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Comboset 4- (C228) ATI-Community Health <Chapter 6, 7, 12, 18, 27, 30>

Terms in this set (155)

Populations at risk for communicable disesases
Young children
older adults
immunocompromised clients
IV drug users
Health care workers
Airborne transmission
Measles
chickenpox
Streptococcal infection
TB
Pneumonia
Flu
Foodborne
Salmonellosis
Hep A
Trichnosis
E. coli
Waterborne
Cholera
Typhoid
Giardia lamblia
Vector-borne
lyme disease
rocky mountain spotted fever
malaria
Direct contact
STDs (HIV, gonorrhea, syphilis, genital herpes, hep B, C, D)
Infectious mononucleosis
Impetigo, lice, scabies
Portals of entry
Respiratory
GI
Skin
Mucous membranes
Portals of exit
Respiratory
Feces
Blood
Semen/vaginal secretions
Saliva
Skin
Defense mechanisms
Natural immunity - antigen/antibody response
Artificial immunity - through vaccination (active: live/killed/toxoid, passive: antitoxin, antibodies)
Disaster preparedness
Federal response plan
ID and assessment of at risk pop's (resources, isolation)
Plan for possibility of worldwide pandemics
individual plan should include: action plan with communication, evac route, disaster kit
Mass casualty drills
Federal response plan
government plan hat includes FEMA, US Public health service and CDC to guide the coordination of efforts in response to disaster
Disaster response
FEMA - federal emergency management agency
OEM - office of emergency management
American Red Cross
Nursing: triage, immunize, shelter nursing (into recovery)
Disaster recovery
length of time it takes involved agencies to restore economic and civil life to a community - time it takes individuals to become functioning person within community again

Plague and sanitation controls important

PTSD and delayed stress reactions common
Phases of emotional reaction to disaster
Heroic - Occurs at the time of the disaster, intense excitement and concern for survival
Honeymoon - post-disaster period (2 weeks to 2 months), feel support from government
Disillusionment - several months to a year or more, unexpected delays in receiving aid
Reconstruction - several years, attempt to rebuild
Category A biological agents
highest priority - risk to national security because they are easily transmitted and have high mortality rates

Smallpox, botulism, anthrax, tularemia, hemorrhagic viral fevers, plague
Category B biological agents
Second highest priority - moderately easy to disseminate and have moderate morbidity rates and low mortality rates

Typhus, cholera
Category C biological agents
third highest priority - comprising emerging pathogens that can be engineered for mass dissemination because they are easy to produce and/or have high potential for high morbidity and mortality rates

Hantavirus
Inhalation anthrax
Symptoms: sore throat, fever, muscle aches, severe dyspnea, meningitis, shock

Tx: IV ciprofloxacin
Botulism
Symptoms: difficulty swallowing, progressive weakness, n/v, abd cramps, difficulty breathing

Tx: Airway management, antitoxin, elimination of toxin
Smallpox
Symptoms: high fever, fatigue, severe HA, rash (begins on face/tongue and spreads to arms/legs then hands/feet), vomiting, delirium, excessive bleeding

Tx: no cure, supportive care (hydration, pain, antipyretics), prevention (vaccine - 10 yr immunity)
Ebola
Symptoms: sore throat, HA, high temperature, n/v, diarrhea, internal and external bleeding, shock

Tx: no cure, supportive care (minimize invasive procedures), prevention, vaccine in testing phase
Consultation
consultants provide expert advice in a partiular area, consultation is requested to help determine what treatment/services are needed (ex- cardiologist, psychiatrist)
Referrals
typically based on medical diagnosis or other relevant clinical information

assist in restoring, maintaining or promoting health
Case management
Promoting interdisciplinary services and increased client/family involvement
Decreasing cost by improving client outcomes
Providing education to optimize health participation
Advocating for services and client rights
Telehealth
delivery of quality health care through the use of telecommunication technologies

particularly useful in rural areas

increasing use in home health services
CIRCLE model of spiritual care
Caring
Intuition
Respect for religious beliefs and practices
Caution
Listening
Emotional support
Missionary nurses
seek to promote health and prevent disease by meeting spiritual, physical and emotional needs of people across globe

culture and language barriers often impact provision of care
Parish nurses
Promote health and wellness of populations of faith communities - often includes church members and individuals/groups in community

Personal health counseling, health education, liaison between faith community and local resources, facilitator support groups, spiritual support
Occupational safety and health act of 1970
Occupational safety and health administration (OSHA) develops and enforces workplace health regulations to protect the safety and health of workers
National advisory committee on occupational safety (NIOSH) gathers and disseminates data on incidence and prevalence of occupational illness and injury
Workers compensation acts
state-level legislation that regulates financial compensation to workers suffering from injuries or illness resulting from the workplace
The factors, exposures, characteristics, and behaviors that determine patterns of disease are described using:
a. Descriptive epidemiology
b. Analytic epidemiology
c. Distribution
d. Determinants
d. Determinants
To understand the causes of health and disease, epidemiology studies:
a. Individuals
b. Families
c. Groups
d. Populations
d. Populations
When a nurse examines birth and death certificates during an epidemiologic investigation, what data category is being used?
a. Routinely collected data
b. Data collected for other purposes but useful for epidemiologic research
c. Original data collected for specific epidemiologic studies
d. Surveillance data
a. Routinely collected data
An epidemiologist wanting to know what caused severe diarrhea and vomiting in several people at a local banquet would be using:
a. Descriptive epidemiology
b. Analytic epidemiology
c. Distribution
d. Determinants
b. Analytic epidemiology
Which is an example of an epidemic?
a. "Bird" flu in China
b. Adult obesity in the United States
c. An isolated case of smallpox in Africa
d. The nursing shortage in the United States
b. Adult obesity in the United States
John Snow is called the "father of epidemiology" because of his work with:
a. Cholera
b. Malaria
c. Polio
d. Germ theory
a. Cholera
The interaction between an agent, a host, and the environment is called:
a. Natural history of disease
b. Risk
c. Web of causality
d. The epidemiologic triangle
d. The epidemiologic triangle
Public health professionals refer to three levels of prevention as tied to specific stages in the:
a. Epidemiologic triangle
b. Web of causation
c. Natural history of disease
d. Surveillance process
c. Natural history of disease
Which is an example of an agent in the epidemiologic triangle?
a. Human population distribution
b. Salmonella
c. Genetic susceptibility
d. Climate
b. Salmonella
When studying chronic disease, the multifactorial etiology of illness is considered. What does this imply?
a. Genetics and molecular structure of disease is paramount.
b. Single organisms that cause a disease, such as cholera, must be studied in more detail.
c. Focus should be on the factors or combinations and levels of factors contributing to disease.
d. The recent rise in infectious disease is the main focus.
c. Focus should be on the factors or combinations and levels of factors contributing to disease.
Immunization for measles is an example of:
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Health promotion
a. Primary prevention
Screening for hearing defects is an example of:
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Health promotion
b. Secondary prevention
Vocational rehabilitation of a person with a neuromuscular disease is an example of:
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Health promotion
c. Tertiary prevention
An example of primary prevention is:
a. Pap smear
b. Blood pressure screening
c. Diet and exercise
d. Physical therapy
c. Diet and exercise
An example of secondary prevention is:
a. Rehabilitation
b. Avoidance of high-risk behaviors
c. Immunization
d. Mammogram
d. Mammogram
An example of tertiary prevention is:
a. Rehabilitative job training
b. Parenting education
c. Testicular self-examination
d. Family counseling
a. Rehabilitative job training
The probability an event will occur within a specified period of time is called:
a. Rate
b. Risk
c. Epidemiology
d. Epidemic
b. Risk
Which statement is true about mortality rates? Mortality rates:
a. Are informative only for fatal diseases
b. Provide information about existing disease in the population
c. Are calculated using a population estimate at year-end
d. Reveal the risk of getting a particular disease
a. Are informative only for fatal diseases
A screening for diabetes revealed 20 previously diagnosed diabetics and 10 probable new cases, which were later confirmed, for a total of 30 cases. This is called:
a. Prevalence
b. Incidence
c. Attack
d. Morbidity
a. Prevalence
An example of an attack rate is the:
a. Number of cases of cancer recorded at a medical center
b. Number of people who died of cholera in India in a given year
c. Number of beef cattle inoculated against mad-cow disease on a farm
d. Proportion of people becoming ill after eating at a fast-food restaurant
d. Proportion of people becoming ill after eating at a fast-food restaurant
Which would be considered a serious epidemic of influenza?
a. 50 cases
b. 100 cases
c. 500 cases
d. Unable to determine
d. Unable to determine
The most important predictor of overall mortality is:
a. Race
b. Age
c. Gender
d. Income
b. Age
An outbreak of a gastrointestinal illness from a food-borne pathogen is an example of a(n):
a. Attack rate
b. Point epidemic
c. Secular trend
d. Event-related cluster
b. Point epidemic
A study that uses information on current health status, personal characteristics, and potential risk factors or exposures all at once is called:
a. Cross-sectional
b. Ecological
c. Case-control
d. Cohort
a. Cross-sectional
The type of epidemiologic study that is used to describe a group of persons enrolled in a study who share some characteristic of interest and who are followed over a period of time to observe some health outcome is a(n):
a. Case control study
b. Cross-sectional study
c. Cohort study
d. Experimental study
c. Cohort study
Voters have recently decided to have fluoride added to the city water system. Epidemiologists wanting to study the effect of fluoride on dental caries would be conducting a(n):
a. Ecological study
b. Double-blind study
c. Community trial
d. Screening
c. Community trial
The proportion of persons with positive test results who actually have a disease, interpreted as the probability that an individual with a positive test result has the disease, is the:
a. Sensitivity
b. Specificity
c. Positive predictive value
d. Negative predictive value
c. Positive predictive value
A nurse is told that a screening test has high specificity. This means that the test:
a. Provides precise and consistent readings
b. Accurately identifies those with the condition or trait
c. Accurately identifies those without the trait
d. Has a high level of false positives
c. Accurately identifies those without the trait
In which situation does the nurse need to be aware of the potential for selection bias?
a. Determining the population to be studied
b. Considering how the participants will enter the study
c. Studying cause and effect relationships
d. Documenting results of the study
b. Considering how the participants will enter the study
As a result of an outbreak of influenza in a community, a nurse encourages members of the community to receive the influenza vaccine. Which level of prevention is being used?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Multifactorial prevention
a. Primary prevention
Epidemiologic studies of diseases conducted by nurses during the twentieth century were influenced by the (select all that apply):
a. Increasing rate of poverty
b. Declining child mortality rates
c. Overcrowding in major cities
d. Development of new vaccinations
b. Declining child mortality rates

d. Development of new vaccinations
Nurses incorporate epidemiology into their practice and function in epidemiologic roles through (select all that apply):
a. Policy making and enforcement
b. Collection, reporting, analysis, and interpretation of data
c. Environmental risk communication
d. Documentation on patient charts and records
b. Collection, reporting, analysis, and interpretation of data

c. Environmental risk communication

d. Documentation on patient charts and records
Change for the community as client must often occur at several levels because:
a. Health problems caused by lifestyle are multidimensional.
b. Most individuals can change their habits alone.
c. Aggregates are responsible for social change.
d. Geographic areas often have health risks that the nurse must identify.
a. Health problems caused by lifestyle are multidimensional.
A nurse cares for the community as the client when focusing on:
a. Providing care for aggregates living in the community
b. The collective good of the population
c. The provision of care for families in the home setting
d. Providing health education in the community
b. The collective good of the population
A collection of individuals who have in common one or more personal or environmental characteristics is the definition of a(n):
a. Community
b. Group
c. Family
d. Aggregate
d. Aggregate
What are the critical attributes in the definition of community?
a. Families, groups, and health organizations
b. Health needs, geographical boundaries, and target population
c. People, place, and functions
d. Populations and health resources
c. People, place, and functions
A group of nursing students forms a student nursing association to provide support while they are enrolled in a nursing program. This is known as a community of:
a. Place
b. Special interest
c. Problem ecology
d. Function
b. Special interest
A public health nurse is collecting data about the biological aspects of community health. What data will the nurse collect?
a. Race/ethnicity
b. Traditional morbidity and mortality rates
c. Policy making and social change
d. Homicide rates
b. Traditional morbidity and mortality rates
A community that has residents who are very involved in its activities and encourage activities that promote the health of the community displays which condition of community competence?
a. Commitment
b. Participation
c. Articulateness
d. Effective communication
b. Participation
Which data source provides information about the function of the community?
a. Maps
b. Census data
c. State departments, business and labor, local library
d. Civic groups
c. State departments, business and labor, local library
Which characteristic is an indicator of community health process?
a. Participation and community action
b. Live birth rate
c. Racial distribution
d. Socioeconomic levels
a. Participation and community action
A community that demonstrates commitment would most likely support the development of a:
a. Community club to facilitate community involvement
b. Children's recreation program
c. Curb-side recycling program and community-based education about recycling
d. Cooperative agreement with a neighboring city to share needed services
c. Curb-side recycling program and community-based education about recycling
The main characteristics of partnership are:
a. Awareness, flexibility, and distribution of power
b. Rights, responsibilities, and consensus
c. Commitment, participation, and articulation
d. Collaboration, advocacy, and utility
a. Awareness, flexibility, and distribution of power
When completing a community assessment, the nurse will:
a. Identify community needs and clarify problems.
b. Determine the weaknesses of a community.
c. Perform the core functions of public health nursing.
d. Assess individual needs within a community.
a. Identify community needs and clarify problems.
When a nurse focuses intervention strategies on the structural dimension of community health, they are directed toward:
a. Health services
b. Primary prevention
c. Health promotion
d. Secondary prevention
a. Health services
Which characteristic is an indicator of community health structure?
a. Infant mortality rate
b. Effective communication
c. Crime rate
d. Emergency room utilization
d. Emergency room utilization
After identifying the boundaries of a community, what is the next step the nurse should take in completing a community assessment?
a. Gather relevant existing data and generating missing data.
b. Plan interventions that benefit the entire community.
c. Formulate nursing diagnoses.
d. Evaluate the interventions that were used.
a. Gather relevant existing data and generating missing data
What intervention would be the most appropriate for the nurse to use when trying to develop community partnerships?
a. Involve only the community residents.
b. Use nurses as the source of information and leadership.
c. Rely on the power of local officials.
d. Include a variety of disciplines.
d. Include a variety of disciplines.
When writing a community-level diagnosis, "Among" refers to the:
a. Specific problem or health risk faced by the community
b. Characteristics of the community
c. Community client experiencing the risk or problem
d. Likelihood that the problem will be solved
c. Community client experiencing the risk or problem
Which nursing diagnosis is written at the community-level?
a. Risk of hypertension related to poor diet and sedentary lifestyle
b. Risk of obesity among school-age children related to lack of opportunities to engage in physical activity
c. Risk of ineffective health maintenance among individuals who do not have access to a primary care provider
d. Ineffective coping related to multiple stressors as evidenced by client crying and stating she has no support system
b. Risk of obesity among school-age children related to lack of opportunities to engage in physical activity
A nurse surveys the school nurses in a community to determine their roles in the schools because this data is not available. The nurse is engaging in the process of data:
a. Collection
b. Gathering
c. Generation
d. Interpretation
c. Generation
A nurse schedules an appointment with a physician who has a practice in the community to learn more about the community's beliefs regarding childhood immunizations. This is known as:
a. Informant interview
b. Participant observation
c. Secondary analysis
d. Windshield survey
a. Informant interview
When conducting informant interviews in a small community, the nurse would most likely contact:
a. The state department of health for death records
b. A local priest for congregation information
c. Surrounding communities for crime comparison
d. The Centers for Disease Control and Prevention (CDC) for illnesses in the area
b. A local priest for congregation information
A nurse collects data about seat belt usage by interviewing key informants and observing behaviors in the community. What type of data is being collected?
a. Quantitative
b. Qualitative
c. Focus-groups
d. Survey
b. Qualitative
A nurse who reads the local community newspaper is using which method to gather data about the community?
a. Informant interview
b. Survey
c. Participant observation
d. Windshield survey
c. Participant observation
Which method of data collection is being used as a nurse gathers information about the condition of homes, size of lots, neighborhood hangouts, road conditions, and modes of transportation?
a. Participant observation
b. Windshield survey
c. Survey
d. Informant interviews
b. Windshield survey
A nurse who uses such data as minutes from a community meeting is using:
a. Secondary analysis
b. Informant interviews
c. A survey
d. A windshield survey
a. Secondary analysis
A nurse plans on implementing a community-wide influenza immunization program. Which factor should the nurse consider when implementing this program?
a. The number of community members who have already received the immunization
b. The existence of formal groups in the community
c. Public policy that mandates influenza immunization for certain populations
d. The community's readiness to participate in the program
d. The community's readiness to participate in the program
To effectively complete the evaluation phase, the nurse must have:
a. Demonstrated the ability to improve the health of the participants
b. Developed measureable objectives and goals before implementation
c. Encouraged full participation by community members
d. Improved the health of the population through the program
b. Developed measureable objectives and goals before implementation
To analyze the problem of increased adolescent alcohol use in the community, a nurse brings together several groups of people to address the issue. These groups come together at the same time to work on identifying potential causes of the problem, but do not interact during the process. Which model is the nurse applying?
a. Delphi technique
b. Program planning model
c. Community-as-partner model
d. Community empowerment model
b. Program planning model
A nurse is trying to increase participation in a free colorectal screening program for middle-aged adults who lack health insurance. Which implementation mechanism would be most effective?
a. Small interacting groups
b. Health policy
c. Lay advisors
d. Mass media
d. Mass media
A nurse may define a community as a(n) (select all that apply):
a. Social group determined by geographic boundaries
b. Group of people who share common values and interests
c. Group of people defined by their interactions
d. Individual with a specific health concern
a. Social group determined by geographic boundaries

b. Group of people who share common values and interests
Which data would be useful for a nurse to collect when assessing safety in a community? Select all that apply.
a. Number of billboards in the area
b. Interviews with health care providers who are familiar with the community
c. Observation of community members
d. Nurse's own observations
b. Interviews with health care providers who are familiar with the community

c. Observation of community members

d. Nurse's own observations
Violence
act involving a serious abuse of power. Usually, a relatively stronger person controls or injures another,
True
True or false.
...
Natural disasters, such as hurricanes and earthquakes, can cause mental health effects comparable to those caused by human-made violence.
...
Violence against a person who has a mental illness is more likely to occur when factors such as poverty, transient lifestyle, or a substance use disorder are present.
...
A person who has a mental illness is no more likely to harm strangers than anyone else.
Female
What sex is most common for family abuse
When partner tries to leave relationship
Greatest risk for relationship violence
...
Pregnancy tends to increase the likelihood of violence toward the intimate partner. The reason for this is unclear.
3 year and under
Age of children at risk for abuse
...
Older or other adults who are vulnerable within the home may suffer abuse because they are in poor health, exhibit disruptive behavior, or are dependent on a caregiver.
maltreatment
Family violence occurs across all economic and educational backgrounds and racial and ethnic groups in the United States.
Tension-building phase -
The abuser has minor episodes of anger and may be verbally abusive and responsible for some minor physical violence. The victim is tense during this stage and tends to accept the blame for what is happening.
Acute battering phase -
The tension becomes too much to bear and serious abuse takes place. The victim may try to cover up the injury or may get help.
Honeymoon phase -
The situation is defused for awhile after the violent episode. The abuser becomes loving, promises to change, and is sorry for the behavior. The victim wants to believe this and hopes for a change. Eventually, the cycle begins again.
...
Periods of escalation and de-escalation usually continue with shorter and shorter periods of time between the two. Emotions for the abuser and victim, such as fear or anger, increase in intensity. Repeated episodes of violence lead to feelings of powerlessness.
Physical violence
occurs when physical pain or harm is directed: Toward an infant or child, as is the case with shaken baby syndrome (caused by violent shaking of young infants)
Sexual violence
occurs when sexual contact takes place without consent, whether the victim is able or unable to give that consent.
Emotional violence
includes behavior that minimizes an individual's feelings of self-worth or humiliates, threatens, or intimidates a family member.
Economic maltreatment
Failure to provide for the needs of a victim when adequate funds are available
Demonstration of low self-esteem and feelings of helplessness, hopelessness, powerlessness, guilt, and shame
Vulnerable person (victim) characteristics
Possible use of threats and intimidation to control the victim Is usually an extreme disciplinarian who believes in physical punishment Possible history of substance use disorder Has difficulty assuming typical adult roles Is likely to have experienced family violence as a child
Perpetrator characteristics
Shaken baby syndrome -
Shaking may cause intracranial hemorrhage. Assess for respiratory distress, bulging fontanelles, and an increase in head circumference. Retinal hemorrhage may be present. Any bruising on an infant before age 6 months is suspicious.
...
Preschoolers to adolescents Assess for unusual bruising, such as on abdomen, back, or buttocks. Bruising is common on arms and legs in these age groups.
forearm spiral fractures
result of twisting the extremity forcefully. The presence of multiple fractures is suspicious.
Critical incident stress debriefing
This is a crisis intervention strategy that assists clients who have experienced a traumatic event, usually involving violence
Trauma Affect Regulation: Guide for Education and Therapy (TARGET) -
Provides trauma survivors with a therapeutic approach to healing while offering education about practical skills to manage emotions and the effect of memories on daily life.
Trauma Recovery and Empowerment Model (TREM) -
A gender-specific model (TREM for female and M-TREM for male) designed to assist survivors of trauma, specifically physical or sexual trauma.
...
Refusing to pay bills for a dependant is economic maltreatment, rather than neglect. B. CORRECT: Physical violence occurs when physical pain or harm is directed toward another individual. C. INCORRECT: Striking an intimate partner or other individual is an example of physical, rather than sexual, violence. Sexual violence occurs when sexual contact takes place without consent. D. INCORRECT: Failure to provide a stimulating environment for normal development is neglect, rather than emotional abuse.
...
Minor injuries on the arms and legs, such as abrasions, are common in this age group. B. CORRECT: Round burn marks anywhere on the child's body can indicate cigarette burns and should alert the nurse to possible abuse. C. INCORRECT: Mismatched clothing is consistent with the child's developmental age. D. INCORRECT: Abdominal rebound tenderness is a possible indication of appendicitis rather than abuse. E. CORRECT: Areas of ecchymosis on the torso, back, or buttocks should alert the nurse to possible abuse.
Violence from one person toward another is a social act involving a serious abuse of power. Usually, a relatively stronger person controls or injures another, typically the least powerful person accessible to the abuser. This includes acts of violence committed by spouse against spouse, parent against child, or child against parent.
...
The nurse must be prepared to deal with various types of violence and the mental health consequences.
■ Violence may be caused by a family member, a stranger, or an acquaintance, or it can come from a human-made mass-casualty incident, such as a terrorist attack.
■ Natural disasters, such as hurricanes and earthquakes, can cause mental health effects comparable to those caused by human-made violence.
■ Violence against a person with mental illness is more likely to occur when factors such as poverty, transient lifestyle, and substance abuse are present.
■ A person with mental illness is no more likely to harm strangers than anyone else.
■ The factor most likely to cause violence between strangers is a past history of violence and criminal activity.
Risk Factors
◯ The female partner is the victim in the majority of family violence, but the male partner may also be a victim of violence.
◯ Victims are at the greatest risk for violence when they try to leave the relationship.
◯ Pregnancy tends to increase the likelihood of violence toward the domestic partner.
The reason for this is unclear.
◯ Factors that make abuse against children more likely include:
■ The child is under 3 years of age.
■ The child is perceived by the perpetrator as being different (the child is the result of an unwanted pregnancy, is physically disabled, or has some other trait that makes him particularly
vulnerable).

◯ Older adults within the home may be abused because they are in poor health or because they exhibit disruptive behavior and because they are dependent on a caregiver. The potential for violence against an older adult is highest in families where violence has already occurred.
◯ Violence is most common within family groups, and most violence is aimed at family and friends rather than strangers.
■ Family violence occurs across all economic and educational backgrounds and racial/ethnic groups in the United States and is often termed "maltreatment."
■ Family violence/maltreatment can occur against children, domestic partners, or older adult family members.
■ Within the family, a cycle of violence can occur between domestic (intimate) partners:
☐ Tension-building phase - The abuser has minor episodes of anger and may be verbally abusive and responsible for some minor physical violence. The victim is tense during this stage and tends to accept the blame for what is happening.
☐ Serious battering phase - The tension becomes too much to bear and a serious incident takes place. The victim may try to cover up the injury or may get help.
☐ Honeymoon phase - The situation is defused for awhile after the violent episode. The abuser becomes loving, promises to change, and is sorry for the behavior. The victim wants to believe this and hopes for a change. Eventually, the cycle begins again.
☐ Periods of escalation and de-escalation usually continue with shorter and shorter periods of time between the two. Repeated episodes of violence lead to feelings of powerlessness.
Cultural differences can influence whether or not the nursing assessment data is valid, how the client responds to interventions, and the appropriateness of nursing interactions with the client.
Types of Violence
◯
Physical violence occurs when pain or harm results:
■ Toward an infant or child, as is the case with shaken baby syndrome (caused by violent shaking of young infants)
■ Toward a domestic partner, such as striking or strangling the partner ■ Toward an older adult in the home (elder abuse), such as pushing an older adult
parent and causing her to fall
Sexual violence occurs when sexual contact takes place without consent, whether the victim is able or unable to give that consent.

◯
◯
◯
◯
◯
◯
Emotional violence, which includes behavior that minimizes an individual's feelings of self-worth or humiliates, threatens, or intimidates a family member.
Neglect, which includes the failure to provide:
■ Physical care, such as feeding
■ The emotional care, such as interacting with a child, and/or stimulation necessary for a child to develop normally
■ An education for a child, such as enrolling a young child in school ■ Needed health or dental care Economic maltreatment, which includes: ■ Failure to provide the needs of a victim when adequate funds are available ■ Unpaid bills, resulting in disconnection of heat or electricity
Victim characteristics
■ Demonstration of low self-esteem and feelings of helplessness, hopelessness, powerlessness, guilt, and shame
■ Attempts to protect the perpetrator and accept responsibility for the abuse ■ Possible denial of the severity of the situation and feelings of anger and terror Perpetrator characteristics ■ Possible use of threats and intimidation to control the victim ■ Is usually an extreme disciplinarian who believes in physical punishment ■ Possible history of substance abuse ■ Is likely to have experienced family violence as a child



Infants
■ Shaken baby syndrome - Shaking may cause intracranial hemorrhage. Assess for respiratory distress, bulging fontanelles, and increased head circumference. Retinal hemorrhage may be present.
■ Any bruising on an infant before age 6 months is suspicious. ■ Preschoolers to adolescents
☐ Assess for unusual bruising, such as on abdomen, back, or buttocks. Bruising is common on arms and legs in these age groups.
☐ Assess the mechanism of injury, which may not be congruent with the physical appearance of the injury. Numerous bruises at different stages of healing may indicate continued beatings. Be suspicious of bruises or welts that have taken on the shape of a belt buckle or other object.
☐ Assess for burns. Burns covering "glove" or "stocking" areas of the hands or feet may indicate forced immersion into boiling water. Small, round burns may be caused by lit cigarettes.



☐ Assess for fractures with unusual features, such as forearm spiral fractures, which could be caused by twisting the extremity forcefully. The presence of multiple fractures is suspicious.
☐ Assess for human bite marks. ☐ Assess for head injuries - level of consciousness, equal and reactive pupils,
nausea/vomiting.


Older adults
☐ Assess for any bruises, lacerations, abrasions, or fractures in which the physical appearance does not match the history or mechanism of injury.
Nx Care
All states have mandatory reporting laws that require nurses to report suspected abuse; there are civil and criminal penalties for not reporting suspicions of abuse.
Nursing interventions for child or older adult abuse must include the following:
■ Mandatory reporting of suspected or actual cases of child or older adult abuse
■ Complete, accurate documentation of subjective and objective data obtained during assessment
Conduct a nursing history.
■ Provide privacy when conducting interviews about family abuse.
■ Be direct, honest, and professional.
■ Use language the client understands.
■ Be understanding and attentive.
■ Use therapeutic techniques that demonstrate understanding.
■ Use open-ended questions to elicit descriptive responses.
■ Inform the client if a referral must be made to children's or adult

Provide basic care to treat injuries. Make appropriate referrals. Nursing interventions for community-wide or mass casualty incidents include:

Early intervention
Provide psych' first aid, which includes:
Making sure the clients are physically and psychologically safe from harm
Reducing stress-related symptoms, such as using techniques to alleviate a panic attack
Providing interventions to restore rest/sleep and provide links to social supports and information about critical resources

☐ Depending on their level of expertise and training, mental health nurses may provide assessment, consultation, therapeutic communication and support, triage, and psychological/physical care.

Critical incident stress debriefing
☐ This is a crisis intervention strategy used to assist individuals who have experienced a traumatic event, usually involving violence (staff experiencing client violence, school children and personnel experiencing the violent death of a student, rescue workers after an earthquake) in a safe environment.
☐ Debriefing may take place in group meetings with a facilitator that and allows for a safe environment where thoughts and feelings may be expressed.
☐ The facilitator will acknowledge reactions, provide anticipatory guidance for symptoms that may still occur, teach stress management techniques, and provide referrals.
☐ The group may choose to meet on an ongoing basis or disband after resolution of the crisis.


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Care After Discharge
Nursing Actions
■ Help client develop a safety plan, identify behaviors and situations that might trigger violence and provide information regarding safe places to live.
■ Encourage participation in support groups. ■ Use case management to coordinate community, medical, criminal justice, and
social services.
■ Use crisis intervention techniques to help resolve family or community situations where violence has been devastating.
Client Education ■ Instruct clients regarding normal growth and development. ■ Teach clients self-care and empowerment skills. ■ Teach clients ways to manage stress.

Client Outcomes

Client will develop safety plan. Client will participate in self-help or support group. Client will identify strategies to manage stress. Client will be free from injury.
Factor most likely to predict violence between strangers
Past history of violence and criminal activity
Tension building phase
The abuser has minor episodes of anger and may be verbally abusive and responsible for some minor physical violence. The victim is tense during this stage and and tends to accept the blame for what is happening.
Acute battering phase
The tension becomes too much to bear and serious abuse takes place. The victim may try to cover up the injury or may get help.
The tension becomes too uch to bear and serious abuse takes place. The victim may try to cover up the injury or may get help.
The situation is defused for awhile after the violent episode. The abuser becomes loving, promises to change and is sorry for the behavior. The victim wants to believe thas and hopes for a change. Eventually the cycle begins again.
Periods of escalation and de-escalation
Continue with shorter and shorter periods of time between the two. Emotions for the abuser and victim, such as fear or anger increase in intensity.
Sexual violence
occurs when sexual contacts takes place without consent, whether the victim is able are unable to get back consent
emotional violence
includes behavior that minimizes and individuals feelings of self-worth or humiliates, threatens, or intimidate the family member
Neglect
Failure to provide physical care such as feeding
emotional care such as interacting with the child
an education for child
necessary health or dental care
economic maltreatment
failure to provide for the needs of the victim went adequate funds are available
unpaid bills resulting in disconnection of heat or electricity
shaken baby syndrome assessment
may cause intracranial hemorrhage. Assess for respiratory distress, bulging fontanelle's, and an increase in head circumference. Retinal hemorrhage may be present
Nursing interventions for a child or vulnerable adult must include
mandatory reporting of suspected or actual cases of child or vulnerable adult abuse
Trauma affect regulation guide for education and therapy TARGET
provides trauma survivors with therapeutic approach to healing while offering education about practical skills to manage emotions and the effect of memories on daily life
trauma recovery and empowerment model TREM
a gender specific model designed to assist survivors of trauma specifically physical or sexual
Situational/external crisis
often unanticipated loss or change experienced in every day
maturational/internal crisis
achieving the developmental stages, which requires learning additional coping mechanisms
Adventitious crisis
the occurrence of natural disasters, crime, or national disasters
phase 1 of crisis
escalating anxiety from these threats activates increased defense responses
Phase 2 of crisis
anxiety continues escalating as defense responses fail, functioning becomes disorganized, and the client resorts to trial and error attempts to resolve anxiety
phase 3 of crisis
trial and error methods of resolution failed, and the client anxiety escalates to severe or panic levels, leading to flight or withdrawal behaviors
Phase 4 of a crisis
the client experiences overwhelming anxiety that can lead to English and apprehension, feelings of powerlessness and being overwhelmed, disassociative symptoms like depersonalization detachment from reality, depression, confusion, and or violence against others or self
critical incident stress debriefing
a group approach that can be used with a group of people who would been exposed to crisis situation
Medications administered for crisis
Antianxiety and or antidepressants
PRIMARY Prevention
PROMOTES health and PREVENTS mental health problems from occurring.
Example of Primary Prevention is .....
A nurse leads a group for parents of toddlers discussing normal toddler behavior and ways to promote healthy development.
SECONDARY Prevention
Focuses on EARLY DETECTION of mental illness.
Example of Secondary Prevention is .....
A nurse screens parents of children who have developmental disorders.
TERTIARY Prevention
Focuses on rehabilitation and prevention of further problems in clients PREVIOUSLY DIAGNOSED.
Example of Tertiary Prevention is .....
A nurse leads a support group for clients who have completed a substance use disorder program.
THIS SET IS OFTEN IN FOLDERS WITH...