Public Health After Exam 2

Front 1

substance abuse

Back 1

people are diagnosed as having substance abuse when they exhibit the following behaviors associated with substance abuse: problems @ work, problems w/ friends, physical danger, trouble with law

Front 2

addiction

Back 2

WHO recommends be substituted with substance DEPENDENCE. full range of behavioral probelsma dn continued use in spite of these problems

Front 3

substance dependence

Back 3

withdrawal symptoms and tolerance: health and emotional problems associated w/ substance use
ex. prescribed use of analgesics
unsuccessful efforts to cut down
symptoms of tolerance or withdrawal
reducing other activities to use substance
spending time in activities r/t substance use

Front 4

abstinence

Back 4

no use of illicit substances or alcohol in the preceding 12 months---considered "abstinent"

Front 5

Nurses & Substance Abuse

Back 5

observe symptoms when pt has different complaint.
know rates of use in special populations
be aware of community trends, prevention, treatment.
participation in community task forces, policy development, consultation to agencies, awareness

Front 6

National Scope of Experience and Evidence

Back 6

USA= high proportion who abuse/depend on illicit substances
weed is most frequently used
patterns of dependence vary by age, gender, race, ethnicity, geographic location

Front 7

Community Impact of Substance Abuse

Back 7

change focus from the individual to the community
impacts:
health, legal, social services, work force

Front 8

Florida's "Pill Mill"s

Back 8

offices set up with intent to distribute huge amounts of opioids. impact of law requiring tracking of controlled substance prescriptions written and/or filled
October 2011

Front 9

High Risk Groups

Back 9

high risk for MORBIDITY:
- pregnant women
- children under the age of 14
- college students, older adults in the baby-boom generation

Front 10

Is opioid use really a problem?

Back 10

adolescent use of opioids is increasing.
mortality rate for opioids is increasing.

Front 11

pregnancy and substance abuse

Back 11

substance: type/volume/frequency/duration
stage of fetal development
impact of maternal withdrawal
impact on birth weight, prematurity, muscle tone, etc.

Front 12

withdrawal and pregnancy

Back 12

goals: prevent fetal withdrawal, which can cause miscarriage in early pregnancy and premature labor

Front 13

substance abuse during pregnancy child abuse?

Back 13

some states view prenatal substance use as child abuse.
Florida is NOT considered child abuse

Front 14

"Gateway Drugs"

Back 14

most common: tobacco
next: alcohol
next: weed

Front 15

What is gateway theory?

Back 15

if you are willing to break a law, you are more likely to continue breaking it. evidence does support it.

Front 16

environmental factors associated /w substance abuse

Back 16

poverty, lack of access to health services, capacity of law enforcement to constrain supply, ethnic groups:
native americans, alaskan natives, african americans

Front 17

Religious/ cultural values r/t substance abuse

Back 17

peyote, hashish, iboga shrub, communion wine:
prescribed use vs required abstinence

Front 18

Biopsychosocial Risk Factors

Back 18

genetic history, family history, social learning, history of trauma, early initiation (earlier- more of an issue)
poverty, group affiliation

Front 19

Self-Medication Hypothesis

Back 19

you pick which substance becomes your favorite depending on your "disease"
-Depression= stimulant
-Rage= alcohol
-ADD/ADHD= cocaine
recreational use --> dependence/addiction

Front 20

Population Based Inventions: Adolescents

Back 20

population based interventions to decrease substance use among adolescents: law enforcement, developmentally appropriate prevention efforts, early screening, harm reduction

Front 21

Harm Reduction example

Back 21

needle exchange programs:
1. sterile syringes & needles
2. less risky routes of administration
3. decrease/ crease substance use
4. access to other health service
HOOK

Front 22

College Students & Binge Drinking

Back 22

primary prevention: education targeting all students
developmentally appropriate prevention programs
early screening and brief interventions
government laws/school policies to reduce harm
tertiary treatments for those who meet criteria for substance use disorder

Front 23

Older Adults: Assessment

Back 23

screen based on age appropriate behaviors
screening for alcohol and prescription drug use is recommended yearly for all older adults and more frequent screening as needed.
Use multiple medication leading to "chemical soup" in brains

Front 24

Behavioral Counseling of Alcohol Abuse: Older Adults

Back 24

standardized screening instruments
advise older adult to reduce alcohol consumption to moderate levels
review all medications for problems
agree on goals for reducing alcohol use/ abstinence
arrange follow-up counseling & treatment

Front 25

methamphetamine users

Back 25

school nurses have to be part of the solution to methamphetamine epidemic through education.
ENVIRONMENTAL HAZARDS, TOXICITY TO CHILDREN, PRISON VS. DRUG TREATMENTS

Front 26

Opioid Addiction & brain

Back 26

1. opioids attach to receptors in brain -> pleasure
2. repeated opioid use -> tolerance
3. absence of opioids after prolonged use-> withdrawal

Front 27

Pain Disorders & Addiction

Back 27

all opioids can create dependence
tapering of analgesics as possible
maintenance w/ long acting narcotics sometimes needed
pain management is a specialty
nurses can advocate for adequate pain control
former opioid addicts need pain control, too

Front 28

Pharmacologic Treatments for Alcohol- Dependent Disorders

Back 28

Naltrexone, Acamprosate, Disulfiram

Front 29

Evidence Based Psychosocial Treatments in Substance Use Disorders

Back 29

evidence-based modalities for people w/ substance use disorders
- cognitive behavioral strategies that focus on relapse prevention
-motivational enhancement therapy

Front 30

Treatment

Back 30

identify problem, education: relevant & meaningful, rarely sufficient.
Must tip person's thinking away from negative choices

Front 31

Are nurses at higher risk than general population?

Back 31

nurses are at higher risk for substance abuse due to coping strategy & access to meds.

Front 32

emergencies

Back 32

considered events that require a swift, intense response on part of existing community resources

Front 33

disasters

Back 33

unforeseen, serious, and unique events that disrupt essential community services and cause human morbidity and mortality that cannot be alleviated unless assistance is received from others outside the community

Front 34

Types of Disasters

Back 34

Natural: earthquake
Accidental: oil tanker spills
Terrorist attacks: ricin attacks on subway riders in Japan

Front 35

Disaster Management

Back 35

Preimpact
Impact
Postimpact

Front 36

Preparedness

Back 36

although disasters do not occur with frequency, planning with vulnerability assessment can reduce the impact on the community

Front 37

Identification of Hazards

Back 37

identification of all existing and potentially dangerous situations before disasters occur is the first step in planning fro an effective response.

Front 38

Analysis of Vulnerability

Back 38

predicts who will be affected the most and identifies community resources that are available for a response.

Front 39

Assessment of Risk

Back 39

comprehensive data gathered from hazard identification and vulnerability analysis. PROBABILITY OF ADVERSE HEALTH EFFECTS

Front 40

National Incident Management System

Back 40

structured, flexible framework that guides the response to disasters at all levels of government, private companies, and nongovernmental organizations

Front 41

Mitigation

Back 41

effort to prevent identified risks from causing a disaster. involved efforts to lessen the impact of a disaster by initiating measures to limit damage, disease, disability, and loss of life among the members of a community

Front 42

Response begins where?

Back 42

all response begins at the LOCAL level, where the disaster management plan is implemented and responders are deployed

Front 43

Incident command system

Back 43

common organizational structure implemented to improve emergency response. Chaos at disaster scenes can be magnified by poorly coordinated communication amongst responding individuals/groups

Front 44

DEEP Center

Back 44

Disaster Epidemiology Emergency Preparedness
free course

Front 45

Recovery

Back 45

stabilization of the community and the return of the disaster area to its previous status

Front 46

Adverse Health Effects after any kind of Disaster

Back 46

continuing death, chronic illness, and/or disability. Population shift if recovery is prolonged. Contamination of food and water supplies, with an increased risk of infectious diseases.
Collapse of local and regional health care access
Increased need to provide mental health services PSYCHOLOGICAL FIRST AID for disaster victims and responders

Front 47

Evaluation

Back 47

foundation for evidence-based disaster response. Following a thorough review of the responses, a final report is prepared with recommendation for improving emergency response in the future.

Front 48

Role of Nurses in Disaster Mangament

Back 48

public health nurses as first responders.
JITT, field triage, point of distribution plans, personal protective equipment, documentation in a disaster, skill building for disaster response

Front 49

JITT

Back 49

Just In Time Training

Front 50

POD

Back 50

point of distribution plans

Front 51

PPE

Back 51

personal protective equpment

Front 52

Disaster Triage
START

Back 52

Simple Triage And Rapid Treatment
Red (critical)
Yellow (urgent)
Green (delayed)
Black (expectant)

Front 53

FEMA's Emergency Management Institute

Back 53

offers self-paced courses designed for people who have emergency management responsibilities and the general public. All are offered free of charge and online

Front 54

Bioterrorism

Back 54

categories of bioterrorism agents. can be easily disseminated or transmitted from person to person. results in high mortality rates. potential for major public health impact. may cause public panic. biological organism

Front 55

Epidemiology and Bioterrorism

Back 55

must known community baseline for diseases to detect deviations.
The better the agent, the harder it is to detect until it is TOO LATE (delayed symptoms)

Front 56

Detection of a Bioterrorism Event

Back 56

Category A Agents
-Anthrax, Botulism (most potent), Plague, Smallpox, Tularemia, Viral hemorrhagic fevers

Front 57

Chemical Disaster

Back 57

symptoms appear when released, makes its presence known IMMEDIATELY through observation (explosion), self-admission (accidental) or the occurrence of rapidly emerging symptoms, such as burns, difficulty breathing, or convulsions

Front 58

Fear

Back 58

Actual Biological or chemical agent + FEAR= disabling impact

Front 59

Personal Protective Equipment to use in hazardous material attack

Back 59

Agent type + EXPOSURE RISK= type of PPE to use

Front 60

Determine to stay of go in Chemical Disaster

Back 60

based on: hazardous material, population threatened, time span involved, current and predicted weather conditions, ability to communicate emergency information

Front 61

Evacuation

Back 61

occurs when there is potential for massive explosions and fire as well as for long-duration event

Front 62

Invacuation

Back 62

where people in a hospital or residential facility may be moved to another floor or area within the facility, may occur

Front 63

Radiological Disasters

Back 63

Health outcome depends on:
-amount or dose of radiation absorbed
-type of radiation
-route of exposures
-length of time exposed to the dose

Front 64

Public Health Disaster Response

Back 64

scope and magnitude of response.
communication during a disaster.
recovery and after action evaluation.