of family homicide is that small children may witness the murder or find the body of a family member


Homicides committed by spouses or family members equaled 15%.
Most homicides are committed by a friend, acquaintance, or family member
 during an argument.
The underlying dynamics of homicide within families vary greatly from those of other murders. Women are nine times more likely to be killed by an intimate partner than a stranger.
 Other risk factors are access to guns, estrangement, threats to kill and threats with a weapon, nonfatal strangulation, and a stepchild in the home if the
 victim is a female ( Campbell et al, 2007 ).
Types of Family Violence:
Family violence may not be limited to one family member; thus, nurses who detect child abuse should also suspect other forms of family violence.

Physical abuse
of women may be accompanied by sexual abuse
, both inside and outside the marital relationship.
 Severe wife abusers may commit other acts of violence, especially child abuse.
 Also, when one child is abused, others may be physically, sexually, or
 emotionally abused.
Families who are verbally aggressive in conflict resolution (e.g., using name calling, belittling, screaming, and yelling) are more likely to be physically
 abusive.
Female children were four times more likely to be sexually abused than male
 children
Child abuse tends to increase when there is increased family stress, especially
 during economic crunches.
Parents with low social support, a tendency toward depression, multiple stress factors, and a history of abuse are at risk for abusing their children
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1 in 6 women and 1 in 33 men report an attempted or completed rape at some time in their lives
Sexual violence can affect health in many ways ranging from chronic pain, headaches, stomach problems, sexually transmitted diseases, unwanted pregnancies, generalized fear and anxiety, eating disorders, and depression.

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Victims may engage in negative health behaviors such as smoking, abusing alcohol, or drugs, or engaging in risky sexual behaviors.
Rape victims seldom offer sensitive information unless you specifically ask for it and make it clear that confidentiality will be upheld
Rape results in about 32,000 pregnancies annually
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For reported rapes, cities constitute higher risk areas than do rural areas, and the hours between 8 pm and 2 am, the weekends, and the summer are the most critical times. In about 50% of rapes, the victim and the offender meet on the street, whereas in other cases the rapist either enters the victim's home or somehow entices or forces the victim to accompany him. The majority of rapists are known to the victim.
change and clarify misconceptions about rape and victims of rape. Rape is a crime
 of violence, not a crime of passion
The underlying issues are hostility, power, and control rather than sexual desire.
 The defining issue is lack of consent of the victim.
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During the act of rape, survivors are often hit, kicked, stabbed, and severely beaten.
Some cry, shout, or discuss the experience. Others withdraw and are afraid to discuss the attack.
32. Review vector disease.
Vector-borne diseases refer to illnesses for which the infectious agent is transmitted by a carrier, or vector, usually an arthropod (mosquito, tick, fly), either biologically or mechanically.
Vector-borne diseases commonly encountered in the United States are those associated with ticks, such as:
Lyme disease (Borrelia burgdorferi), - Lyme disease became a nationally notifiable disease in 1991 and is now the most common vector-borne disease in the United States – associated with the white tailed dear, and white-footed mouse
- human monocytotropic ehrlichiosis (Ehrlichia chaffeensis),
- Rocky Mountain spotted fever (Rickettsia rickettsii). immigrant populations or with international travelers may encounter malaria (Caused by the blood-borne parasite Plasmodium , malaria is a potentially fatal disease characterized by regular cycles of fever and chills. Transmission is through the bite of an infected Anopheles mosquito.)
and dengue fever, both carried by mosquitoes.
West Nile virus is an example of endemic mosquito-borne viruses, which include
St. Louis,
LaCrosse, western and eastern equine encephalitis.

Plague (Yersinia pestis) is carried by fleas of wild rodents.
More rarely seen & associated with ticks: babesiosis ( Babesia microti ), tularemia ( Francisella tularensis ),
Q fever ( Coxiella burnetii ),
A zoonosis is an infection transmitted from a vertebrate animal to a human under natural conditions.
Means of transmission include animal bites, inhalation, ingestion, direct contact, and arthropod intermediates. This last transmission route means that some vectorborne diseases may also be zoonoses more common zoonoses in the United States include:
toxoplasmosis (Toxoplasma gondii),
cat-scratch disease (Bartonella henselae),
brucellosis (Brucella species),
listeriosis (Listeria monocytogenes),
salmonellosis (Salmonella serotypes),
rabies (family Rhabdoviridae, genus Lyssavirus).
15. NCLEX Questions:
Amish:
A community nurse is creating partnerships to address health needs within the
Amish community. The nurse should be aware that which of the following characteristics must exist for partnerships to be successful?
1. A leading partner with decision-making authority
2. Flexibility among partners when considering new ideas. (x)
3. Adherence of partners to ethical principals. (x)
4. Varying goals for the different partners
5. Willingness of partners to negotiate roles. (x)
Inuit:
What is the Inuit Community at high risk for?
A) a poor unbalanced diet due to the consumption of mostly animal meat, leaving out the important parts of nutrition such as fruit, vegetables, and grains. (x)
B) 58% of adults smoke contributing to the Inuit culture having the highest lung cancer rates in the world.
C) The cold climate associated with living in an Arctic region, averaging anywhere between 20 and 30 as a usual temperature.
D) The lack of availability of healthcare in their native area due to no year-round road access.

Mormon:
In order to provide culturally competent care for someone of the Mormon faith, which of the following would be important to consider:a. Leaving lights off when entering the patient's room. b. Giving the patient hot tea every night before bed. c. Being sure to provide a meal with a lot of fruit and vegetable options. (x) d. Facing the bed East for prayer.
Hasidic Jews
The nurse has a patient who states his ethnic and cultural background is Hasidic
Judaism. The patient has been diagnosed with schizophrenia and is reluctant to take medications while in the hospital because he doesn't want to accept what this designation signifies. The nurse understands that in this certain religion, mental illness attracts stigma. Which of the following actins would be the best way for the nurse to handle this situation? a. Tell patient he has no choice in medication administration and must take the pills b. Information patient about the importance of the medication to his illness c. Contact the individual's spiritual leader (Rebee) to find ways in which the patient can understand his illness more and they can work together to provide treatment.
(x) d. Agree with patient that he doesn't need to take medication document and leave room.
Muslims:
A Muslim women enters the clinic to have her yearly gynecological exam, in and office with all male providers. Which nursing intervention best shows cultural competence?
A. Saying "everyone has to get a yearly exam, don't be upset."
B. Recognize Muslim women are usually very modest and patient should be referred to another clinic with a female provider. (x)
C. Explain there is not female provider available and apologize for the inconvenience.
D. Educate the patient on the importance of yearly exams in an attempt to convince the patient to stay.
Christian Science
Which of the following responses to a Christian Scientist regarding their religious beliefs toward immunizations would be most therapeutic?
A. If your child doesn't get this vaccine, he/she will die."
B. "You have the right to refuse this medication. Let me just document it on the
MAR." (x)
C. "why don't you want to protect your child in everyday shape and form?"
D. Are you sure I can't sway your decision by telling you all the benefits?"

Japanese
Which of the following persons would be highly respected and valued within the
Japaneses culture? (select all that apply)
A. 29 year old male with a Bachelor's degree in English (x)
B. 16 year old female with a talkative personality
C. An 80 year old man (x)
D. A 35 year old landscaper (x)
E. A 25 year old who never completed high school.
Buddhism
Which component of care would the nurse most likely have to adjust for a patient who is a practicing Buddhist?
A. mobility
B. nutrition (x)
C. infection control
D. hygiene