Final Review NBSN3002
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Date Created: 10/04/15
Community amp Public Health Nursing Weeks 712 Environmental Health amp Safety Chapter 9 o Ecology the study of the interactions and relationships between living organisms and their environments 0 Ecosystems dynamic communities that no organism including humans can exist outside of o The scientific study of ecosystems provides an understanding of the relationship between humans and the environment and why knowledge of environmental health is so important for nurses LongRange Environmental Impact 0 Consideration of present and future needs 0 Food and fuel limitations of the natural environment 0 Attendance to conservation through balancing of present and future needs 0 Prevention of the consequences of environment abuse Concepts and Theories 0 John McKinley in 1979 quotA Case for Focusing Upstream I Identifies root causes of disease and manufacturers of illness I It considers socioeconomic factors and also the environmental origins of disease and health problems I Public health nurses are often the quotsentinels of surveillance who detect unusual illness patterns and respond to environmental emergencies in work and community settings o In the absence of clear data that indicate the safety of an action chemical or material that poses a threat to human health it should not be used 0 The principle states quotWhen an activity raises threats of harm to human health or the environment precautionary measures should be taken if some cause and effect relationships are not fully established scientifically Guiding Documents 0 Environmental Principles for Public Health Nursing 0 ANA s Principles of Environmental Health for Nursing Practice 0 American Nurses Association ANA Nursing Scope and Standards of Practice Standard 16 Environmental Health 0 Healthy People 2020 Initiatives 0 Core Functions of Public Health 1 Assessment a Monitoring health status b The diagnosis and investigation of health hazards into the community 2 Assurance a The enforcement of policy 3 Policy Development a Provides guidance through the essential community services b Engages scientists to analyze and develop policies to ensure health based upon sound evidence Major Global Environmental Concerns o Overpopulation 0 Effects food scarcity water shortages depletion of other vital resources 0 Demographic entrapment population gt ability of ecosystem to support it or acquire needed support or when population exceeds its ability to migrate to other ecosystems in a manner to preserve its standard of living 0 Government s role solutions possibly controversial depending on culture religious beliefs personal values and convictions o Nurse s role teaching about birth spacing preventing highrisk pregnancies preventing growing epidemic of HIVAIDS providing family planning education and providing prenatal care 0 Air pollution 0 One of the most hazardous sources of chemical contamination adverse effects including costs to property productivity quality of life and human life Difficulty establishing actual cause and effect Certain geographic areas more susceptible to ill effects due to weather or physical terrain o Dusts gases and naturally occurring elements 0 Dusts silica dust asbestos gases sulfur oxides nitrogen oxides chlorine ozone sulfur dioxide carbon monoxide radon o Pollen volcanic ash airborne microorganisms 0 Acid precipitation 0 Air contaminants precipitation sulfuric and nitric acid acid rain 0 Effects killing small life forms danger to forest and freshwater ecologies 0 Ozone depletion and global warming 0 Effects increased risk for skin cancer and cataracts indirectly damaging food chain increasing exposure to vectorborne diseases raising of ocean levels and negative impact on crop production 0 Government s role clean air legislation reduction of greenhouse gases 0 Nurse s role detection community education lobbying for appropriate legislation 0 Water pollution 0 Surface water lakes and streams underground sources Effects cause of disease contamination of streams lakes and wells contamination of fish upset of ecosystem Government s role legislation for water quality testing groundwater protection Nurse s role examining household or city drinking water identifying increased incidences of waterrelated diseases promoting safe healthy water Deforestation wetlands destruction and desertification 0 Effects upset of ecosystem gases contributing to ozone depletion geographic changeslandslides drought famine starvation Government s role saving wetlands and forests Nurse s role acting as a voice at the local level leading and collaborating to initiate grassroots efforts to save wetlands and forests Energy depletion o Nonrenewable sources primarily used today nuclear energy still controversial including building of plant and disposal of nuclear waste 0 Government s role discovery rediscovery or tapping of other renewable sources of energy use of environmentally friendly sources 0 Nurse s role education about energy conservation alternative energy sources encouragement to become interested in and knowledgeable about potential energy depletion Unhealthy or contaminated food 0 O O O Inherently harmful foods contaminated foods foods with toxic additives Food irradiationcold pasteurization for global food safety Government s role regulatory agencies and monitoring Nurse s role education about proper food storage cooking and handling Waste disposal O 0 Issues involving disposal of human waste garbage hazardous waste Government s role establishment of standards for safe waste disposal monitoring and enforcing compliance Nurse s role educating public and lobbying for enabling legislation encouraging use of recyclable products avoiding use of aerosol sprays plastics and other nonrecyclable items Insect and rodent control 0 Effects irritationdiscomfort direct threat to health via attack contamination of food vectors for disease transmission mosquitos flies ticks roaches fleas rats mice and ground squirrels Government s role vector surveys research control community awareness pest control programs Nurse s role increasing awareness of threat remaining alert to evidence of insectsrodents educating persons notifying proper authorities surveying communities influencing policy makers Safety in home worksite and community 0 Exposure to toxic chemicals radiation noise pollution biologic pollutants injury hazards psychological hazards o Government s role standards and regulation monitoring of chemical use and production public education and community safety programs 0 Nurse s role monitoring preventive measures for injuries safety education promotion of firstaidCPR noise education active lobbying for crime prevention reduction or workplace stressors and development of educational and support programs Strategies for Nursing Action in Environmental Health 0 Learn about possible environmental health threats 0 Assess clients environment and detect health hazards 0 Plan collaboratively with citizens and other professionals to devise protective and preventive strategies 0 Assist with the implementation of programs 0 Take action to correct situations in which health hazards exist 0 Educate consumers and assist them to practice preventive measures 0 Take action to promote the development of policies and legislation that enhance consumer protection and promote a healthier environment 0 Assist with and promote program evaluation to determine the effectiveness of environmental health efforts 0 Apply environmentally related research findings and participate in nursing research Theoretical Basis of Community Public Health Nursing Chapter 14 Orem s SelfCare Model 0 Communities with collective set of selfcare actions and requirements affecting wellbeing of the group 0 Selfcare deficit demand exceeds client abilities related to 0 Universal requirements 0 Developmentalrequirements 0 Health deviation requirements 0 Nursing care supports clients 0 Specific theories selfcare deficit theory theory of selfcare theory of nursing system Pender s Health Promotion Model 0 Proactive set of behaviors to increase level of wellbeing and selfactualization 0 Individuals acting on environment not reacting to stressors from environment 0 Modifying factors 0 Demographic factors 0 Biologic characteristics 0 Interpersonal influences o Situational factors 0 Behavioral factors King s Theory of Goal Attainment 0 Personal and interpersonal systems 0 Any nurseclient encounter each comes with own goals and expectations 0 Success at goal achievement possible only when the nurse and client work together to set goals Roy s Adaption Model 0 Open adaptive systems experiencing stimuli developing coping mechanisms and producing responses 0 Adaptive or maladaptive responses provide feedback influencing amount and type of stimuli that can be handled in future 0 Regulator process stimuli from internal and external environment processed for a response 0 Cognator process perceptions learning judgment and emotion considered in formulating response Global Health amp International Community Health Nursing Chapter 16 Three P s 0 Population populations rather than individuals 0 Provider health care team 0 Procedure interventions health care providers implement for or with populations Three eras of health conditions 0 Era of Infectious Diseases families had many children because most would die before adulthood and children were their parents form of livelihood sons were preferred over daughters 0 Era of Chronic LongTerm Health Conditions antibiotics allowed people to survive common infections children lived longer than their parents but suffered from chronic longterm illnesses like heart disease cancer and debilitating arthritis 0 Era of Social Health Conditions new array of health conditions affecting world populations like addiction obesity prostitution sexual abuse and deviant behavior Universal Imperatives of Care 0 Mortality first priority keep its population alive and free from illness 0 Morbidity focus on its population s conditions that make people sick 0 Daily functioning ability to care for oneself 0 Decision making options to providers and health care 0 Cost health services are being rationed restricted or placed under insurance 0 Access the ease to which someone can obtain health services Community as Client Applying the Nursing Process Chapter 15 pgs 45982 Community as Client 0 A healthy community attends to and achieves the goals of Healthy People 2020 o A communitywide group of people as the focus of nursing service 0 The community directly influences the health of individuals families groups subpopulations and populations who are a part of it 0 Provision of most health services occurs at the community level Dimensions of Community as a Client 0 One perspective 0 Status morbidity and mortality data identifying physical emotional and social determinants of health 0 Structure services and resources 0 Process ability to function effectively 0 Another perspective 0 Location community boundaries location of health services geographic features climate flora fauna humanmade environment 0 Population size density composition rate of growth or decline cultural characteristics social class and educational level mobility 0 Social system variable health care delivery system Nursing Process Characteristics and Community 0 Problemsolving process management process process for implementing change 0 Characteristics 0 Deliberative adaptable cyclic 0 Client focused need oriented 0 Interaction with community communication reciprocal interaction paving way for helping relationship aggregate application 0 Forming of partnerships and building of coalitions 0 Process of determining real or perceived needs of a defined community 0 Types Windshield survey familiarization assessment 0 Problemoriented assessment 0 Community subsystem assessment 0 Comprehensive assessment key informants 0 Community assets assessment 0 Surveys 0 Descriptive epidemiologic studies 0 Community forumstown hall meetings 0 Focus groups 0 Primary gathered by talking to the people 0 Secondary records produced by people who know the community well 0 International 0 National 0 State 0 Local Community Diagnoses o Portray a community focus 0 Include community response and related factors that have potential for change via CHN logically consistent response and factors logically linked 0 Include statements narrow enough to guide interventions 0 Use a community response instead of a risk goal or need statement 0 Include factors within the domain of community health nursing intervention 0 Deficit and wellness diagnoses which include maintenance or potential change responses due to growth and development when no deficit is present Planning to Meet Community Health Needs Implementing Plans 0 Planning 0 Tools for assistance operational definitions of objectives and activities conceptual frameworks and models systematic approach 0 Health planning process 0 Implementing 0 Preparation 0 Activities or actions Evaluating Implemented Community Health Plan 0 Measuring or judging effectiveness of goal or outcome attainment 0 Types of evaluation 0 Formative focus on process during actual interventions development of performance standards 0 Summative focus on the outcomes of interventions effect impact Community Development Theory 0 Outcome of effective communitylevel nursing practice 0 Collaboration with community members to assess collective needs and desires for positive change and address these needs through problem solving use of community experts and resource development 0 Presumption that all community members participate in all aspects of change 0 Agent of change nurse considered a partner not authority figure responsible for community s health 0 Outcomes benchmarked against those of other groups Immunization amp Screenings and Primary amp Secondary Prevention Chapter 8 pgs 25462 26679 Major Communicable Diseases pgs 25462 0 Influenza 0 Acute communicable viral disease of the respiratory tract characterized by fever headache myalgia prostration coryza sore throat and cough Influenza A virus causes the most severe and widespread disease outbreaks and influenza C is connected with only sporadic cases of milder respiratory disease Influenza is usually seasonal in nature but can be found year round Vaccine preparation involves the previous year s flu strain information to calculate the next year s subtype through complex formulations done globally and nationally by public health authorities Often occurs in the winter months affecting all age groups children have the highest rates of infection but individuals age 65 years and older children younger than 2 years of age and those with medical conditions who are at risk for complications have the highest rates of hospitalizations and of serious morbidity and mortality Older adults account for more than 90 of the death attributed to influenza and pneumonia Influenza vaccine is recommended for all people 6 months and older Injected vaccine is inactivated but the nasally inhaled version is a live attenuated vaccine Influenza pandemics occur when a flu subtype has not circulated previously novel strain or has reemerged in a population that has never been exposed o Pneumonia 0 Pulmonary infection that causes inflammation of the lobes of the lungs bronchial tree or interstitial space In the U5 the most common bacterial cause of pneumonia is Streptococcus Pneumoniae and the most common viral causes are influenza parainfluenza and respiratory syncytial viruses Symptoms sudden onset with a shaking chill fever pleural pain dyspnea and productive cough of quotrustyquot sputum and tachypnea The onset is less abrupt in elderly individuals and the diagnosis may need to be confirmed by radiographic studies In infants and young children fever vomiting and convulsions may be the initial symptoms Communityacquired pneumonia is a significant cause of morbidity and mortality Globally pneumonia kills more than 1 12 million children younger than 5 each year this is greater than the number of deaths from any other infectious disease Incidence is highest in the winter Pneumonia is spread by droplets by direct oral contact and through fomites inanimate objects freshly soiled with respiratory discharges 0 People most susceptible to pneumonia are the elderly and people with a history of chronic disease a compromised immune system or any condition affecting the anatomic or physiologic integrity of the lower respiratory tract Vaccine is available for the highrisk groups ages 2 and up Highrisk groups include those with chronic diseases immunesuppressing health conditions or those who are asplenic o Reimmunization is recommended only for highrisk children or adults over 65 who had their first vaccination before the age of 65 o The vaccine is not effective in children under 2 and is not recommended for healthy population between ages 2 and 65 for the healthy population education about the prevention of pneumonia is a major role of a communitypublic health nurse 0 Hepatitis o Hepatitis A Caused by infection with the hepatitis A virus HAV occurs worldwide and is sporadic and epidemic with cyclic recurrences affecting children and young adults most frequently Case rates are high in Central and South America the Caribbean Mexico Asia except Japan Africa and southern and eastern Europe Identified by the presence of immunoglobulin M antibodies against HAV in the serum of acutely or recently ill individuals Transmitted by the fecaloral route and is characterized by the abrupt onset of symptoms fever malaise anorexia nausea and abdominal discomfort followed byjaundice in more severe cases Mild illnesses last 12 weeks but more severe cases can last 1 month or longer In areas of the world where environmental sanitation conditions are poor endemic infection may exist and cause infection at an early age Hep A vaccine has been available for use since 1995 it is inactivated it is administered in a twodose series and these vaccines induce protective antibody levels in virtually all who are immunized Recommended as a routine vaccine for children older than 12 months Communitypublic health nurses play a role in prevention and control of the disease through offering the vaccine to travelers case investigation education and identifying exposed contacts that need referral or assistance in obtaining post exposure prophylaxis and vaccination are vital to preventing and controlling this disease 0 Hepatitis B Hep B virus is often a lifelong infection and may cause cirrhosis of the liver liver cancer liver failure and death Common transmission patterns are parenteral and sexual blood and body fluid pathogen In countries with high endemicity the primary cause of infection is from mother to fetus 0 Symptoms range from unnoticeable to fulmination and include anorexia vague abdominal discomfort nausea and vomiting and rash often progressing to jaundice Immunization is the most effective way to prevent HBV transmission Communitypublic health nurses play a role in the prevention and control of hep B including teaching that encourages immunization compliance and consistent adherence to universal precautions especially for people in highrisk lifestyles or occupations Hepatitis C HIVAIDS HIV is a retrovirus that attacks the body s immune system HIV is contracted through blood and body fluids from an infected person to a O 0 Causes a complex infection of the liver and is one of the leading known causes of liver disease in the US It is a common cause of cirrhosis and hepatocellular carcinoma and liver transplantation HCV is more widespread than AIDS and many people are unaware they are infected Symptoms are similar to those of hep A and B and may be unrecognizably mile to fulminating Diagnosis depends on the demonstration of antibody to HCV and a screening test for blood donors was established in 1992 People who are at greater risk of developing HCV infection are recommended by the CDC to get tested 0 People who inject drugs even if only once or twice in the past 0 People who received transfusions or organ transplants before 1992 0 People with selected medical conditions including recipients of clotting factors before 1987 people undergoing chronic hemodialysis and those with persistently elevated alanine aminotransferase levels 0 Those exposed to HCVpositive sources such as needlesticks sharps or mucosal exposures There is no vaccine for HCV The public health nurse is primarily supportive encouraging testing for people who identified as having HCV infection risk factors and referring individuals for care and treatment and to supporteducation groups Teaching adherence to universal precautions in the home is important too susceptible person Transmission can occur during unprotected sex sharing of contaminated needles placental transmission from mother to fetus and may also be transmitted through blood or blood components Two types HIV1 and HIV2 Viewed by many as a chronic manageable disease process especially in the developed world HIV infected person may remain symptom free for long periods but viral replication is active during all stages of infection AIDS is a severe lifethreatening condition representing the late clinical stage of infection with HIV in which progressive damage to the immune and other organ systems occurs particularly the CNS AIDS has been staved off in many individuals by the use of medications during the HIV stage of the spectrum 0 Tuberculosis 0 Disease primarily of the lungs and larynx caused by the mycobacterium tuberculosis MTB TB can also infect other parts of the body it is referred to as extrapulmonary TB outside ofthelungs TB has two stages latent infection noninfectious to others and active disease highly infectious to others TB is airborne and is spread through droplet nuclei sprayed from the mouth by coughing sneezing laughing yelling singing or any way in which air is expelled vigorously from the lungs through the mouth The incubation time for TB is about 10 to 12 weeks exposure does not lead to actual disease in all cases A latent period may persist for many years before the infected person develops the disease and becomes infectious if ever Groups at increased risk include children younger than 3 adolescents and young adults the aged the immunosuppressed and those who are early in their infection Poor nutrition health status and chronic illness can inhibit the immune system ability to prevent TB activation from the dormant state HIV infection contribute dramatically to the development of active TB Immunosuppressed individuals can develop TB within weeks after exposure and the disease progressed much faster than in those with a normal competent immune system Infectious Diseases of Bioterrorism o Smallpox Screening 0 O 0 Last case was reported in 1978 Declared globally eradicated in May 1980 Routine vaccination in the US ended in 1972 1976 for health care workers and 1990 for military Ring vaccination containing an outbreak by rapidly isolating and vaccinating people who have had close facetoface contact with the victim If people who are exposed get vaccinated within 7 days they will be protected from the small pox MantouxTB 0 Measures by visible reaction whether the body has had immunologic experience with M tuberculosis o Classifies the disease on a scale of 0 to 5 most common are infected without current disease 2 and with current TB disease 3 0 Not a diagnostic of the disease 0 Delivers 01 mL of PPD purified protein derivative by intradermal injection 0 BCG vaccine is an attenuated strain of Mycobacterium bovis not used in the U5 Hepatitis Bprenatal HIVseveral screening tests Primary Prevention pg 26676 Education Immunization Passive immunity shortterm resistance to a specific diseasecausing organism it may be acquired naturally or artificially Active immunity longterm sometimes lifelong resistance to a specific diseasecausing organism it also can be acquired naturally or artificially Natural immunity person come in contact with a disease and develops longlasting antibodies or newborns through maternal antibody transfer Vaccine a preparation made from a live organism or an inactivated form of the organism Herd immunity central to understanding immunization as a means of protecting community health the immunity level present in a particular population of people Secondary Prevention pgs 27677 Screening 0 Validity and reliability 0 Predictive value and yield Tertiary Prevention pgs 27779 Care and Treatment Isolation and Quarantine Safe Handling and Control of Infectious Wastes Chapter 21 pgs 684 Read Chapter 22 pgs 71214 Read Communicable Diseases Over the past several decades the incidence of vaccinepreventable diseases has generally decreased Climate change can affect the incidence and distribution of communicable diseases Chapter 24 pgs 79798 Immunizations CDC recommends all adults over 50 receive immunizations for influenza pneumonia and shingles In older adults influenza can have exacerbating effects on other conditions eg pneumonia congestive heart failure or COPD Certain racial and ethnic groups remain substantially below those of the general population in receiving vaccinations to improve immunization coverage we need to change provider knowledge attitudes and behavior through reminders and standing orders so there are no missed opportunities Also ask clients about their beliefs and fears related to immunizations and then to address them directly and honestly Also people can be reached outside of the primary care setting ED visits neighborhood and senior centers religious facilities etc Anyone who had chicken pox can develop shingles Commonly develops in people 50 and older people who have medical conditions that keep the immune system from working properly or people who receive immunosuppressive drugs CDC recommends the Zostavax for use in people 60 years old and older to prevent shingles it is a onetime vaccination and there is no maximum age to receive the vaccine Violence Chapter 20 Types of Violence Children neglect physical sexual emotional shaken baby syndrome Munchausen syndrome internet crimes abduction by babysitters school violence Partner cycle of violence dating violence abuse during pregnancy effects on children 0 Cycle of violence a repetitive cyclic pattern of abuse seen in domestic violence situations 0 Wheel of violence figure 201 on page 634 Elder physical sexual emotional psychological neglect abandonment financial or material exploitation selfneglect Suicide Homicide Rape Prevention Toll globally in human costs and economically in health care services Lifelong health problems Preventing violence will also help reduce other noncommunicable diseases Primary Prevention 0 Health promotion and education 0 Anticipatory guidance parenting skills 0 Positive coping strategies social problemsolving skills and assertiveness skills 0 Social support and other resources 0 Health protection 0 Reduce factors that increase vulnerability 0 Reduce hazards in some events 0 Laws Secondary Prevention 0 Early diagnosis recognize signs and symptoms of crisis signs and symptoms of abuse 0 Prompt treatment 0 Provide necessary assistance including emergency medical and emotional support and assist with reaction to the even and functioning Ensure safety Allow behavior 000 Refer to resources 0 Set goals with the client 0 Reporting of abuse Tertiary Prevention 0 Rehabilitation 0 Promote adaptation to a changed level of wellness 0 Promote interdependence o Reinforce newly learned behaviors lifestyle changes coping strategies 0 Explore application of learned behaviors to new situations 0 Identify and use additional resources 0 Continue primary prevention to avert future crises Criteria for Effective Health Services for the Elderly o Comprehensiveness Adequate financial support Adult day care programs Access to highquality health care services Health education including preparation for retirement nhome services Recreation and activity programs OOOOOO Specialized transportation services Chapter 21 pgs 666 67778 Intimate Partner Violence pg 666 0 Any coercive action taken by someone against an intimate partner 0 Pregnancy is a vulnerable period for women and can increase their risk for IPV Can range from physical abuse to woman and fetus via blows to the belly and psychological coerciveness Estimated 4 to 8 of pregnant women of all walks of life experience IPV per year Reasons for increased IPV during pregnancy can be an unintended pregnancy increased stress related to supporting a child and jealousy Victims of IPV have high levels of stress and higher rates of smoking during pregnancy as well as inadequate utilization of prenatal care services Pregnant women who experience psychological IPV also have 258 higher incidence of postpartum depression Child Maltreatment pg 67778 Any type of abuse directed at a child under 18 years old Can be physical emotional and sexual abuse and child neglect Neglect is more an act or acts of omission in which a child s basic needs are not met The problem is difficult to detect and underreported Shaken baby syndrome suspected in infants or toddlers who exhibit traumatic brain injuries caused by violent shaking or impact characterized by a triad of symptoms retinal hemorrhage subdural hemorrhage andor subdural hemorrhage with few signs of external trauma the soft brain tissues are injured as they move violently against the rough cranial bones as the infant is shaken or thrown against a hard object Failure to thrive FTI39 can be related to many behavioral or physiological etiologies for infants but can also be related to child neglect Risk factors for child maltreatment are found in 4 areas Parent or caregiver behaviors Family characteristics Child factors Environment 000 Chapter 22 pg 72728 Read Chapter 24 pg 810 Read Substance Use Chapter 21 pgs 66266 Read Chapter 23 pgs 76263 Substance Use Substance use refers to the selected use of potentially dangerous substances including alcohol tobacco products drugs inhalants and other substances that can be consumed inhaled injected or otherwise absorbed into the body with possible damaging effects In the US 13 of lifestylerelated deaths annually are attributed to excessive alcohol use heavy drinking more than two drinks per day on average for men or more than one drink per day on average for women or binge drinking five or more drinks during a single occasion for men or four or more drinks during a single occasion for women White are more likely to be current drinkers than other ethnic groups at 58 HispanicsLatinos 42 and Blacks 39 More than 32 of automobile fatalities were alcohol related in 2009 Tobacco use is a significant public health and financial cost to persons living in the US Number of deaths due to CVD and cancer increase annually due to tobacco use American Indians and Alaska Natives smoke more cigarettes than Whites Blacks and HispanicLatinos 18 objectives of Healthy People 202 are related to tobacco use Illicit drug use refers to use and misuse of illegal and controlled drugs Primary illicit drugs use in the US are cocaine ecstasy heroin marijuana and methamphetamine American Indians and Alaska Natives used more illicit drugs than other racialethnic groups Blacks Whites and HispanicsLatinos Abuse of prescription drugs is the misuse of these drugs for nonmedical reasons Prescription drug misuse in one of the fastestgrowing forms of drug abuse and is becoming a major public health concern Oxycodone hydrocodone and methadone are the most frequently misused drugs Young adults aged 1825 had a higher prevalence of dependence on or abuse of prescription drugs compared to person in other age groups Men usually have higher rates than women for misuse Chapter 27 pgs 87685 88993 Prevalence and Consequences of Substance Use and Substance Use Disorders 50 of adult population report current alcohol use Alcohol highest incidence of problem drinking in young adults 1825 years 14 of those that use alcohol meet criteria for alcohol dependence at some point in lifetime Homeless population AUD range 58 84 Alcohol and benzodiazepines increase the risk of falls in the elderly No safe level of alcohol during pregnancy Increase in motor vehicle crashes related to the location of bars and liquor stores especially drivethrough stores Tobacco decline over past decade but no consistent across age groups and genders Almost 25 of population are estimated to be current smokes Tobacco use is primary cause of every 1 in 5 deaths in the US Related to 33 of all cancer and 90 of lung cancer Reported to die 14 years earlier than nonsmokers Tobacco is most prevalent addictive disorder Persons with MI are reported to smoke twice as much as the general population of smokers Secondary tobacco smoke increases risk for health issues Marijuana most frequently reported illicit drug Cocaine use doubled between 19822008 One gram of cocaine cost about 175 31 of drug related ED visits were associated with cocaine Opiatesheroin death rates for dependent heroin users are 6 to 20 times higher than for the general population 15 million people worldwide use opiates Use of opiates such as heroin and opiate derivatives or synthetic opiates rising Increase in hep B and C related to injecting heroin Prescription drugs across all age groups rise in collegeage students 24 million people in past year abuse Rx drugs for nonmedical purposes 50 were females 13 of those between 1217 years old Substance Use Disorders Homeless population with SUD 2757 20 of state prison inmates have SUDs 22 of adults with MI or SUDs have no insurance 18 of counties nationally have shortages of all mental health professionals 96 reported a shortage of prescribing mental health professionals Consequences of SU Increased risk of morbidity and mortality related to SU Decreases healthy workforce Increases cost of providing health care Determinants of Substance Use Disorders Nature versus nurture Genetics playing a major role in development of alcohol dependence Individual factors associated with AUDs high antisocial behavior high impulsivity major depression social anxiety problems history of childhood sexual abuse hyperactivity attention problems seminal events Environmental factors influence of peers lower socioeconomic status partner use substance use by family members Health People 2020 2 of the 44 Focus Areas relate to the reduction of substance use this includes tobacco 0 Reduce substance abuse and protect the health safety and quality of life for all 0 Over reaching goals include increasing access to treatments for SUDs reducing alcohol related motor vehicle crashes reducing illicit drugrelated crime and reducing secondary smoke exposure in public areas Screening for Substance Use and SUDs 0 Three levels screening for actual consumption screening for atrisk drinking and screening for SUDs 0 Level of risk based on level of consumption 0 Screening instruments 0 Selfreport Michigan Alcoholism Screening Test MAST Drug Abuse Screening Test CAGE questionnaire Drug Use Screening Inventory DUSI o Biologic screens urine blood hair saliva breath and meconium 0 Positive screen possible brief intervention CommunityLevel Interventions 0 Community assessment and focus of intervention 0 Level of prevention 0 Mental health community interventions o Integrative health assessment 0 Factors including treatment history personal life stressors disturbances in sleep appetite or energy level not attributable to a rational explanation complaints of chronic pain history of abuse trauma substance use and family history of mental illness Substance Use and the CHN o Continuum including abstinence lowrisk use riskhazardous use harmful use and dependence 0 CHN needs basic understanding of issues related to specific substance clear idea of desired outcomes related to treatment or prevention program 0 Trends of substance use across different populations and communities 0 Differences between legal and illegal substance use 0 Consequences of substance use on community 0 Substance use from environmental perspective Drug Use during Pregnancy 0 Drugexposed motherdrugdependent infant 0 Various substances usedpolysubstance abuse 0 Often associated with limited prenatal care inadequate nutrition low prepregnancy weight hypertension more rapid heart rate preterm labor and birth high rates of depression physical abuse HIVAIDS and other STDs 0 Increased risk for intrauterine fetal death prematurity low birth weight increased risk for infection birth defects neurologic problems learning disabilities and HIVAIDS Fetal growth restriction neonatal withdrawal Alcohol Use 0 Fetal alcohol spectrum disorders FASD 0 Fetal alcohol syndrome FAS o Alcoholrelated birth defects ARBD o Alcoholrelated neurodevelopmental disorder ARND Tobacco Use 0 Associated with ectopic pregnancy spontaneous abortions intrauterine growth retardation preterm birth stillbirth increased perinatal mortality smallforgestationalage birth low birth weight neonatal anomalies and lower APGAR scores Passive smoking associated with decreased head circumference depressed cognitive development lover birth weight
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