Copyright © 2008 Delmar. All rights reserved. Chapter 17 Health Care Management.
Copyright © 2008 Delmar. All rights reserved.
Transcript of Copyright © 2008 Delmar. All rights reserved.
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Part IV
Provision of Public Health
Nursing to Vulnerable Populations
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Chapter 20
Populations with
Infectious and Communicable Disease
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Contributing Factors
• Institute of Medicine (IOM) 1992 report Emerging Infections: Microbial Threats to Health in the United States – Emerging infectious diseases– Increasingly present infectious diseases– Identified six important factors in disease
emergence and reemergence
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Six Factors
1. Changes in human demographics and behavior
2. Advances in technology and industry3. Economic development; changes in land
use4. Commerce5. Microbial adaptation6. Deterioration in the public health system
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Models of Transmission
• Epidemiological triangle and the chain of transmission– Agent-host-environment
• Agent and reservoir– Biological agents
• Fungi, parasites• Bacteria, viruses
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Models of Transmission
• Agent and reservoir– Reservoir
• Human, animal, environment
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Models of Transmission
• Infectivity
• Pathogenicity
• Virulence
• Antigenicity
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Models of Transmission
• Modes of exit– Respiratory– Gastrointestinal– Urinary and reproductive system
• Mode of entry to a new host is often the same as the mode of exit from the reservoir
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Models of Transmission
• Modes of transmission (Table 20-1)– Direct person to person– Common vehicle– Vectors
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Types of Host Immunity
• Natural
• Acquired
• Passive
• Active
• Herd
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Levels of Prevention
• Leavell and Clark (1958) Preventive Medicine for the Doctor in His Community
–Three levels of prevention 1. Primary
• Education, immunizations• Chemoprophylaxis, universal precautions• Protective clothing, barrier protection
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Levels of Prevention
• Three levels of prevention 2. Secondary
• Screening• Disease management• Treatment• Directly observed treatment (DOT)
3. Tertiary • Management of complications• Prevention
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Common Infectious and Communicable Diseases
• Foodborne and waterborne disease– Food intoxication
• Shellfish, mushrooms, bacterial growth, mercury
– Food infections• Trichinosis, Salmonellosis• Escherichia coli, Toxoplasmosis• Hepatitis A, Parasites
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Prevention
• Five keys to safer food:1. Keep clean
2. Separate raw and cooked
3. Cook thoroughly
4. Keep food at safe temperatures
5. Use safe water and raw materials
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Vectors
• Disease carriers– Animals, insects, birds
• Malaria
• Anthrax
• Brucellosis
• Mad Cow
• Avian Flu
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Lyme Disease
• Most common vector-borne disease– White-tailed deer– Bull’s-eye skin lesion
• Red spot at the site of bite, followed by spreading rings of inflammation as infection progresses
• Develops 3-30 days after tick bite
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Lyme Disease
• Symptoms– Fatigue– Headache– Fever – Stiff neck, joint pain– Muscle aches – Enlarged tender lymph nodes
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Lyme Disease
• Treatment: 10-14 days of penicillin or tetracycline– Left untreated can progress to Stage II
• Neurological and cardiac symptoms
– Stage III• Months to years of ongoing attacks
– Arthritis and arthralgia
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RockyMountain Spotted Fever
• Vector– Dog and wood ticks
• Atlantic and western south central region
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RockyMountain Spotted Fever
• Occurs 4-6 hours after bite
• Incubation period 3-14 days– Maculopapular rash on extremities, palms of
hands, soles of feet– Antibiotic therapy required
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Malaria
• Vector– Infected mosquito
• Tropical and subtropical area
• Travelers should use mosquito repellent – Use mosquito nets while sleeping– Prophylaxis can begin 4-6 weeks prior to
travel
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Parasitic Diseases
• Tropical climates, underdeveloped countries– Lack of sanitation– Insufficient primary care– Inadequate access to medications
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Parasitic Diseases
• Four groups of organisms:1. Roundworms
2. Tapeworms
3. Flukes
4. Single celled organisms
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Nosocomial Infections
• Acquired in a hospital setting
• May affect anyone who has contact with a hospital– Other patients– Staff– Environment
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Respiratory Infections
• Tuberculosis – Airborne pathogen
• Droplet nuclei
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Respiratory Infections
• Symptoms– Fever, cough, chest pains, fatigue– Hemoptysis, weight loss– Incubation period 4-12 weeks
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Respiratory Infections
• Active cases begin 6-12 months after infection– Extrapulmonary– Multi-drug resistant
• Isoniaid and Rifampin
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Respiratory Infections
• Influenza– Influenzia A, B, or C virus– Occur annually – Last 5-6 weeks
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Respiratory Infections
• Small children and elderly most vulnerable– Flu vaccine 70-90 percent effective
• Pneumonia– Aspiration of virulent and nonvirulent
organisms– Inhalation of toxic fumes– Aspiration of stomach acids
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Respiratory Infections
• Symptoms– Upper respiratory tract infection– Chills, fever, cough– Chest pain and dyspnea
• Treatment– Antibiotics
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Hepatitis
• Hepatitis A– Fecal-oral routes– Vaccine available and provides protection
• Hepatitis B– Blood borne pathogen
• Fatigue and right upper quadrant discomfort• Treat with Interferon and Lamivudine
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Hepatitis
• Hepatitis C– Blood-borne infection – Causes up to 10,000 deaths a year – Interferon, Ribavirin
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HIV
• Destruction of immune system
• Antibody test can confirm diagnosis
• Early detection better prognosis– Elisa – Western Blot
• Treatment– Protease inhibitors, anti-retroviral drugs
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HIV
• Role of public health nurse– Promote prevention of spread of HIV through
education
• Venereal Warts– HPV
• Gardasil
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STDs
• Syphilis
• Gonorrhea– Bacterial disease, purulent discharge with
painful urination– Treatment
• Antibiotics
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Bioterrorism
• Three categories of biological agents:1. Category A highest risk
• Easy spread • Can be transmitted person to person• High death rates• Public panic• Require special action
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Category A
• Anthrax
• Plague
• Smallpox
• Botulinum toxin
• Tularemia
• Hemorrhagic fever
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Category B
2. Category B second highest: – Moderately easy to spread– Moderate illness rates– Low death rates– Require specific enhancements of CDC’s
lab capacity
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Category B
• Q Fever• Brucellosis• Glanders• Melioidosis• Psittacosis
• Ricin toxin• Typhus Fever• Staphylococcal
Enterotoxin B• Viral encephalitis• Food and waterborne
diseases
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Category C
3. Category C third highest priority:– Emerging pathogens– Easily available– Easily produced and spread– Potential for high morbidity and mortality
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Category C
• Napin virus
• Hantaviruses
• Tick-borne encephalitis viruses
• Yellow fever virus
• Multi-drug resistant Mycobacterium tuberculosis
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Managing Bioterrorism
• Plans in place for local response
• State and Federal agencies can assist
• U.S. Department of Homeland Security
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Strategies for Nurses
• Often first to detect presence of illness
• Often manages the communicable disease program for county– Surveillance systems– Nurse conducts case and contact follow up– Communication skills
• Risk communication
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Planning for Pandemic Disease Events
• WHO Global Influenza Preparedness Plan– Inter-pandemic
• Phase I and II
– Pandemic alert • Phase III, IV, V
– Pandemic period• Phase VI