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Community Test 2

Chapter 4 Epidemiology

Age adjusted rates: (also known as standardization of rates) method of reducing bias
when there are differences in the age distributions of two populations being compared.
Determines the rate for specific subgroups of a population and using a denominator
that reflects only the subgroup removes age related bias. P. 56

Analytic epidemiology: method that investigates the causes of disease by determining

why a disease rate is lower in one population group than in another.

Descriptive epidemiology: a form of epidemiology that describes a disease according

to its person, place, or time related to amount and distribution of disease.

Crude rates: rates that summarize the occurrence of births (crude birth rate), deaths
(crude death rates), or diseases (crude disease rates) in the general population. The
numerator is the number of events, and the denominator is the average population size
or the population size at midyear (usually July 1) multiplied by a constant. Can appear
distorted because risk is not accounted for.

Epidemiological triangle: an organized method of inquiry to derive an explanation of

disease which analyzes three elements: agent, host, and environment.

Wheel model: Biological > Social> Physical environments around >Host w/ Genetic

Web of causation: a model that can be used to illustrate complex interrelationships of

factors interacting with each other to influence the risk for, or distribution of, health

Surveillance: ongoing collection of community health information

Incidence: occurrence of new cases of a disease or condition in a community over a
period of time relative to the size of the population at risk for that condition in that
time period: # new cases at point in time X 1000
Population at risk at same point in time
-particularly good for acute disease
-may be the most sensitive indicator of the changing health of a community

Prevalence: # existing cases a point in time X 1000

Population at same point in time
-often used in cross-sectional studies

Prospective studies: monitor a group of disease free individuals to determine if and

when disease occurs. These individuals, or the cohort, share a common experience
within a defined time period. It summarizes data collected over time by the incidence
rates of new cases or relative risk= incidence rate among exposed
Incidence rate among unexposed
- (also called longitudinal, cohort, or incidence studies) they are advantageous
because they obtain more reliable information about the cause of disease than do other
study methods

Retrospective studies: compare individuals with a particular condition or disease with

those who don’t have it. They determine whether cases, or a diseased group, differ in
their exposure to a specific factor or characteristic relative to controls, or a non-
diseased group. Data collection extends back in time to determine previous exposure or
risk factors. A greater proportion of exposed cases than controls suggests a relationship
between the disease and the risk factor.

Experimental studies: a type of analytic study. Investigations apply experimental

methods to test treatment and prevention strategies. The investigator randomly assigns
subjects at risk for a particular disease to an experimental group or a control group.
Both groups are observed for occurrence of disease over time, but only the
experimental group receives intervention.

Cross-sectional: (prevalence) examines relationships between potential causal factors

and disease at a specific time. Limitations in discovering etiology factors. Hypothesis
generating studies.

*Person place and time:* researcher try to identify common characteristics of people
suffering from a disease and compare them with common characteristics of people who
are healthy. (eg: age, wealth, health) They look to see if location/ living environment of
the ill is a common factor. Researchers also evaluate common time factors. p. 51

Specificity: extent to which a screening tool can correctly identify those who don’t
have a disease
Sensitivity: extent to which a screening tool can correctly identify those who do have
a disease correctly

Morbidity & mortality

Chapter 11 Politics

Coalitions: two or more groups join to maximize resources, thus increasing their
impact and improving their chances of success in achieving a common goal.

Epidemiological transition: the change in patterns of illness and death from acute to
chronic conditions influenced by improvements in a country's economic status.

WHO: an international agency of the UN founded after World War II to promote

health around the world.

*POLICY* p.187
Public policy refers to decisions made by legislative, executive, or judicial
branches at the local, state, or federal levels of government.

Compliance by states to federal program standards is voluntary, but the advantage of

the revenue, which states don’t get if they don’t comply, is generally enough incentive
to have states participate.

Common law is the body of law derived from judicial decisions rather than from
statutes or constitutions.


Developed, developing, and underdeveloped

Tobacco pandemic: established in 2003 under the auspices of the World Health
Organization, it is the first legal instrument designed to reduce tobacco-related deaths
and disease around the world. Among its many measures, the treaty requires countries
to impose restrictions on tobacco advertising, sponsorship, and promotion; establish
new packaging and labeling of tobacco products; establish clean indoor air controls;
and strengthen legislation to clamp down on tobacco smuggling.

Political action committee (PAC): $ often funds lobbyists to go to the legislature.

Political action committees are nonpartisan entities that promote the election of
candidates believed to be sympathetic to their interests.

ANA: writes standards for nursing. Umbrella for state nursing organizations
Lillian Wald: early twentieth-century community health nurse and political activist
who recognized the connections between health and social conditions. She was a
driving force behind the federal government's development of the Children's Bureau in

Health policy: public policies that pertain to or influence the pursuit of health, or a
course of action to obtain a desired health outcome for an individual, family, group,
community or society. Health policies influence health care through the monitoring,
production, provision, and financing of health care services.

The nursing workforce development programs administered by the Health Resources and
Service Administration (HRSA) through Title VIII provide federal support for nurses'
workforce development.

Chapter 12 Cultural Diversity

Culture represents a person’s way of perceiving, evaluating, and behaving within his
or her world, and it provides the blueprint for determining his or her values, beliefs,
and practices.
It is learned from birth through language, socialization, and acquisition.
It is shared by all members of same cultural group.
It is adapted to the environment and resources.
It is dynamic.

Subculture: ethnicity, religion, occupation, health related characteristics, age, sex,

geographical location etc.

Lineal relationships: kinship ties- client may seek assistance from other members of
family and allow a relative to make decisions about important health related matters.
Collateral relationships: group goals, family honor
Individual relationships: autonomy and independence. Individual goals dominate


Poverty & generational poverty:

Religion: an organized system of beliefs concerning the cause, nature, and purpose of
the universe, especially belief in or the worship of god or gods.

Spirituality: born out of the individual’s life experiences and personal effort to find
purpose and meaning in life.

Transcultural Nursing Theory: Madeline Leininger "a formal area of study and
practice focused on a comparative analysis of different cultures and subcultures in the
world with respect to cultural care, health and illness beliefs, values, and practices with
the goal of using this knowledge to provide culture-specific and culture-universal
nursing care to people" (Leininger, 1978, p. 493).

Space: Hispanics, east India, middle easterns invade personal space p.219

Yen-Yang: Asian belief of mind and body healing/ balance

A culturologic assessment of the community is an important part of the overall

assessment process that is essential to any effective community health efforts.

A cultural self-assessment is necessary to identify personal beliefs, values, and

attitudes that may interfere with the nurse's ability to see health issues from the
perspective of those being served.

Chapter 13 Environmental & Chapter 32 Global Issues

Environmental health is a vast field of subcategories including living patterns, work

risks, atmospheric quality, water quality, housing, food quality, waste control, and
radiation risks.

Critical theory is utilized to help community health nurses think about social, cultural,
economic and political factors of health, thereby assisting him or her to attack the
problem at its source and alter community-wide precursors of poor health.

Health & justice

Living Patterns: p.241 (eg: other countries walk places while we drive) the
relationships among persons, communities, and their surrounding environments that
depend on habits, interpersonal ties, cultural values, and customs. Living patterns is the
area of environmental health that is being addressed. Living patterns are the
relationships among people, communities, and their surrounding environments that
depend on habits, interpersonal ties, cultural values, and customs. Examples of living
patterns include driving while intoxicated, secondhand smoke, noise exposure, urban
crowding, and technological hazards.

Sick Building syndrome: a phenomenon in which public structures and homes cause
toxic syndromes in their occupants because of building materials, poor ventilation,
substances in furniture and carpeting, building operations, or cleaning agents.

Housing issues: elevated indoor allergen levels, radon poisoning, lead paint, tobacco,
availability, safety, cleanliness, location

Atmospheric quality: the amount of protection in the atmospheric layers is

diminishing. Devegetation of the earth is reducing the amount of CO2 that can be
Water quality: a global problem

(PAHO) Pan American Health Organization: an international public health agency

working to improve the health and living standards of Americans.

(UNICEF) United Nations International Children’s Fund: global health

organization founded in 1964 to assist children in war-ravaged Europe.

The World Health Organization (WHO) introduced the goal of "health for all." The CDC
strives to prevent and control infectious and chronic diseases, injuries, workplace
hazards, disabilities, and environmental health threats. UNICEF focuses on child and
women's health. The World Bank strives to improve the health status of individuals living
in areas that lack economic development. UNICEF works for children's survival,
development, and protection by developing and implementing community-based
programs. UNICEF achievements are well documented in child health, nutrition,
education, water, sanitation, and progress for women. PAHO is an international public
health agency that works to improve the health and living standards of the Americas. The
World Health Organization (WHO) introduced the goal of "health for all." The CDC
strives to prevent and control infectious and chronic diseases, injuries, workplace
hazards, disabilities, and environmental health threats.

Chapter 17 Senior Health

Young old 65-74

Middle old 75-84
Old old 85-99
Elite old 100+

10% live in poverty

Advanced directives: a written document in which a competent person gives

instructions about his or her health care that are to be implemented in the future if the
individual is not able to make the decisions.

The Patient Self-Determination Act requires health care facilities to inform patients in
writing about their rights to execute advance directives. This is a federal law that applies
to facilities that receive Medicare and Medicaid funds. A living will is a legal document
whose purpose is to allow individuals to specify what type of medical treatment they
want to receive if they are incapacitated. A durable power of attorney authorizes
someone to act on an individual's behalf with regard to property and financial matters. A
durable power of attorney for health care allows an individual to designate a health care
proxy or surrogate to make decisions about medical care if one is unable to do so.

Medicare: "Medicare Part B will pay for your doctor's visits." Medicare Part B covers
the costs for physician and nurse practitioner services; outpatient services such as
diagnostic procedures, qualified physical, speech, and occupational therapy; ambulance
services; durable medical equipment; and some home health services. Medicare Part A
is a hospital insurance plan that covers acute care, short-term rehabilitative care, and
some costs associated with hospice and home health care.

Common problems: Glaucoma, Macular degeneration, Dental/nutrition, Suicide 19%

of suicides, depression, agoraphobia, substance abuse, Elder abuse, Polypharmacy

Stochastic theories generally describe aging as the effect of specific biologic process
resulting in cellular impairment. Thus each individual will have a unique accumulation of
the cellular processes resulting in aging.

Nonstochastic theories describe life as a finite process, with defined cellular life
processes, such as cellular division, defining the life span for a given species.

According to 2004 federal statistics, individuals who survive to age 65 can expect to live
an average of nearly 18 more years. If they are then healthy at 85 they will probably live
6-7 years longer.

Elder abuse: Individuals who are most at risk for elder abuse include female widows age
75 and older, elders dependent on a caregiver for food and shelter, those with
incontinence, and individuals who are frail or have illness or mental disability. Studies
have described the typical abuser as a family member (typically a son or daughter) who is
middle age or older with low self-esteem and low impulse control. The caregiver's
perception of his or her own stress is strongly related to the risk of abuse. Elder abuse
occurs at all cultural and socioeconomic levels.

Chapter 23 Communicable Disease

Acquired immunity: derived from actual exposure to the specific infectious agent,
toxin, or appropriate vaccine.

Active immunity: develops when the body can build its own antibodies that provide
protection from a bacterial or other antigenic substance, such as the introduction of a
vaccine or toxoid.

Agent: causative factor invading a susceptible host through an environment favorable

to produce disease, such as biological or chemical agent

Chain of Transmission: Pathogenic agent > Reservoir > Portal of exit > Transmission
> Portal of entry > Host susceptibility

Direct transmission: immediate transfer of an infectious agent from an infected host

or reservoir to a portal of entry

Indirect transmission: spread of infection through a contaminant

Elimination: controlled within a specified geographical area and the prevalence and
incidence of the disease is reduced to near zero.

Eradication: world wide permanent elimination of the disease: smallpox

Control: reduction of incidence or prevalence of a given disease to a locally

acceptable level as a result of deliberate efforts.

Endemic occur at consistent expected levels in a geographical areas

Epidemic: unexpected increase of an infectious disease in a geographic area over an

extended period of time.

Pandemic: steady occurrence of a disease over a large geographic area

Herd immunity: 80% of population must be immune to be reasonably well protected

as is the unvaccinated population

Latency period of replication before shedding

Vector: a nonhuman organism, often an insect, that either mechanically or biologically

plays a role in the transmission of an infectious agent from source to host.

Incubation period: time from invasion to the time when disease symptoms first
appear. Often communicable before this time.

Live vs. inactivated vaccine

Primary vaccine failure- didn't work at all

Secondary vaccine failure- wears off with time


MMR and varicella vaccines are contraindicated during pregnancy. Polio and yellow
fever are not recommended

Chapter 26 Disasters

Bioterrorism: flu like symptoms

Triage colors:
Mass Casualty

MA- Tech Disaster

Push packs: 12 hours

Nerve, radiation, water, aerosol

Chapter 27 School Nursing

Youth Risk Behavioral Survey: national state and local Youth Risk Behavior
Surveillance System (YRBSS) developed in 1990 to monitor priority health risk
behaviors that contribute markedly to the leading causes of death, disability, and social
problems among youth and adults in the United States

1:750 Nurse to student ratio recommended 1:3000 is what TN has

Give mostly ADD and asthma drugs

EPSDT: The Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
mandate in Medicaid requires states to conduct regularly scheduled examinations
(screens) of all Medicaid- eligible recipients under the age of 22 to identify physical
and mental health problems. If a problem is detected and diagnosed, treatment must
include any federally authorized Medicaid service, whether or not the service is
covered under the state plan. If problems are suspected, an "interperiodic" screen is
also required so the child need not wait for the next regularly scheduled checkup. * a
program within Medicaid. It is a comprehensive child health program for uninsured
under the age of 21. It includes health education, periodic screening, vision, dental, and
hearing services.

FERPA: The Family Educational Rights and Privacy Act protects the privacy of
student education records. Parents or eligible students have the right to inspect and
review the student's education records maintained by the school.

ADA: Americans with disabilities act 1990 prohibits discrimination based on disability