NSG3130/ NSG3130 Exam 2 V2 | Questions & Answers (2026/ 2027 Update) | Nursing Practice II (Galen) | Updated Version | 100% Verified Solutions

NSG3130/ NSG3130 Exam 2 V2 | Questions & Answers (2026/ 2027 Update) | Nursing Practice II (Galen) | Updated Version | 100% Verified Solutions 1. You are caring for a client who has diabetes complicated by kidney disease. You need to make a detailed assessment when administering medications because this client may experience problems with: A. absorption. B. biotransformation. C. distribution. D. excretion. D 3. If a nurse experiences a problem reading a physician's medication order, the most appropriate action will be to: A. call the physician to verify order B. call the pharmacist to verify order. C. consult with other nursing staff to verify. D. withhold the medication until physician makes rounds. A 4. Nurses are legally required to document medications that are administered to patients. The nurse is mandated to document which of the following? A. Medication before administering it. B. Medication after administering it. C. Rationale for administering it. D. Prescriber rationale for prescribing it. B Time it takes after a medication is administered for it to produce a response onset Time it takes for a medication to reach its highest effective concentration peak Minimum blood serum concentration of medication reached just before the next scheduled dose trough Time during which medication is present in concentration great enough to produce a response duration 1 ml 15 drops 5 ml 1 teaspoon 15 ml 1 tablespoon 30 ml 2 tablespoons 1. It is important to take precautions to prevent medication errors. A nurse is administering an oral tablet to a patient. Which of the following steps is the second check for accuracy in determining the patient is receiving the right medication? 1. Logging on to automated dispensing system (ADS) or unlocking medicine drawer or cart. 2. Before going to patient's room, comparing patient's name and name of medication on label of prepared drugs with MAR. 3. Selecting correct medication from ADS, unit-dose drawer, or stock supply and comparing name of medication on label with MAR or computer printout. 4. Comparing MAR or computer printout with names of medications on medication labels and patient name at patient's bedside. 2 3. An older adult states that she cannot see her medication bottles clearly to determine when to take her prescription. What should the nurse do? (Select all that apply.) 1. Provide a dispensing system for each day of the week. 2. Provide larger, easier-to-read labels. 3. Tell the patient what is in each container. 4. Have a family caregiver administer the medication. 5. Use teach-back to ensure that the patient knows what medication to take and when. 1, 2, 5 4. The nurse must take a verbal order during an emergency on the unit. Which of the following guidelines can be used for taking verbal or telephone orders? (Select all that apply). 1. Only authorized staff may receive and record verbal or telephone orders. The health care agency identifies in writing the staff who are authorized. 2. Clearly identify patient's name, room number, and diagnosis. 3. Read back all orders to health care provider. 4. Use clarification questions to avoid misunderstandings. 5. Write "VO" (verbal order) or "TO" (telephone order), including date and time, name of patient, and complete order; sign the name of the health care provider and nurse. 1, 2, 3, 4, 5 5. A nurse is administering ophthalmic ointment to a patient. Place the following steps in correct order for the administration of the ointment. 1. Clean eye, washing from inner to outer canthus. 673 2. Assess patient's level of consciousness and ability to follow instructions. 3. Apply thin ribbon of ointment evenly along inner edge of lower eyelid on conjunctiva. 4. Have patient close eye and rub lightly in a circular motion with a cotton ball. 5. Ask patient to look at ceiling, and explain the steps to patient. 2, 1, 5, 3, 4 6. The nurse is administering an IV push medication to a patient who has a compatible IV fluid running through intravenous tubing. Place the following steps in the appropriate order. 1. Release tubing and inject medication within amount of time recommended by agency policy, pharmacist, or medication reference manual. Use watch to time administration. 2. Select injection port of IV tubing closest to patient. Whenever possible, injection port should accept a needleless syringe. Use IV filter if required by medication reference or agency policy. 3. After injecting medication, release tubing, withdraw syringe, and recheck fluid infusion rate. 4. Connect syringe to port of IV line. Insert needleless tip or small-gauge needle of syringe containing prepared drug through center of injection port 5. Clean injection port with antiseptic swab. Allow to dry. 6. Occlude IV line by pinching tubing just above injection port. Pull 2, 5, 4, 6, 1, 3 7. A nurse is administering a metered-dose inhaler (MDI) with a spacer to a patient with chronic obstructive pulmonary disease. Place the steps of the procedure in the correct order. 1. Insert MDI into end of spacer. 2. Perform a respiratory assessment. 3. Remove mouthpiece from MDI and spacer device. 4. Place the spacer mouthpiece into patient's mouth, and instruct patient to close lips around the mouthpiece. 5. Depress medication canister, spraying 1 puff into spacer device. 6. Shake inhaler for 2-5 seconds. 7. Instruct patient to hold breath for 10 seconds. 8. Instruct patient to breathe in slowly through mouth for 3 to 5 seconds. 2, 3, 6, 1, 4, 5, 8, 7 8. A patient is to receive medications through a small-bore nasogastric feeding. Which nursing actions are appropriate? (Select all that apply.) 1. Verifying tube placement after medications are given 2. Mixing all medications together to give all at once 3. Using an enteral tube syringe to administer medications 4. Flushing tube with 30 to 60 mL of water after the last dose of medication 5. Checking for gastric residual before giving the medications 6. Keeping the head of the bed elevated 30 to 60 minutes after the medications are given 3, 4, 5, 6 9. Place the steps of administering an intradermal injection in the correct order. 1. Inject medication slowly. 2. Note the presence of a bleb. 3. Advance needle through epidermis to 3 mm. 4. Using nondominant hand, stretch skin over site with forefinger. 5. Insert needle at a 5- to 15-degree angle into the skin until resistance is felt. 6. Cleanse site with antiseptic swab. 6, 4, 5, 3, 1, 2 10. After receiving an intramuscular (IM) injection in the deltoid, a patient states, "My arm really hurts. It's burning and tingling where I got my injection." What should the nurse do next? (Select all that apply.) 1. Assess the injection site. 2. Administer an oral medication for pain. 3. Notify the patient's health care provider of assessment findings. 4. Document assessment findings and related interventions in the patient's medical record. 5. This is a normal finding, so nothing needs to be done. 6. Apply ice to the site for relief of burning pain. 1, 3, 4 The nurse is obtaining a sexual history from an adolescent male. Which of the following would be the best way to begin the sexual history interview? 1.Often young men your age... 2.I worry that you might... 3.Do you... 4.You don't...do you? 1 The nurse is reviewing the importance of testicular self-examination (TSE) with a 17-year-old male. Which statement by the client confirms the client's understanding of TSE? 1."I will check my testicles for lumps in the shower." 2."I will bear down and check my groin area while seated." 3."I will check my testicles while lying on my right side." 4."I will have my testicles examined by my health care provider every year." 1 The parent of a newborn girl is concerned because the baby's vagina and clitoris appear large and swollen. What is the nurse's best response? 1."This is a normal finding in newborn girls and should resolve within a few weeks." 2."I would make an appointment to see your infant's pediatrician as soon as you get her home." 3."The infant will need some additional tests to determine the cause of this problem." 4."We will have the doctor examine the infant right away." 1 When a female client with an indwelling urinary (Foley) catheter insists on walking to the hospital lobby to visit with family members, nurse Rose teaches how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information? A. The client sets the drainage bag on the floor while sitting down. B. The client keeps the drainage bag below the bladder at all times C. The client clamps the catheter drainage tubing while visiting with the family D. The client loops the drainage tubing below its point of entry into the drainage bag B The nurse is reviewing a client's fluid intake and output record. Fluid intake and urine output should relate in which way? A. Fluid intake should be double the urine output B. Fluid intake should be approximately equal to the urine output C. Fluid intake should be half the urine output D. Fluid intake should be inversely proportional to the urine output B The nurse is reviewing the report of a client's routine urinalysis. Which value should the nurse consider abnormal? A.Specific gravity of 1.005 B.Urine pH of 3.0 C.Absence of protein D.Absence of glucose B Nurse Mary is inserting a urinary catheter into a client who is extremely anxious about the procedure. The nurse can facilitate the insertion by asking the client to: A. breathe deeply B.initiate a stream of urine C.turn to the side D.hold the labia or shaft of penis A While performing a cardiac assessment on a client with an incompetent heart value, the nurse auscultates an incompetent heart valve, the nurse auscultates a murmur. The nurse documents the findings. As describes. The sound as which? A. Lub-dub sound B. Scratchy, leathery heart noise C. A blowing or swooshing noise D. Abrupt, high-pitched snapping noise C A client is wearing a continuous cardiac monitor, which begins to sound its alarm. The nurse sees no electrocardiographic complexes on the screen. Which is the priority nursing action? A. Call a code B. Check the client's status C. Call the healthcare provider D. Document the lack of complexes B A nurse is caring for a client with heart failure. On assessment, the nurse notes that the client is dyspneic, and crackles are audible on auscultation. What additional manifestations would the nurse expect to note in this client if excess fluid volume is present? A. Weight loss and dry skin B. Flat neck veins and decreased urinary output C. An increase in blood pressure and increased respirations D. Weakness and decreased central venous pressure C The nurse is caring for a client with several broken ribs. The client is most likely to experience what type of acid imbalance? A. Respiratory acidosis from inadequate ventilation B. Respiratory alkalosis from anxiety and hyperventilation C. Metabolic acidosis from calcium loss due to broken bones D. Metabolic alkalosis from taking analgesics containing base products A before meals ac twice each day bid after meals pc whenever there is a need prn every morning q am every hour qh every day daily every 4 hours q4h 4 times per day qid give immediately STAT 3 times per day tid buccal medication effects local on mucosa, systemic on saliva topical medication effect local topical medication has systemic effects if the client's skin is the client's skin is broken What are community assessment and diagnosis the foundation of? community specific program planning What is program planning used for? to promote healthy communities What should community health program planning reflect? the priorities set as a result of analysis of community assessment data What are priorities set based on? - the extent of the problem - the relevance of the problem to the public - estimate effect of the intervention What is the community health assessment process? 1.) assessment 2.) diagnosis 3.) plan 4.) implementation 5.) evaluation What are the community assessment components? 1.) people 2.) place 3.) social systems What are some factors to consider when determining the health of a community? - status a. involves physical (morbidity and mortality rates), emotional (client satisfaction), and social (crime rates) components - structure a. services and resources in a community b. patterns of use c. demographic data - process a. effective community functioning or problem solving b. relationships c. communication d. commitment to the participation in health What are some ways of data collection to determine health needs? - community forms - secondary data (existing data on deaths, births, minutes from meetings, prior health surveys) - participant observation - focus groups - surveys - informant interview - Windshield Survey What is important when collecting data? - sensitivity - openness - curiosity - ability to listen, taste, touch, smell - ability to see life as it is lived in a community Informant Interview direct discussion with community members for the purpose of obtaining ideas and opinions from key informants Informant Interview Strengths - minimal cost - participants serving as future supporters - insight into community beliefs and attitudes - elicit detailed response Informant Interview Limitations built-in bias Windshield Survey - motorized equivalent of simple observation - observe many dimensions of community life Windshield Survey Strengths descriptive overview of community Windshield Survey Limitations - driver required Subsystems to Investigate - recreation - physical environment - education - safety and transportation - politics and government - health and social services - communication - economics Secondary Data Collection municipal/state/national a. WebPages b. statistical data c. policy/position papers - Healthy CT 2020 What are the steps in analysis of community assessment data? - Gather collected data (database). - Assess completeness of data. - Identifying and generating missing data. - Identify community needs and problems. - Identify community strengths and resources (problem analysis). Community Health Diagnosis Risk of _________________ (specific problem or risk in the community) among _________________ (group/target pop) is related to _______________ (strengths and weaknesses in the community that influence the problem or risk) Service Learning Project - propose educational program - align with Healthy People 2020 health objective - design population-specific health care program to meet that objective CHAPTER 11: USING HEALTH EDUCATION AND GROUPS IN THE COMMUNITY Health Promotion - education occurs in all 3 levels of prevention (primary, secondary, and tertiary) - educate individuals, families, groups and communities Educational Goal - obtain optimal health - prevent health problems - identify and treat health problems early - minimize disability - change behaviors - prevent illness and manage chronic disease How do people learn? - hearing message - observing - participating What do learners accept information based on? - what they already know - what they believe - the culture in which they were raised - how well they understand - how well they relate to the information What percentage of Americans read below a 5th grade level? 1 out of 5 What percentage of adults may lack skills needed to manage their health and prevent disease? 9 out of 10 What percentage have below basic health literacy? 30 million Health Literacy the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions Nature of Learning - cognitive domain - (thinking) teach to their level of understanding - affective domain - (feeling) listen for clues to feelings that will influence learning - psychomotor domain - (acting) demonstrate skills - each domain has behavioral components that form a hierarchy of steps, or levels - each level builds on the previous one - motivating adult learners What is important to know about learning? - involves change and that is difficult - recognize people learn differently - evaluate intellectual, emotional and physical ability to learn - teach to the learners ability Adult Learning Theory (Andragogy) adults are motivated to learn when: Andragogy the art and science of helping adults learn... based on certain crucial assumptions about the differences between children and adults as learners Health Belief Model (HBM) 1. Perceived susceptibly- will it happen to me 2. Perceived severity- will it be a big problem 3. Perceived benefits - will it really help 4. Perceived barriers is it costly, hurt? 5. Cues to action- What might motivate me to actually do something? 6. Self efficacy- Can I really do this? Transtheoretical Model (TTM) 1.) three pre-action stages a. pre-contemplative stage - no plan to change b. contemplative stage - well maybe c. preparation stage - ok I will start 2.) action stage - new behavior 3.) maintenance stage - okay this isn't so bad What are the typical steps in developing a health education program? Identify a population-specific learning need for the community health client. Select one or more learning theories to use in the education program. Consider which educational principles are most likely to increase learning and choose those that are most appropriate and feasible. Examine educational issues. Design and implement the educational program using carefully chosen strategies. Evaluate the effects of the educational program. What are some way to develop an effective health education programs? Message. Sending a clear message to the learner Format. Selecting the most appropriate learning format Environment. Creating the best possible learning environment Experience. Organizing positive and meaningful learning experiences Participation. Engaging the learner in participatory learning Evaluation. Evaluating and giving objective feedback to the learner How can we promote health through group education? Health behavior is influenced by the groups to which people belong. Groups who will support an individual's health changes are unavailable to some people because of their social or emotional isolation. Choosing groups for health change Established groups Selected membership groups Beginning interactions Conflict Strategies for change Evaluation of group progress How can we effectively educate groups? Groups can be used to initiate and implement changes for individuals, families, organizations, and the community. Community groups represent the collective interests, needs, and values of individuals; they provide a link between the individual and the larger social system. Groups can bring about changes to improve the health and well-being of individuals and communities. Some individual changes for health are difficult or impossible to achieve without group support and encouragement. Through community groups, nurses help people identify priority health needs and capabilities and make valuable community changes. Group Culture Group norms set the standard for group members behaviors, attitudes and perceptions Task norms keep group focus on work Maintenance norms- the group works to keep everyone at ease, location of meeting pleasing to all Some diversity in groups is positive What are the stages of group development? 1.) forming - get acquainted and leader emerges 2.) storming - individual characteristics emerge, may be hostile to others and polarization occurs 3.) norming - acceptance and cohesion, norms and roles emerge 4.) performing - accomplish goals 5.) adjourning - engages in separation What are some tips for public health nurses when group is forming? - be patient - be knowledgeable - be a good role model - counsel, facilitate, supervisor - have members establish ground rules, processes for enforcing violations, consequences - guide development of common vision and mission Conflict - occurs when members feel obstructed or irritated by one another, competition - best approach is match the response style to the situation - open communication, diffuse negative feelings, and perceptions, concentrate on the issues, be fair, and use a structured approach CHAPTER 14: DISEASE MANAGEMENT Disaster - any natural or human-made incident that causes disruption, destruction, and/or devastation requiring external assistance - range in size - are expensive (lives affected, property lost/damaged) - developing countries experience disproportionate burden from natural disasters Types of Disasters - natural disasters - human-made disasters - chemical - biological - radiologic - nuclear - explosive US Agencies, Directives, and Systems US Department of Homeland Security (FEMA) National preparedness guidelines National response plan National incident management system Public health and medical preparedness and the national health security strategy Disaster Impact Variables - vulnerable populations a. children b. older adults c. disabled d. chronically ill e. visual/hearing impaired - community identifiers a. population density b. impoverished c. lack of technological advancement - predictability - scope and intensity - timing - frequency - controllability What are the 4 stages of disaster involvement? 1.) mitigation 2.) preparedness 3.) response 4.) recovery (1) Mitigation - What disasters could happen? - Who are the most vulnerable populations? - prevention - reducing risks to people and property from natural hazards before they occur (2) Preparedness - create a disaster plan - community: a. Presidential Policy Directive (PPD)-8 true preparedness is a whole community event b. Federal Emergency Management Agency (FEMA) - personal: a. be Red Cross ready b. get a kit c. make a plan d. emergency supplies, ID, pocket references e. BP cuff, gloves, radio, medications for self, cell phone, pre-entered emergency numbers, flashlight - professional: a. workplace and community disaster plans b. National Disaster Medical System (NDMS) - Disaster Medical Assistance Teams (DMATs) - Activated by Assistant Secretary of Health Medical Reserve Corps (MRC) & Community Emergency Response Teams (CERT) - local opportunities c. "One of the essentials for baccalaureate prepared nurses is to be informed about disaster preparedness" (p. 241) (3) Response - what is the type, level, scope of the disaster? - local level: a. mobilizing first responders (fire department, law enforcement, public health, emergency services) - National Disaster Response Framework: a. federal emergency has been declared - National Incident Management System (NIMS): a. universal protocols and response (4) Recovery - How can we rebuild? - recovery is about returning to the new normal with the goal of reaching a level of organization that is as near the level prior to the disaster as is possible - often the hardest part of the disaster - recovery occurs as all involved agencies pull together to restore the economic and civic life of the community Healthy People 2020 Goal - improve the nation's ability to prevent, prepare for, respond to, and recover from a major health incident - many factors determine a community's level of preparedness and its ability to recover after an emergency National Response Framework - Office of Homeland Security - mission to develop and coordinate the implementing of a comprehensive national strategy to secure the US from terrorist threats - FEMA- On March 1, 2003, the Federal Emergency Management Agency (FEMA) became part of the U.S. Department of Homeland Security (DHS). Strategic Plans : National Response Framework NRF- guide for can be used to prepare for disasters. Source FEMA_NRF What are some ways that disasters affect communities? - physical and emotional effects depend on: a. type, cause, and location b. magnitude and extent of disaster c. duration of disaster d. amount of warning - stress reactions in individuals a. depends on age, cultural background, health status, social support structure, general ability to adapt to crises What are some examples of stress reactions in the community? - heroic - working in overdrive - honeymoon - rejoicing, sharing stories - disillusionment - no reinforcement, burnout - reconstruction - longest, time to rebuild What are a nurse's role and responsibilities during disasters? - clarify legal issues re: professional care during an emergency What is the role of the nurse in disaster preparedness? - help initiate or update the agency's disaster plan - provide educational programs and materials regarding disasters specific to the area - organize disaster drills - provide an updated record of vulnerable populations within the community - review individual strategies What is the role of the nurse in disaster response? - advocate - assessment - understand what community resources are available - often first responder a. case finding and referring b. prevention c. health education d. surveillance e. triage - depends on nurse's experience, professional role in a community disaster plan, speciality training, and special interest Primary Disaster Prevention participate in developing disaster plan for community Secondary Disaster Prevention - assess disaster victims - triage for care Tertiary Disaster Prevention participate in home visits to uncover dangers that may cause additional injury to victims or cause other problems (house fires from faulty wiring, mold from flooding) What do nurses working in shelter management do? - provide assessments and referrals - meet health care needs, such as helping clients get prescription glasses, medications, first aid, and appropriate diet adjustments - keep client records - ensure emergency communications - provide a safe environment What is the role of the nurse in disaster recovery? - teach proper hygiene and make sure immunization records are current - make referrals to mental health professionals - be alert for environmental hazards - assess dangers of live or dead animals - case finding and referral What is the future of disaster management? - continue to plan and train in all-hazards environment, regardless of speciality practice - the nature of disasters will retain the element of unpredictability - that unpredictability and the medical and public health surge requirements in disaster make prevention and preparedness activities on the part of individuals and communities even more important CHAPTER 15: SURVEILLANCE AND OUTBREAK INVESTIGATION Disease Surveillance "ongoing systematic collection, analysis, interpretation dissemination of specific health data for use in public health" What can public health surveillance be used to do? - estimate the magnitude of a problem (disease or event) - determine geographic distribution of an illness or symptoms - portray the natural history of a disease - detect epidemics; define a problem - generate hypotheses; stimulate research - evaluate control measures - monitor changes in infectious agents - detect changes in health practices - facilitate planning What is a purpose of surveillance? helps public health departments: events Why is collaboration important? - a quality surveillance system requires collaboration among a number of agencies and individuals - such collaboration promotes the development of a comprehensive plan and a directory of emergency responses and contacts for effective communication and information sharing - nurses are often in the forefront of responses to be made in the surveillance process What are the core nursing competencies? - analytic assessment skills - define problem, determine cause, identify relevant data, partner, identify risks - communication - oral and written reports - community dimensions of practice - collaboration - basic public health science skills - individual and organizational responsibilities - leadership and systems thinking - contribute to developing, implementing, and monitoring investigations What are the basic steps for surveillance? - Is surveillance an appropriate intervention? - Organize knowledge of program. - Establish criteria for what constitutes a case. - Collect data from multiple valid sources. - Analyze and interpret. - Disseminate and evaluate impact of the surveillance system. What are some data sources for surveillance? - cases reported by clinicians, health care agencies, and laboratories to state health departments - death certificates - administrative data (i.e. billing) - sentinel surveillance system National Notifiable Diseases - National Notifiable Disease Surveillance System (NNDSS) - reporting of disease data is essential if trends are to be accurately monitored - Morbidity and Mortality Weekly Report - Summary of Notifiable Diseases - United States (annual report) State Notifiable Diseases - requirements for reporting diseases are mandated by law or regulation - each state differs on the list of reportable diseases - not all nationally notifiable diseases are legally mandated for reporting in a state What are the types of surveillance systems? - passive system - active system - sentinel system - special systems Passive System - report to local health department - summarized, forwarded to state health department, national government or other organization like CDC Active System nurse may search for cases Sentinel System - trends in commonly occurring diseases are monitored - reports requested Special Systems - syndromic surveillance systems - automated data systems continued or daily outbreaks What do we investigate? - control or prevent disease or death - identify factors that contribute to the outbreak of the disease and occurrence of the event - implement measures to prevent occurrences - patterns of occurrence What are some patterns of occurrence? - common source outbreak Common Source Outbreak an outbreak characterized by exposure to a common, harmful substance Point Source all persons exposed become ill at same time Mixed Outbreak outbreak with a common source followed by secondary exposures related to person-to-person contact, as in the spreading of influenza Intermittent or Continuous Source cases may be exposed periodically or uninterrupted over a period of days or weeks Propagated Outbreak outbreak resulting from direct or indirect transmission of an infectious agent from an infected person to a susceptible host; secondary infections can occur Epidemiological Triangle 1.) agent a. biological - bacteria, fungi b. physical - trauma c. chemical - pollutants d. nutrients - absence, excess e. psychological - stress, isolation, social support 2.) host a. age b. sex c. race d. socioeconomic status e. genetics f. lifestyle choice 3.) environment a. weather b. temperature c. humidity d. physical surroundings What are ways to define the magnitude of a problem/event? - endemic - hyperendemic - sporadic - epidemic - pandemic - outbreak detection Endemic disease or event occurring in population (low to moderate number of cases) Hyperendemic persistently high number of cases Sporadic irregular patterns Epidemic occurrence of disease within an area is clearly in excess of expected levels Pandemic spread of problem over several countries or continents (outbreak) Outbreak Detection identifying increase in frequency Why is intervention and protection important? - response to bioterrorism or large-scale infectious disease outbreak - protecting health care providers from exposure CHAPTERS 21 & 22: VULNERABILITY AND VULNERABLE POPULATIONS: AN OVERVIEW RURAL HEALTH AND MIGRANT HEALTH Vulnerability susceptibility to actual or potential stressors that may lead to adverse effect Vulnerable Populations groups who have increased risk of developing adverse health outcomes What are some aspects of vulnerability? - limited resources - physical - environment - personal (human capital) - lack of power - limited control - disadvantaged status - disenfranchisement - health risks What are some factors that affect health? - income and social status a. higher income and social status are linked to better health - education a. low education levels are linked with poor health, more stress and lower self-confidence a. safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health b. employment and working conditions - people in employment are healthier, particularly those who have more control over their working conditions - social support networks a. greater support from families, friends and communities is linked to better health b. culture - customs and traditions, and the beliefs of the family and community all affect health - genetics a. inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses b. personal behavior and coping skills - balanced eating, keeping active, smoking, drinking, and how we deal with life's stresses and challenges all affect health - health services a. access and use of services that prevent and treat disease influences health - gender a. men and women suffer from different types of diseases at different ages What are the 5 key areas of social determinants of health? 1.) neighborhood and built environment 2.) health and health care 3.) social and community context 4.) education 5.) economic stability Health Disparities variation in health services, health status among groups Health Equity attainment of the highest level of health for all people What are some public policies affecting vulnerable populations? Social Security Act of 1935 Social Security Act Amendments of 1965, Medicare, and Medicaid: Title XXI of the Social Security Act (1997) State Children’s Health Insurance Program (SCHIP) Health Insurance Portability and Accountability Act of 1996 The Patient Protection and Affordable Care Act, Affordable Care Act or nicknamed Obamacare - a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010 What are some nursing approaches to care in the community? - trend toward providing more comprehensive, family-centered services when treating vulnerable population groups - family-centered "one stop" services a. wrap-around services b. comprehensive services - advocacy - social justice Primary Prevention - seek to promote health and prevent disease from the beginning - involves health promotion and education Secondary Screening seeks to detect disease by screening and providing health care early in its progression before clinical signs become apparent Tertiary Screening - continued long-term health care - interventions that begin once disease is obvious - aim is to interrupt the course of the disease, reduce the amount of disability that might occur, begin rehabilitation What should assessment include client evaluation of? - socioeconomic resources - preventive health needs - congenital and genetic predisposition to illness - amount of stress - living environment and neighborhood surroundings How can we plan and implement care for vulnerable populations? - create a trusting environment What is the role of a PHN? - assess vulnerable population - develop a nursing diagnosis of their strengths and needs - planning and implementing interventions in partnership with vulnerable clients - evaluate the effectiveness Nurse/Client Partnership - social services - clinics and physicians' offices - medication assistance programs - preventive services - home care - hospital discharge planners CHAPTER 22: RURAL HEALTH AND MIGRANT HEALTH History of Red Cross Red Cross Rural Nursing Service (1912) Later known as "Town and Country Nursing Program" Classes and instructors to women Led by Lillian Wald What does the US Census Bureau identify as urban? - Urbanized Areas (UAs) of 50,000 or more people - Urban Clusters (UCs) of at least 2,500 and less than 50,000 people What is rural? encompasses all population, housing, and territory not included within all urban area Why are people moving to rural areas? - fastest growing areas - "doughnut effect" - more affordable housing Population Characteristics and Cultural Considerations for Rural Populations - higher proportion of whites - higher-than-average numbers of younger (age 6-17) and older residents (over 65) - more likely to be married or widowed - fewer years of formal education - tend to be poorer (nearly 1/4 live near poverty; 40% children impoverished) - working poor at higher risk for being underinsured or uninsured Health Status of Rural Residents - poorer perception of their overall health and functional status - less likely to engage in preventive behavior - more likely to have one or more of the following conditions: a. heart disease b. COPD c. hypertension d. arthritis and rheumatism e. diabetes f. cardiovascular disease g. cancer - nearly 50% rural vs. 25% nonrural have chronic conditions - tend to have poorer health and less likely to seek medical care - traveling time and/or distance to ambulatory care services affects access to care - health providers: a. live and practice in a particular community for decades b. may provide care to people who live in several counties c. small staff to service large area - health professional shortage What is there a need for in most rural areas? - school nurses - family planning services - prenatal care - care for individuals with AIDS and their families - emergency care services The Rural Registered Nurses The Health Resources and Services Administration (HRSA) document The U.S. Nursing Workforce: Trends in Supply and Education (2013) notes that rural RNs are: Nearing retirement – Nearly one million RNs who are older than 50, about 1/3 of the current workforce, will reach retirement age in the next decade. More likely to be white – 91.2% of RNs working in rural areas are white, compared with 72.4% of RNs in urban areas. Less likely to have a bachelor's degree – 51.6% of RNs working in rural areas have a nursing diploma or an associate's degree as their highest level of education, compared with 35.3% of their urban counterparts. Less likely to work for a hospital – 59.4% of RNs working in rural areas are employed in hospitals compared with 63.9% of urban RNs. About 16% of the RN workforce – From 2008 to 2010, there were 2.8 million RNs in the workforce. Of that number, 445,000 live in rural areas. The 2017 HRSA report Supply and Demand Projections of the Nursing Workforce: offers state-level projections for RNs and LPNs for the year 2030. Women's Health in Rural Areas - higher infant and maternal morbidity rates a. live on or near Indian reservations b. are migrant workers c. are of African-American descent and live in rural counties of states in the deep south d. are victims of sexual assault Children's Health in Rural Areas - urban children more likely to see a pediatrician when they are ill - rural adults and children more likely to have a general practitioner as regular caregiver - children who work on farms: a. highest rate of farmworker injuries boys 16-18 (tractors, off terrain vehicles, working with cattle, farm hand tools, barbed wire, falls) - school nurses scarce Mental Health in Rural Areas - delay seeking care - depression a. high rate of poverty b. geographic isolation c. insufficient number of mental health services - domestic violence - alcohol, tobacco, and other drug use and abuse What high-risk industries are found primarily in rural areas? What are some occupational and environmental health problems due to these industries? - lack of OSHA regulation for farming and ranching - common injuries - exposure to chemicals a. pesticide exposure What are some barriers to care in rural health care delivery? - available - affordable - accessible - acceptable services and professionals What does Healthy People 2020 say about rural health? - consider rural factors - community must be involved in developing the plan and assume some ownership of it - consider how to use resources What are some ways of connecting rural providers and consumers? - text messages - telehealth Migrant Farm Worker - an individual who travels 75 miles or greater to obtain a job in US agriculture - a person whose "principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months and who establishes for the purpose of such employment, a temporary abode" - seasonal farm workers work cyclically without migrating Migrant Worker Statistics - 2-3 million migrant farm workers in the US - 71% male, 29% female - average age: 37 years - 28% do not speak English at all - 9% somewhat - 3-5 million follow crops - 70.7% foreign born a. 64.1% Mexico b. 53% have legal authorization to work in the US Migrant Farm Workers: Language and Education - likely to speak the native language of their country of origin with limited English - may not be able to read/write English - likely to have less than a high school education Migrant Farm Workers: Economics retirement benefits Migrant Housing Issues - availability varies by site - may be in camps, trailers, cabins - some may sleep in cars or tents - may be in overcrowded conditions (at risk for communicable diseases) - much of the housing is substandard, lacks adequate sanitation, and working appliances How do our migrant farm workers travel? Three 'streams' of travel California, Oregon and Washington Texas/Arizona moving thru the Mississippi River Valley and into the mid-west Eastern Stream: Florida/Georgia, Carolinas, Maryland, Delaware, New Jersey, New York and New England Are "streams" a thing of the past? - less pronounced, fewer "follow the crop" migrants - fading streams may be related to increases in speciality farming vs. multiple crops - advent of some mechanical harvesters may interrupt the "sequence" of the stream - work is dependent on weather, status of the crops, "first come, first employed," go where the work is Eastern Stream Demographics Ethnically heterogeneous Jamaicans, Haitians, Puerto Ricans, Mexicans, Mexican Americans and African Americans Connecticut River Valley CT Long Island Sound to Massachusetts border of VT, 100 miles long, 20-30 miles wide Connecticut River Valley Farmworker Health Program Free health care services & outreach to farms The Experience in the Connecticut River Valley Largest agricultural region for migrant farm worker employment in New England 2014 - 4,900 farms in Connecticut; 400,000 acres; 5,920 farm workers Seasonal workers account for 60-75% of farm workers 50% come from out of state: 60% Mexico 20% Guatemala 10% Jamaican 2% American What New England crops use a migrant farm workers? - field crops - landscape nurseries What are environmental stressors of migrant workers? - hard physical work - long hours - fatigue - unhealthy living conditions - unhealthy work conditions - social isolation - depression, anxiety - geographic isolation What are some other factors impacting health? - transient nature of the population - fatalistic attitude towards illness - mistrust of health system and/or providers of the dominant culture - definitions of health/illness What are some health issues experienced by migrant farm workers? - high rate of toxic chemical injury/illness - high rates of HIV/TB/CA/HTN/diabetes - increased occupational fatality rate - exposure to carcinogenic agents (pesticides, sun, chemicals, solvents) - respiratory illnesses - dermatitis - parasitic infections Health Issues: Female Workers - occupational illness and injuries - reproductive issues - lack of prenatal care - domestic violence - sexual abuse - mental health (depression, anxiety) Health Issues: Children/Adolescents - pesticide related illnesses - respiratory illnesses - musculoskeletal injuries - over/under immunized - dental caries - lead exposure - accidents - difficulty completing their education Barriers to Access to Care: Culture - language - expectations of patient/provider relationship - beliefs about health/wellness/illness - folk/home remedies - community elder/healer - structure of the social group/familial roles Barriers to Access to Care: Geographic - mobility required to secure employment - continuity of care/health history - rural location of most farms - hours of work vs. hours of clinic operations - lack of transportation Barriers to Access to Care: Financial/Legal - low wages/variations in earnings or employment - disincentives to miss work - lack of health insurance - eligible/not eligible for benefits a. cannot maintain primary care provider b. benefits may be linked to residence in particular state c. fears of deportation Migrant Health Program Authorized by the Migrant Health Act (1962), the federal Migrant Health Program provides funds to health centers located around the country to provide health care to nearly 800,000 farmworkers and their families every year. Affordable Care Act of 2010 - 47% covered by employer-provided health insurance - others do not receive employed mandated coverage because small farms may be exempt and working less than 120 days/year at a particular employer - undocumented excluded from individual insurance coverage mandates How does the migrant farm worker impact the health system? - ER use only - no follow-up - no prevention/health maintenance - increase costs for care due to severity of illness/injuries - treatable illnesses vs. death/disability Nurse-Client Relationship - respecto - respect to the individual - personalismo - relate to the individual - dignidad - dignity - simpatia - polite, non-aggressive - cultural humility - linguistic capability Nursing Interventions As We Move "Upstream" Advocacy Political activism Awareness of the unique health issues associated with the occupation Development of working relationships with providers Education of providers THE HEALTH IMPACTS OF CLIMATE CHANGE: THE CRITICAL ROLE OF NURSES Air Quality Impacts - exacerbation of acute and chronic respiratory conditions - throat irritation, cough - increase in allergies - congestion - impaired lung function Temperature Related Impacts - heart attack - cardiac dysrhythmia - hypertension - stroke - heat stroke - sudden death Vector Borne Diseases - lyme Water Impacts - bacterial infection - diarrhea - dehydration - cholera and other serious infections - more toxic algal blooms Mental Health Impacts - acute traumatic stress - depression - anxiety - post-traumatic stress - sleep disruption - substance abuse Mitigation and Adaptation - stop burning fossil fuels as fast as possible - rapidly shift to renewable sources of energy - reduce energy use through EE initiatives - electrification of our transportation system Nurses' Role ANA, state organizations Meet your municipal and state legislators Advocate for policies that will mitigate climate change Take steps within your own practice setting CHAPTER 6: ENVIRONMENTAL HEALTH Nursing: Historical Perspective Florence Nightingale: Crimean War Mary Brewster: Henry Street neighborhood Environmental contamination Poverty and exposure to environmental hazards What percent of communicable and non-communicable diseases are influenced by environmental hazards? over 80% What percentage are environmental factors responsible for the total burden of the disease in the world? over 1/2 What are some environmental health sciences? - toxicology - epidemiology - multidisciplinary approaches Toxicology the basic science that studies the health effects associated with chemical exposures Epidemiology epidemiology triangle (agent/host/environment) Vulnerable Population: Children - breathe more rapidly than adults = greater exposure to air pollutants - contact with ground - pregnant women - infant development Vulnerable Populations: Elderly - population is aging - 2015 - 8.5% of world population age 65+ - 2050 - 25% (1.6 billion) - preparing older citizens for global climate change - physiologic changes make older persons more vulnerable to climate change - reduced ability to regulate body temperature; sense of thirst and awareness of dehydration - decreased cardiac reserves; respiratory muscle strength; immune response What are some ways to reduce environmental health risks? - ethics a. sacrifice self interests for greater good? - apply the basic principles of disease prevention - risk communication a. right information b. right people c. right time - governmental environmental protection a. enforcement b. permitting (construction, discharges, emissions) - environmental standards Clean Water Act - EPA authority to set effluent standards - focus toxic pollutants, funded sewage treatment plants Clean Air Act defines EPA responsibilities for protecting and improving nation's air quality Toxic Substance Control Act give EPA ability to track 75,000 industrial chemicals currently produced or imported Occupational Safety and Health Act (OSHA) ensure workplace safety (chemicals, noise, mechanical dangers, unsanitary conditions, heat/cold) The Right to Know Laws - public has right to know about hazardous chemicals in the environment - EPA Envirofacts What are things we look at when assessing environmental health? - air (indoor/outdoor) - water - land/soil - food - chemical - biological - radiological - Windshield surveys - environmental databases - environmental health assessment form - inquire/observe about unintended environmental exposures What are reasons we have to prepare the elderly for global climate change? - limited access to health care and medication in crisis - isolation What are some adaptive strategies for secondary prevention efforts? - built environment a. home weatherization and cooling systems b. sidewalk plowing c. shade shelters - community services a. warming centers b. registries for vulnerable elderly c. community evacuation plan d. insect control - protective policies a. outdoor worker hours and clothing b. sanitation c. water resource management - education a. safe activity guidance during inclement weather b. disaster preparedness c. community agency resources What are some things nurses can do for advocacy? Write letters to local newspapers responding to environmental health issues affecting the community. ● Serve as a credible source of information at community gatherings, formal governmental hearings, and professional nursing forums. ● Volunteer to serve on state, local, or federal commissions. Know the zoning and permit laws that regulate the effects of industry and land use on the community. ● Read, listen, and ask questions. As informed citizens, nurses can lead in fostering community action to address threats to environmental health. What are some ANA principles? - essential that nurses know about environmental health - nurses should not use products or practices that harm health or the environment - nurses have a right to work in a safe and healthy place and nurses and other health care professionals have the right to know in a timely manner about any possible harmful products, chemicals, pollutants, and hazards to which they may be exposed - multidisciplinary collaboration is a factor that sustains a healthy environment - the choice of materials, products, technology, and practices in the environment that affect nurses is based on best practices - nurses should respect the diversity of the people whom they serve and also focus on the quality of the environment in which they and their clients work and live - nurses, other health care workers, families, patients, and communities have the right to know timely information about potentially harmful products - nurses should participate in both research and advocacy related to promoting a safe and healthy environment What are some government health care functions? - direct services - financing a. National Institute of Nursing Research (NINR) - information a. health, United States - policy setting - public protection Referral Resources - no single source of information about environmental health is available, nor is there a single resource to which individuals or a community can be referred if they suspect an environmental problem - start points: a. the environmental epidemiology unit or toxicology unit of your state health department or environmental agency b. environmental health experts in nursing or medical schools, or schools of public health c. Association of Occupational and Environmental Clinics What are the 3 branches of government? 1.) executive 2.) legislative 3.) judicial Nurses Role: Mitigation - individual, community, institutional, governmental levels - energy conservation policies procedures - rational transportation practices - changes in consumption (1) Executive - president - suggests, administers, regulates policy - US Department of Health and Human Services (USDHHS) - mission to enhance and protect the health and well-being of all Americans Nurses Role: Response - planning for long-term high heat weather conditions - storm preparation - fires preparation - disaster preparedness (2) Legislative - Congress - identifies problems and proposes, debates, modifies and passes laws to address the problems CHAPTER 7: GOVERNMENT, THE LAW, AND POLICY ACTIVISM (3) Judicial interprets laws and their meanings and interprets state's rights to provide health services to citizens Policy a settled course of action to be followed by a government or institution to obtain a desired end Article 1, Section 8 of US Constitution - most legal bases for actions of Congress in health are found in Article 1, Section 8 - provide for the general welfare welfare of citizens ex. states requiring immunization of children Health Policy a set course of action to obtain a desired health outcome, for an individual, family, group, community, or society Medicare Act of 1965 - 1st federal health insurance program - establishes Medicare health insurance program for the elderly, and Medicaid health insurance for the poor Politics the art of influencing others to accept a specific course of action Patient Protection and Affordable Care Act 2010 - enacted by 111th Congress and signed by President Obama - most significant regulatory overhaul and expansion of coverage since Medicare - mandated that everyone get health insurance or pay a tax - insurance for 95% of legal population - purchase through health insurance exchange - attempts to repeal Sheppard-Towner Act 1921 - provided federal funding for maternity and child care - made nurses available to provide well-child and child-development services - defined how the consumer could influence, formulate and shape public policy - 3,000 child and maternal health centers created over 8 years - Rep. Jeannette Rankin (Montana) What is rising in the US as it declines elsewhere? maternal mortality What are some organizations and agencies that influence health? World Health Organization (WHO) - (1946) “Health for All” World Health Assembly (WHA) – WHO’s health policy making body – policy statements Federal health agencies Health Resources and Service Administration (HRSA) – programs / education for health professions Centers for Disease Control and Prevention (CDC) – mission is to promote health and quality of life by preventing and controlling disease, injury, and disability National Institutes of Health (NIH) – uncover new knowledge to lead to better health for everyone National Institute of Nursing Research (NINR) – focal point for nation’s nursing research What is the nurse's role in the policy process? - the number and types of laws influencing health care are increasing - legislative action - regulatory action - the process of regulation - nursing advocacy Learn More You can also click on terms or definitions to blur or reveal them