Exam 7

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Exam 7
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  1. Objectives of a school nurse
    facilitate normal development, safety, case management and collaboration
  2. After the family ___________ is the primary institution responsible for development
    school
  3. Poor academic performance is strongly correlated with
    uninsured status of youths
  4. Health problems in schoolage children lead to
    increaed absenteesim
  5. By 1911 ______ schools employed school nurses
    over 100

    Assessment, tx minor conditions, referrals
  6. in _________ first NP programs included schools
    1960
  7. 1975 Education for Handicapped Act
    • kids with disabilities have access to education
    • increases nurse responsibilities to work with special needs kids
  8. 1990s CDC Division of Adolescent and School Health Informed
    Funded state education agencies to develop and implement programs aimed at alcohol and tobacco use, PE, and reduction of STDs
  9. 2001 No Child Left Behind
    Safe and Drug Free Schools and Committees Act

    Created safe, drug free enviornment
  10. 2004 CHild Nutrition and WIC Authorization Act
    r/t childhood obesity- kids get healthier school lunches
  11. 2010 Patient Protection and Affordable Care Act
    • Awareded funds to 278 school-based health service centers to create new sites and expand services
    • Led to expanded services in medically underserved areas
  12. Components of school health
    • Heath education
    • physical education
    • heath services 
    • nutrition services
    • counseling, psych and social services
    • healthy enviornment
    • health promotion for staff
    • family and community envolvement
  13. In regards to Health education, the CDC targets
    • Alcohol and drug use
    • injury and violence
    • tobacco
    • poor nutrition
    • lack of physical activity
    • sexual behavior resulting in STDS
  14. National Health Education standards
    • promoted positive health behaviors in all grades
    • gave students families and communities a framework for development of health education programs
  15. CDC conducts youth risk behavior survey every ______ years
    2 years

    • Reports provided valuable info that can help improve health education programs in schools
    • Utilizes Healty People 2020
  16. Injury prevention should be taught early and be age appropriate:
    • Bicycle safety- helmets
    • proper use of backpacks
    • schoolyard and playground safety
    • motor vehicle safety- teens
    • sport safety- equipment, hydration, stretching, pool safety
  17. Most comonly used and abused drug
    alcohol
  18. Most commonly used illicit drug in school age
    marijuana
  19. teens are sexually active at ______
    younger ages
  20. Teen pregnancy rate in US
    highest vs other developing countries
  21. ______ states mandate sex ed be taught
    • 21
    • controversial
  22. Teen pregnancy are at increased risk of
    • not finishing school
    • poverty
    • single parent

    Increased success rate if adequate support system
  23. HIV is ______ in teens, esp among
    • increased
    • gay/bisexual men 18-24
  24. Getting tatoos may be sign of ______ behavior
    attention seeking

    Hep c & MRSA common
  25. Most common health complaint among school age
    dental
  26. Medicaid provides
    early and periodic screenig, dx and tx
  27. most common med in school
    ADHD
  28. FERPA
    strong pt protection act of education and health records
  29. If a nurse is assigned to multiple schools
    delegate fundtions to teachres/secretaries

    nurse resonsible for education, written proceudes, ongoing supervision and eval
  30. Fastest rising public health concern
    obesity
  31. Female althete triad
    syndrome of: eating disorders, amenorrhea, and osteoporosis

    Psych and physiologic problem

    Can result in: menstrual irregularies, premature osteoporosis, decreased bone mineral density---possibly life threatening
  32. _______ is a majors public health problem
    violence
  33. Violence prevention programs start in
    elementary schools

    focus on stress management, confilict and anger resolution, and personal and self-esteem development
  34. Terrorism
    • every school expected to have emergy plan
    • nurse potential first responder and should be activie participant
  35. Health promotion for staff
    • BP control, daily exercise, smoking cessation, weight control, improve moral, reduce job stress
    • increase educaiton: health related topics
  36. A school nurse is a resource to the
    community

    education, resource leadership, consultant, advocat
  37. Familly risk index
    • Single parent
    • Household with 1 high school dropout
    • Poverty
    • Ling with parents with no steady income
    • Family on welfare
    • No health insurance
  38. ______ degree recommended for school health
    bachelours
  39. Best way to offer comprehensive health care to kids and teens
    school health centers

    NP, social workers, psychologist, Drs
  40. When teaching children in preschools and elementary schools...
    • lessons no more than 10 minutes
    • Use lots of examples, pictures, and stuffed animals
  41. number 1 and 2 work related deaths
    • 1: fishing
    • 2: logging
  42. Occupation heatlh
    focuses on promotion, prevention, and restoration of health with in the context of safe and healthy enviornment
  43. occupation nurse must be
    • very autonomous
    • independent and able to make nursing judgements
  44. foundation for OHN
    OHN multidiciplanary bases
  45. Nursing science (OHN Multidiciplinary Bases)
    context of health care delivery and recognizes needs
  46. Medical science (OHN Multidiciplinary Bases)
    specific to treatment and management of injury or illness
  47. Occupational science (OHN Multidiciplinary Bases)
    • Toxicology_ recognizes routs of exposure, examin relationships between exposuers nad workplace and health effects
    • Industrial hygiene- ID and evaluate workplace hazards so control mechanisms can be implemented
    • Safety- ID and control workplace injuries through activie safeguards and worker training
    • Ergonomics- to match the job to the worker, emphasizing capabilities and minimizing limitations
  48. Epidemiology (OHN Multidiciplinary Bases)
    study heatlh and illness trends and characteristcs of worker population
  49. Business and economics (OHN Multidiciplinary Bases)
    strategic and operational palnning for quality and cost-effective service
  50. Social and behavior science (OHN Multidiciplinary Bases)
    explores influences of arious envornments ( home and work) relationships, and lifestyle factors on worker health to detrmine interactions affecting workers
  51. Legal and ethical (OHN Multidiciplinary Bases)
    compliance with mandates and ethical considreations
  52. Biggist deficit for OHN
    toxicology and ergonomics
  53. OHN 1888
    betty moulder hired by group of coal mining companies to take care of miners and their families
  54. OHN 1895
    Ada Mayo Stewart was first industrial nurse (hired by Vermont marble company)
  55. OHN 1897
    Anna Duncan emplyed to visit sick emplyees at home
  56. OHN 1912
    • Workers comp legislation passed- 38 nurses were emplyed by business firms
    • Cost effectiness of providing health care to employes more recongized
  57. OHN 1916
    Factor Nurses Converance Organized
  58. OHN World War 1:
    Gov demanded health services for workers at factories and shipyards holding defense contracts
  59. OHN World War 2
    increased number of women in workforce
  60. OHN 1993
    OSHA established

    RE-energized the concept of OH into practice: Established competencies
  61. Industrial transformations in 21st century
    • Changing demographics
    • increase healthcare costs
    • diverstiy of healthcare systems
    • influence of world economy
    • shift in production: goods to services
    • advanced technology
  62. Industry moving which direction
    away from large facilities to smaller, service-based businesses
  63. OHN is resonsible to and compensated by
    management
  64. (Preventing exposure to chemicals) Biological
    • bloody, body fluid
    • example: hep B
  65. (Preventing exposure to chemicals) Chemical
    • solvents, lead, asbestos, acids, glycol ethers, mercury, arsenic
    • Ex: HA, CNS dysfunction, asbestosis, burns, reproductive problems, ataxia, periph neuropathy
  66. (Preventing exposure to chemicals) Enviornmechancial
    • static/nonneutral postures, repetitive exertions, lighting, shift-work, electrical, slips and falls, struck by object
    • Ex: muculoskeletal disorders, back injuries, HA, eye strain, sleep disorders, electrocution
  67. (Preventing exposure to chemicals) Physical
    • noise, radiation, vibration, heat
    • Ex: hearing loss, reproductive effects and cancer, Raynaud's disease, heat exhaustion/stroke
  68. (Preventing exposure to chemicals) Psychosocial
    • stress, work-home balance
    • Ex: anxiety, interpersonal relationships
  69. Occupational Factors of Stress and Nursing
    • Work overload
    • Time pressure
    • Lack of social support
    • Exposure to infectious disease
    • Needle sticks injuries
    • Exposrue to work related violence
    • Sleep deprivation
    • Understaffing
    • Dealing with difficult pts
  70. Work related disease/injry
    • Lung Disease- cancer, asthma
    • Musculoskeletal- back, arms, shoulders
    • Cancer- leukemia, bladder, skin
    • Trauma- death, amputation, fracture
    • CV- HTN, heart disease
    • Reproductive- infertility, miscarriage
    • Neurotoxic- neuropathy, toxic psychosis
    • Noise-induced hearing loss
    • Skin- burns, allergies
    • Psych- neurosis, alcholol/substance abuse
  71. OHN Primary prevention
    • Facilitates lifestyle change- enhances awareness, increases motivation, builds skills, and creates supportive enviornment
    • Recognize risks: routinely do walk through
    • size the moment with every employee encounter- ALWAYS BE OBSERVENT
    • CV health, cancer awareness, personal safety, immunizaiton, prenatl and postpartum heatlh, accident prevention, retirement health, stress management, relaxation techniques, maternal-child
  72. OHN secondary prevention
    • Focuse on id of health needs, probs, empolyees at risk
    • preplacement, periodic and job transfer evals
    • vision, cancer, cholesterol, HTN, DM, TB, pulmonary, mammography screenings
  73. OHN tertiary
    • Case managemtn, negotion of workplace accomodations, counseling and support for workers continually affected by chronic disease and disability
    • Disability syndrome: a state in which an individual chooses not to work when medical clearance has been granted
    • If a pt has na injury- always get them back to work ASAP even if it is a modified job
  74. OSHA
    Employers must “furnish a place of employment free from recognized harm that are causing or likely to cause death or serious physical harm to employees.
  75. Workers Comp
    • State based
    • Provided income replacement & health care for employees who sustained a work related injury or death
  76. Americans with Disbilities Act
    Employers must make “reasonable accommodations” to enhance opportunities for individuals w/ disabilities

    Prohibits discrimination on basis of disability
  77. Forensic nursing
    application of nursing process to public or legal proceedings, & the application of forensic health care in the scientific investigation of trauma &/or death r/t abuse, violence, criminal activity, liability, & accidents
  78. Responsibilites of forensic nurse
    • Screening
    • Assessment and collection of evidence
    • Documentation and expert testimony 
    • Involvement with workplace injuries, malpractice, vehicle accidents, food and drug tampering, and medical equipment defects
  79. SANE nurse
    • Collect forensic evidence r/t a reported crime & frequently testifies as a witness
    • Conducts a thorough exam & history
    • Crisis intervention referral
    • Eval of victim for STDs
    • Pregnancy risk assessment & care
    • Client referral for additional support –follow up testing
  80. For SANE nursing privacy is
    • critical
    • no curtains
    • Walls

    Exam process is voluntary nad pt has right to refuse or leave at any point during the exam or evidence collection
  81. Nurse death investicator evaluates death scene from
    • holistic perspective
    • Posesses essential knowledge of anatomy, physiology, pharmacology, G&D, physical exam, and heatlh hx interviewing techniques
    • Might interpret scene differently than professionals w/o medical knowledge
  82. Nurse coroner
    • Responsible for ensuring that appropriate measures were taken to perform death investigation & certify death certificates
    • Use nursing knowledge to ID disease processes that lay coroners might not recognize as foul play
    • Utilize crucial communication skills when dealing w/ grieving families
    • Board certified by American Board of Medicolegal Death Investigation
  83. Legal nurse consultant
    • Provides assistance w/in legal system using specialized nursing knowledge
    • Evaluates, analyzes, renders informed opinions on delivery of care
    • Review/interprets medical records
    • Provides objective opinions based on standards of care
    • Testifies in court as expert
  84. Nurse Attorney
    • Educated in law & nursing
    • Often involved in malpractice cases
    • May be involved in licensure disciplinary action or agency oversight
    • Serves as legal consultant
  85. Forensic psych nurse
    • Connects gap b/w criminal justice, legal, & mental health systems
    • Applies nursing process to cts pending criminal hearing or trial
    • Determines intent or diminished capacity in pts thinking @ time of the incident
    • May be called on to testify as expert witness
  86. Forensic nurse examiner
    • Emergency and critical care
    • Delivers care to living and dead
    • Works with survivors (DV, assault, homicide)
    • ID forensic cases
    • Initiates proper colleciton, preservation, and chain or command of evidence
    • provides accurate documentation
  87. Organ and Tissue Donation
    • Conducts & provides detailed physical exam & collects evidence
    • ID acceptable candidates & potential organs & tissues for harvest
    • Must be knowledgeable about legal specifications r/t organ donations & have familiarity when determining brain death
    • Has excellent communication skills and ability to relate empathetically with grieving families
  88. Child abuse and neglect
    • Prevention & Treatment Act (CAPTA) & DHHS – neglect, sexual abuse, physical abuse, emotional abuse
    • Ensures abuse is swiftly identified & reported to proper authorities
  89. Elder abuse
    • Most underdx & under reported crime in U.S.
    • Forms: physical, psych, financial, neglect, sexual Most frequent abusers = adult children
  90. Disabled population
    • Well documented that disabled more likely to be mistreated
    • Across lifespan, risk of 1+ forms of maltreatment triples compared w/ risk for individuals w/o disability
  91. Correctional nurse
    • Primary goal: maintain a safe, secure, & humane environment for inmates
    • Recognize safety & security issues for nurse: care wont be given if safety and security needs arent met
    • Always maintain an escapse route
    • Undersand prison culture: inmates maniuplate nurses and environment is highly isolated
  92. Heatlh issues in prison
    • Screening each inmate upon entry into facility
    • Health care triage – psychical & mental exam
    • Chronic & communicable diseases: HIV, hepatitis, TB
    • Women – drug use, victimization, stress (separation from kids)
    • Teens – ill equipped to deal w/ adult challenges (r/t development) & must be aware of vulnerability
  93. Education and Forensic nursing
    • Specialty education needed to obtain certificate in forensic nursing, a minor or concentration, or graduate degree
    • Specialized curriculum: fundamentals of forensic nursing, forensic law, forensic science
    • Minimum # of supervised clinical hours
    • Clinical internship maybe required
  94. focus of FCN
    care of the spirit, assist to maintain/regain wholeness in body, mind, & spirit
  95. FCN voerned by
    Nurse State Practice Act, ANA, FCN Scope, & Code of Ethics
  96. Mission of FCN
    Intentional integration of the practices of faith & nursing so that people can achieve wholeness in, with, & through the community of faith in which they serve.
  97. Rev. Granger Westberg
    • Lutheran Minister 
    • Founder of Parish Nurse/FCN
    • 1984: proposed first FCN program
    • Huge advocate for nurses and recognized team approach to incorporate nures into pastoral team
    • "To attempt to practice medicine and nursing as if they were pure sciences is impossible. They are also arts and as such are intimately connected with the faith both of the healer and the healed."
  98. 1990s FCN
    parish nursing gained national attention because huge money crunches and reimburements changes lead to push of pts outside hosiptal
  99. 1998 FCN
    Standards and Scope of Parish nursing
  100. 2005 FCN
    parish nursing changed to FCN
  101. 2014 FCN
    American Nurse Credentialing Center – portfolio based certification Internationally Practices (>23 countries)
  102. Key elements of parish nursing
    • Spiritual dimension = central to practice
    • Balances nursing science & technology w/ service & spiritual care
    • Cts are members of faith community/church & public service
    • Services built on principles of self-care & capacity
    • Holistic health—connects spiritual, psych, physical, & social
  103. FCN recommended core curriculum
    • Role of church in healthcare
    • Hx & philosophy of FCN
    • Models of faith
    • Roles & functions of FCN
    • Community Assessment & Resources
    • Health promotion across the lifespan
    • Philosophy of self-care
    • Legal & ethical issues
    • Ministerial team & nsg role
    • FCN’s role in worship, prayer, healing
    • Starting FCN program
  104. (FCN Roles) Heatlh educator
    • heatlhy eating
    • exercise
    • CPR
    • first aid
  105. (FCN Roles) Referral agent
    Transportation, go to Dr with ct
  106. (FCN Roles)Health advocate
    counselor- DO NO replace other tyeps of nursing ( home health)
  107. what is priority in FCN
    spiritual care NOT nursing tasks
  108. FCN Providing care to vulnerable populations
    • Diversity – still use nsg process
    • Sponsor & support refugees
    • Develop homeless programs
    • Assistance to low-income families
    • Resources to communities during disasters
  109. FCN End of life grief and loss
    • Partner w/ Hospice & home health
    • Education on living wills
    • Establish surrogates
    • Home visits
    • Emotional support
    • Develop grief support groups
  110. FCN Family Violence Prevention
    • Understand Risk factors
    • Knowledge of cycle of abuse
    • Assessment skills critical
  111. FCN Accountability
    • Same degree as paid employees
    • Not exempt from discrimination laws
    • May required to disclose confidential info in court
    • Nsg standards & civil laws
  112. Spirituality
    human desire for sense of meaning, purpose, connection. & fulfillment thru intimate relationships & life experiences
  113. spiritual distress
    • a disruption in the life principles that pervades a person’s entire being & that integrates & transcends one’s theological & psych nature.
    • Disruption in what people believe & how they incorporate that into their lives
  114. CIRCLE model
    • Caring
    • Intuition
    • Respect
    • Caution
    • Listening
    • Emotional support
  115. homehealth used more by women or men
    women
  116. most important part of first meeting in home heatlh
    builidng rapport
  117. Home health Official Agencies
    • Organized, operated, and funded by local or state governments.
    • Located within the county public health system. Taxpayers fund official home health agencies.
    • Agencies also receive reimbursement from third-party payers such as Medicare, Medicaid, and private insurance companies
  118. Nonprofit agencies (home heatlh)
    Not required to pay federal taxes because of tax exempt status

    • Agency reinvests any profits into the agency
    • Eamples: independent home health agencies and some hospital-based home health agencies
  119. Proprietary agencies
    • Agencies classified as for-profit pay federal taxes on the profits generated.
    • Can be individual owned, profit partnerships, or profit corporations.
    • Investors in corporate proprietary partnerships receive financial returns on their investments in the agencies. – larger agencies buy out smaller agencies
    • A percentage of the profits are also reinvested into the agency.
    • Agencies within chains have financial advantage over single agencies.
  120. Hospital based agencies
    • Receive fixed reimbursement under PPS and the hospitals’ incentive to decrease length of stay.
    • Hospitals are able to discharge patients who have skilled health care needs, provide necessary services to patient, and receive reimbursement through third-party payers.
    • Often considered profitable endeavors that provide hospitals with an additional revenue source
  121. Certified home health agencies
    • meet fed standards
    • receive medicare payments for services provided to eligible individuals
  122. Noncertified home care agencies
    • Operate outside the medicare system
    • Provide non-medicare-covered services
    • Do not provide skilled nursing care and are not eligble to recieve medicare reimbursement
    • Do not require Drs. order- bathing, shopping, cooking
    • Companion Care
  123. what determines home health success?
    family or caregivers support
  124. Examples of high-tech services
    • Daily infusions of TPN or antibiotic therapy
    • Pediatric services for children with chronic health problems
    • Follow-up for premature infants at risk for complications
    • Ventilator therapy
    • Home dialysis programs
  125. OASIS
    data set that dtermines Medicare pay rate and measures outcomes of adult home care patients to monitor outcome-based quality improvement
  126. OASIS data set includes
    • sociodemographic
    • environmental
    • support system
    • health status
    • functional status attributes of an adult patient
  127. OASIS is mandatory for
    all Medicare and MEdicaid patients receiving skilled care
  128. APN responsibilites in home health
    • Prescribes pharmacological and nonpharmacological treatment to manage chronic illnesses
    • Provides consultation and serves as a resource to the generalist home health nurse
    • Participates at all levels of quality improvement and research
    • Educates all members of the health care team about emerging trends in home health care
  129. hospice home care provides
    Provides grief support to the family after the patient has died
  130. morphine
    good for air hunger

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