NR 503 Week 4 Midterm Study Questions and Answer

- Healthy People 2020 is a national document with agreed-upon national objectives that guides and assists APNs to focus on and identify levels of population healthcare for persons across the life span. Determinants of health- The range of personal, social, economic, and environmental factors that influence health status. Risk analysis- a technique used to identify and assess factors that may jeopardize the success of a project or achieving a goal. Epidemiological triangle- 3. What is the Campaign for Action? 7 issues- access to care, collaboration, nursing leadership, education diversity, data collection, healthier community. 4. Explain the differences between primary, secondary, and tertiary interventions? Primary- PREVENTION. Usually, primary prevention occurs through application of epidemiological concepts and databases to assess risk factors and then target those populations in which there can be the greatest impact on outcomes to ward off impending disease or unhealthy outcomes. Secondary- SCREENING AND DIAGNOSIS. Secondary prevention is one of the most cost-effective strategies to improve current health status and prevent chronic, debilitating disease states through screening of individuals and populations. Tertiary- consists of interventions aimed at interventions to facilitate the rehabilitation of the patient to the highest level of functioning while addressing the risk factors that could further result in the deterioration of the patient's health. For example, an APN would counsel a patient who has had a myocardial infarction about the risk factors that could elicit further debilitation. The client may be encouraged to lose weight and commit to an appropriate exercise program while being closely monitored for cholesterol levels, and so on. Certainly a cardiac rehabilitation program could be of value to this patient. As stated above, accepted national clinical guidelines should be utilized as a benchmark for this follow-up care. Key Points- Can you answer these? 1. Is screening a tertiary intervention? If yes, why, if not, what is it? ***Screening is not a tertiary intervention; it is a secondary intervention. Screening for further debilitation could take place at the tertiary level but is not considered a tertiary intervention. 2. How does a provider determine the usefulness, appropriateness, of a screening test? The validity of any screening test is the ability of that test to distinguish correctly who has a disease. For example, you as the provider might want to know what the validity of the tuberculin skin test is for identifying TB or the rates of people who have the disease but might be missed, and vice versa. Validity is based in both the specificity (the ability of a test to correctly identify those who do not have the disease) and sensitivity (the ability of a test to correctly identify those who have a disease). This can be defined in the following fractional representation. SENSITIVITY = Those who are TRUE POSITIVES TRUE POSITIVES + FALSE NEGATIVES SPECIFICITY = Those who are TRUE NEGATIVES TRUE NEGATIVES + FALSE POSITIVES A final area of consideration for any healthcare provider in ordering and interpreting test results is the positive and negative predictive value of that test, or PPV and NPV. Positive predictive value is a proportional value of the proportion of people in any given population who are screened as positive and who actually have the disease. PPV is the number of true positives divided by everyone who tested positive. Negative predictive value is also a proportion, but is the opposite (and the probability that a result is a true negative). It is the