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58 Cards in this Set
- Front
- Back
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Primary Prevention:
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focus on health of a population with the goal to prevent disease (immunizations)
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Secondary Prevention:
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Screen those at risk (PAP, Mammogram)
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Tertiary Prevention:
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long-term disease or disability exists; minimize complications and maximize function
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Community Health Nursing:
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focuses on client and populations as community
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Community Based Nursing:
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focuses on individuals and families within the community
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Levels of Healthcare: Primary
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•Health promotion
•Health Education •Specific Protection (immunizations) •Early detection & tx •Environmental protection |
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Levels of Healthcare:Secondary
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•Emergency Care
•Acute & critical care •Elaborate diagnosis and treatment |
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Levels of Healthcare:Tertiary
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•Rehabilitation
•Long-term care •Care of the dying |
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Lice (Pediculosis Capitis, Corporis, & Pubis)
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•Transmitted by personal contact with persons with people harboring them or thru contact with articles that harbor them
•Identify by seeing lice with naked eye or by using hand lens or microscope •Head & pubic lice-see nits on hair shaft within 1cm of skin •Body lice and eggs found in seams of undergarments |
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Head Lice
overview |
•Common in school-age children
•Itching, oily, matted, foul-smelling odor •Visualization of nits & secondary infection of scalp |
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Head Lice Treat With
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•Treat with NIX shampoo; use Lindane if > age 2 10 days later; Suffocation based pediculoside (DSP) applied then blown dried with a hair dryer weekly for 3 weeks
•Do not use shampoos or cream rinses prior to application and for 8 hrs after •Use cool water to rinse hair •Remove nits with fine-tooth comb •Inspect scalp 24-48 hrs after tx |
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Prevention of Head Lice
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•Wash clothing, bed linens, and towels in hot water on hot cycle
•No sharing of combs, brushes, head gear •Soak combs and brushes in hot water for 10 mins •Vacuum carpets and car seats •No environmental insecticides •Screen household and close school contacts •“No nit” policy for return to school |
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Body Lice
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•Rare in US
•Itching in affected areas •Minute red lesions on body •Found in seams of undergarments •Only body lice can transmit disease •No pediculocide needed-wash infected clothing and linens in hot water and dry on hot cycle |
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Pubic or Crab Lice
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•Common in sexually active adolescents or adults
•Found on pubic hair, chest hair, axillary hair, eyebrows, eyelashes, or beards •Treat with same OTC agents as for head lice •Pyrethrin-based products (A-200, RID, Pronto) •Apply vaseline to eyelashes BID •Prophylactic tx of sexual contacts with pubic lice due to high co-infection rate |
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Scabies
overview |
•Disease of the skin produced by burrowing action of parasitic mite resulting in irritation and formation of burrows, vesicles, or pustules
•Sarcaptes sabei •Female lays eggs in tunnels •Occurs in all socioeconomic classes •Transmitted by direct contact with infected people or contact with contaminated clothing or bedding |
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S/S of Scabies
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•Nocturnal itching
•Secondary skin infection •Gray, white burrow threadlike liken between fingers, axillary folds, buttock folds, along belt line, male genitalia, female breast, knees, & ankles •Incubation period 4-6 weeks |
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Treatment of Scabies
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•Scabicide
•Elimite 5% or Lindane-caution if under 2yrs •Apply scabicidal ointment on entire body from neck down and treat head, neck, and body of infants and young children •Wear gloves to treat •Not contagious 24 hrs after tx •Launder all clothing, bed linens and towels used 4 days prior to therapy in hot water •Itching may persist for 2-3 weeks after therapy due to hypersensitivity reaction of mites •Treat all household contacts of person know to have scabies |
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Scabies
Treatment: |
Hot bathsScrubbing to open and expose burrowsApplication of Scabicide (Kwell, Scabene)must be left on for 4-6 hoursEveryone in the household must be treated
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Herpes Simplex I (HSV I)
overview |
Infection typically occurs in childhoodFluid-filled blisters that rupture and leak a sticky, clear fluid and then crust overUsually occur on the mouth, may also have swollen gums & feverBecome dormant & periodically erupt into lesions (cold sores)Genital infection of HSV 1 recur about once a year
Herpes Simplex I (HSV I) Three Phases in HSV recurrences:Prodrome: burning/tingling/or itchingOutbreakHealingViral shedding occurs during all three phases |
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Treatment of Herpes Simplex
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•Dx with smear from ulcer
•Use anti-viral tx with Zovirax or Valtrex-may use topical or oral for acute outbreaks or prevention •Can be transmitted via close and sexual contact •May be genital •Recurrence brought on by illness, stress •Lesions resolve in 1-2 weeks •Avoid contact with immunosupressed persons |
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Clinical S/S of Herpes Genitalis
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•Lesions 2-10 days after initial exposure with fever, malaise, h/a, and lymphadenopathy with primary infection
•Lesions preceded by sensation of tingling •Proceed from vesicles on erythematous base to painful ulcers that crust and heal •Internal lesions cause watery discharge and dyspareunia •Recurrent with stress, illness |
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Treatment of Genital Herpes
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•Antivirals-Zovirax & Valtrex
•IV if immunocompromised host •Episodic or continuous oral tx •Pain med •Local comfort measures-Lidocaine gel, sitz baths •Avoid intercourse from first sign of active outbreak to resolution of lesions (2 weeks with primary infections and 1 week with recurrent) •Safer sex practices at all time-viral shedding when asymptomatic |
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Radon
overview . |
Radon is:A naturally occurring radioactive gas.Produced in the ground through the normal decay of uranium and radium.Produces new radioactive elements called radon daughter or decay productsRadon and radon daughters are colorless, odorless and tasteless
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Childhood Lead Poisoning
overview |
Interferes with the development of a child’s nervous system, bones and kidneys
It can cause permanent damage resulting in learning and behavior problems Children under age six are most at risk Massachusetts Lead Law requires that all children be screen for lead annually between the ages of 8 and 48 months |
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S/S of Lead Poisoning
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•Pica
•Lead concentration in femur, tibia, radius, •Neuro findings •GI findings •Renal •Hematologic •Musculoskeletal •Soft Tissue •Endocrine •Serum Lead level > 1.2umol/L |
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Early s/s lead poisening
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fatigue
ha irritability metallic taste uneasy stomach poor appetite weight loss reproductive problems |
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Late s/s lead poisening
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Memory prob;e,s
nausea kidney problems weight loss constipation weak wrists/ankles |
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Childhood Lead Poisoning
Treatment: |
Chelation therapy/binds with lead
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Lyme Disease (Borella burgdorfei)
overview |
•Carried by deer ticks
•Erythema migrans is first sx in 60% of clients •Annular skin lesion at site of tick bite that expands with central clearing •Flu-like s/s •Mylagia, arthralgia, lymphadenopathy •Weeks to months after onset-limb weakness, facial palsy, ataxia, and aseptic meningitis •Incubation 3-32 days after exposure |
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S/S of Rabies
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•Initial s/s nonspecific
•Malaise, fatigue, h/a, sense of apprehension, pain at site of exposure •Incubation 2-6 weeks •Progresses to paralysis, hydrophobia, and delirium and convulsions •Respiratory arrest occurs followed by death |
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Management of Rabies
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•Prevention!
•Supportive cardiac and respiratory therapy •Contact Isolation for Resp. Secretions •High dose of passive rabies immunoglobulin of vaccine after onset of illness not successful •Almost always fatal due to respiratory failure |
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Food Contamination / Poisoning
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SalmonellaE. ColiBotulism
Campylobacter Clostridium Staph Aureus Mushrooms Shellfish Norwalk virus Toxoplasma gondil |
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Salmonella
def |
Germs (bacteria) that cause Salmonellosis of the bowel in humans and animals
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Salmonella s/s
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cramps & diarrhea fever, nausea & vomitingSymptoms begin 12 to 36 hours after germs are ingested
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Salmonella
How is it spread? |
Germs must be swallowedContaminated FoodNot washing handsusing the toiletchanging diapershandling reptiles
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Salmonella
Foods most likely to spread it: |
Eggs & egg productsMeat & meat products: Poultry
Unpasteurized milk & dairy products Proper cooking will kill salmonella |
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E. Coli
Sx & Sx: |
Diarrhea & Cramps (most common)
Vomiting & fever Diarrhea turns bloody after 2-3 days Symptoms usually go away by themselves after 6-8 days |
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Hemolytic Uremic syndrome (HUS)
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E. Coli 0157:H7 can cause HUS in a small # of people Affects the kidneys and the blood clotting systemStarts about 7 days after the diarrhea beginsAffects more children than adults
Dialysis may be needed Most people will fully recover |
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E. Coli
Prevention: |
Cook hamburgers until center is 155 degrees F.
Thoroughly wash your hands Do not eat unpasteurized dairy products Do not eat undercooked or rare ground beef Once a dish has had raw meat on it, it must be washed before it is used again |
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•Botulism
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Found in improperly canned foods or foods in dented cans, especially corn, green beans and peas.
–Also found in improperly stored or heated restaurant foods. –Infant botulism can be caused by spores in honey |
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Campylobacter
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–Found in the stool of poultry, other birds, and other farm animals
–Children get it easily from eating improperly cooked poultry or drinking unpasteurized milk. |
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Clostridium
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–Found in the stool of humans and other animals.
–Children most often get it when food handlers have not washed their hands properly. –Food is left out for awhile, as on a steam stable (“cafeteria cramps”) |
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Staph Aureus
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–Organism is a common cause of skin infections, from impetigo to pimples to boils.
–Gets into food during improper food handling. –Warm food (100 degrees) is the ideal place for the bacteria to grow and produce a toxin. –Toxin is NOT destroyed by cooking. |
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Shellfish
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–During red tides, contain nerve toxins.
–These can cause paralysis, unusual sensations, and hot-cold reversal, among other symptoms. |
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Cytomegalovirus
overview |
•CMV is found throughout the world in all geographic and socioeconomic groups, but, in general, it is more widespread in developing countries and in areas of lower socioeconomic conditions
•CMV is a member of the herpes virus family, which includes the herpes simplex viruses and the viruses that cause chicken pox (varicella-zoster virus) and infectious mononucleosis (Epstein-Barr virus) •CMV is found in body fluids, including urine, saliva (spit), breast milk, blood, tears, semen, and vaginal fluids •Once CMV is in a person's body, it stays there for life •Most CMV infections are "silent," meaning they cause no signs or symptoms in an infected person •CMV can cause disease in unborn babies and in people with a weakened immune system |
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Cytomegalovirus (CMV)
spread by |
•Spread by direct contact with mucous membranes, secretions and excretions
•Sexually transmitted by intercourse •Transmitted via transfusion and organ transplantation •A fetus may be infected in utero or at delivery |
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Clinical Manifestations of CMV
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•Asymptomatic
•Clinical disease in teens and adults resembles mono •More extensive organ involvement in immunocompromised host (colitis, retinitis, pneumonitis) •GI tract disorder •Congenital infections lead to irreversible CNS and liver infections •Incubation 3-12 weeks after transfusion, 1-4 months after transplants •Neonates-3-12 weeks after delivery |
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Dx of CMV
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•Virus CX
•CMV antigen detection •Serologic studies for CMV specific IgM antibody or a fourfold rise in titer •HIV testing if indicated |
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Management of CMV
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•Supportive therapy to control fever and sore throat if present
•Immune gamma globulin for prophylactically for organ transplantation •Gancyclovir (Foscarnet) for retinitis in HIV-infected individuals •Avoid activity if splenomegaly •Report excess bruising or bleeding, jaundice, or abnormal CNS functioning •Counsel pregnant women to practice good hand hygiene |
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Bacterial Meningitis
Organisms: |
Gram-positive Cocci: Staphlococcus, Streptococcus & Diplococcus
Gram-negative Rods:Klebsiella species, & Pseudomonas Gram negative Cocci: Haemophilus influenzae Gram negative diplocci: Neisseria meningitidis |
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Risk Factors for Bacterial Meningitis
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•Traumatic brain injury
•Systemic infection •Post-surgical infection •Meningeal infection •Anatomic defects •Acute & Chronic sinusitis |
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Clinical Manifestations of Bacterial Meningitis
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•Fever, h/a, and nuchal rigidity
•Altered mental status •Petechial (rug burn) or purpuric rash from coagulopathy •Photophobia •Nuchal rigidty, neck tenderness, or a bulging anterior fontanelle in infants •Children may show behavioral changes, arching of back or neck, blank stare, refusal to feed, and seizures •+ Brudzinski’s and Kernig’s signs |
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Bacterial meningitis
General Manifestations |
•Fever
•Tachycardia •H/a •Prostration •Chills •N,V, D •Irritability progressing to confusion and coma •Seizures |
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Diagnosis of Bacterial Meningitis
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•CBC with Diff-elevated leukocyte count
•WBC 100-10,000 cm/3 with increases polymorphonuclear leukocytes •Blood cx to indicate organism •Lumbar puncture to evaluate CSF for pressure, leukocytes, elevated protein (nml 15-45 mg/dl), & decreased glucose (nml 60-80 mg/dl); cx and smear for organism •MRI/CT to r/o other causes •Low CD4 ct with HIV •MRI if HIV to r/o sinus infection or brain abscess |
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Management of Bacterial Meningitis
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Team approach
•Isolation Precautions •IV antibiotics targeted to organism-intact blood-brain barrier prevents complete penetration of some viruses •Decadron IV •Monitor for ICP •Monitor for Seizures •Maintain fluid balances •Reduce pain-no opioids •Dark room •Elevate HOB •Caution with neck pain Treatment of Contacts •Household contacts, school contacts, intimate contacts •Rifampin: •< age 12 months: 5mg/kg/BID for 2 days •1-12 yrs: 10mg/kg/BID for 2 days •Adults: 600mg BID for 2 days •EXCEPT pregnant or breast feeding women Prevention is the Key to Public Health Management of Bacterial Meningitis •Cases among teenagers have doubled since 1991 •100-125 cases occur on college campuses yearly •US advisory panel recommends that college students be vaccinated against Meningitis •Vaccine lasts for 10 years |
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Viral Meningitis
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•AKA Aseptic Meningitis
•Causative organisms: •Mumps virus •Enteroviruses (coxsackievirus, echovirus) •Herpes simplex 1 •Arthropoid-borne virus (arborvirus) –Mosquitoes belong to a section of the animal kingdom called arthropods. Viruses that are spread by arthropods (including mosquitoes) are referred to as arthropod-borne viruses or arboviruses. –Two different arboviruses found in Massachusetts are West Nile virus (WNV)(RTF) and eastern equine encephalitis (EEE) virus(RTF |
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Clinical Manifestations of Viral Meningitis
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•Drowsiness, h/a, weakness, photophobia, nuchal rigidity,+ Brudzinski’s and Kernig’s sx’s
•Fever, h/a, vomiting •Blood in CSF •Clinical manifestations resolve in 2 weeks •Seizures •Arborvirus may lead to MR, seizures, and deafness •HS 1 may lead to coma and brain death |
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Treatment of Viral Meningitis
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•Symptomatic management to reduce h/a, control fever, and increase general comfort
•Anticonvulsants •Close monitoring of neuro status •For arborvirus and HSV1-give Acyclovir early in course |
