Ch 6. Environmental Health: prevents human injury and illness by promoting well-being Ch.
Ch. 14: Disaster Mngmt: mitigate(prevent), preparedness, response and recovery
by identifying and evaluating environmental sources and hazardous agents, limiting
exposures to hazardous, physical, chemical, biological agents
Toxicology: study of toxic harmful effects of chemical exposure associated with adverse
health outcomes (e.g. cancer, birth defects) Potency: the ability to cause injury/disease
(determined by dose, exposure time, port of entry). Epidemiology: uses information to
study links between disease and personal risk factors. Box 6-1: Gen environ comp for
nurses: understand rel btw ind/pop & env. Exp to health hazard, prevention, control
strategy, effective interven, role of research. Perform env health hx, recog envir
hazards/illnesses, make referrals & give info. Advocacy, ethics, risk communication.
Understand policy framework Env. & elderly: preex LD/CV, long exp to pollu, age,  host
def, meds
First step in assess comm env risk: windshield survey. Env & Child: more susceptible
to env toxins d.t size
Prim prev: education on exposure. Second prev: screenings for toxins. Tert prev: referral
to doctors
Consumer confidence report: right to know report reports drinking water conditions
IPREPARE(environmental health assessment/history): investigate potential exposures,
present work, residence, environmental concerns, past work(longest job), activities,
referrals/resources, educate.
Environmental justice: goal of campaigns seeking to improve the unequal burden of
environmental risks borne by impoverished and minority communities (live near
hazardous waste site/incerator, kids with lead poison and asthma)
Air pollution: vehicles, burning of fossil fuels, waste incineration, natural (lighting,
volcanoes, forests, wildfires), livestocks, cities, airplanes, stationary
OSHA: worker and workplace safety(environ free of health hazards-chem, excess noise,
mech dangers, heat/cold, unsanitary), establish standards
Environmental healthcare assessment: assessing the environment or assessing a
setting(ask questions that cover environmental causes- Look at what you see)
Lead Poisoning symptoms: abd/joint pain, constipation, N/V, learning disability, slow
growth, fatigue, loss of app, hyperactivity, irritability, baby colic, H/A, insomnia, mem loss
Risk Assessment: uses available information to evaluate and estimate exposure of
individuals and communities to a substance and the adverse health effect it may produce
Risk management: Selecting most appropriate action to eliminate or mitigate the risk
Advocacy in community: ask questions at policy meetings, serve as source of info, serve
on health related committees, inform local media about environmental hazards
Ch. 9 Epidemiology: the study of the occurrence and distribution of disease, goal to
prevent, limit consequence of disease, disability, and to maximize their state of health
endemic. Epi Nurse: surv/monitoring disease trends/# of ind with similar disease, symp,
patterns
Primary prevent: health ed/training daycare about health hygiene, immunizations,
seatbelt ed,folic acid ed
Secondary: health screenings (mamm, pap smear, colonoscopy), education (ex. teach
asthmatic client to recog/avoid triggers, replace carpets, keep air sys. (BP, cholest
training, weighing obesity)
Tertiary: clinics, hospitals, rehab, med treatment, PT/OT, education to decrease/prevent
worsening (OSP-nutrients)
Analytic Epi: determinants of patterns observed-how/why factors, characteristics,
exposures, behaviors (factors to certain disease (DM, obesity)
Descriptive Epi: examines occur/distrib of disease in a pop in terms of time, place,
person.
Epi triangle: factors as agent, host, environment, examines all factors that lead to disease
 Agent: animate/inanimate factor that’s present or lacking for disease to occur
(bac, virus, fungi, parasites, chemicals, radiation, heat, cold)
 Host: humans, animals
 Environment: internal or external to a given host or agent that is influenced and
influences the host or agent (climate, plant/animal life, human pop,
socioeconomic, working conditions)
Prospective study: subjects who do not have the outcome under investigation are
classified on the basis of the exposure of interest at the beginning of the follow-up
period.
Retrospective study: rely on existing records to define a cohort that is classified as having
been exposed or unexposed (reviewing)
Ch. 15: Survelliance: Ongoing, systematic collection, analysis, and interpretation of
health-related data essential to the planning, implementation, and evaluation of public
health practice, closely integrated with the timely dissemination of these data to those
responsible for prevention and control. Monitor emerging infections and bioterrorist
outbreaks, monitor disease trends to reduce morbidity and mortality and improve
health(determine local baseline and see change), important to be up to date and attend
conference-usually first to recognize/respond to a problem. Reviews data for mortality
Survellience: whats the problem  risk factor: what is the cause  intervention: what
works  implementation: how do you do it?
Passive: case reports are sent to local health depart by HCP/labs, summarized and
forwarded to the state health department, national government, or organizations
responsible for monitoring the problem
Active surveillance, the health department nurse may begin a search for cases through
contacts to determine the magnitude of the problem(ex. children become ill with GI at
school
Syndromic surv: trips to ER/doc, increase in pharm meds, increase in absenteeism
Seasonal affective: affects during winter months-normal-no action require
Interpret data impact: reviewing the incidence (has it decreased)
Purpose: evaluate effectiveness, monitor/reduce chronic disease, note/help prevent
occup exposure/disease
Recovery is expensive, Goal: lessen the impact , Have a concise, realistic, well-rehearsed
disaster plan-preparedness
Need to be trained as volunteer to respond, reduce or avoid potential losses from
hazards, assure prompt and appropriate assistance to victims, and achieve rapid and
effective recovery
Nurse should prepare: before disaster occurs
Mitigation (prevention): primary prevention to reduce individual or property. Nurses
role: Awareness and Education holding or attending community meetings on disaster
preparedness, Organizing and participating in mass prophylaxis and vaccination
campaigns, Advocacy: Identifying environmental hazards, serving on panels that
contribute to mitigation work, Ex: Supporting efforts for enhancing building codes, or
reporting unsafe equipment in hospitals (educational programs/trainings) Prevention:
structural measures, improved surveillance, security, immunizations
Preparedness: have a plan for you and your family. RN license, ID company, drivers
license, pocket references for emergencies, PPE, stethoscope, first aid, mask, meds, cell
phone etc (prepare kits). Family: 3days food/water (disaster emergency plan)
Volunteering: American Red Cross: local, Certified Emergency Response Team (CERT):
local, Disaster Medical Assistance Teams (DMATS): national and state, Medical Reserve
Corps (MRC: local and national, Salvation Army: local and national, FEMA: countywide,
levels are not determined by number of casualties, but by the amount of resources
needed
Recovery: restore normalcy, proper hygiene to make sure immunization records are
current, make referrals to mental health professionals, be alert for environmental
hazards, case finding and referral,
Stress response: child regresses and wets bed after house fire Primary prevention:
preparing disaster plan
Triage guidelines: Assess needs assistance: priority- life-threatening ab injuries Black:
head injury with GCS<8, burns >85% BSA, multisystem trauma, signs of impending death
(nothing you can do) Red: Airway obstruction, cardiorespiratory failure, significant
external hemorrhage (priority)
Ch. 26 Infectious Disease: number one cause of death worldwide
Healthy People 2020: related to comm diseases, inc immunization rates reduce
infectious disease (Resp,hep, TB, diar disease)
Surveillance: incidence of school absenteeism
Community concern of disease: hold educational campaign
Increase in infectious disease: d/t activities or behavior of human, changes in
environment
Reduce childhood infectious disease: no shots no school legislation
Communicable disease goal: to get rid of specific infectious disease
Epidemiological Triangle: Host: recipient of the organism, Environment: vaginal
environment change. Resistance (ability to withstand the infection) Immunity (natural or
acquired and active or passive) Natural immunity: innate resistance to an infectious
agent (Ex. Opossums) Active immunity: resistance you get after you’ve been exposed (Ex.
Flu-wont get same strain again, measles) Active immunization: admin of antigen
infectious agent/vaccine which produces antibodies. Passive immunization: antibody
transfer (Mother to child) immunoglobin HEP a, rabies, tetanus. Herd immunity:
Immunity to a group or a community, Inc vacc gives greater herd immunity-kids being
immunized stops epidemics. Agent: ability to cause the disease (bacteria, fungi, parasites,
viruses). Infectivity: the ability to enter the host. Pathogenicity: the agent’s ability to
produce a specific clinical reaction. Virulence: ability to produce a severe
pathological/physical reaction. Toxicity: ability to produce a poisonous reaction.
Invasiveness: ability to penetrate and spread throughout the host. Antigenicity: ability to
stimulate an immunological response. Environment: Physical, biological, social, cultural
factors that are external to the host. Ex. Antibiotics change the environment within the
hose causing thrush, cdiff, yeast infection. How to stop mosquito born illness (nets,
spraying, clothes, antimalarials, bug spray, avoid standing water) Vectors: anthropoids
like ticks/mosquitos (Ex. Lyme disease)
Incubation period: actual invasion of the microorganism before clinical S&S appear. Can
last from hours-weeks-years (Ex. Food poisioning vs. viral, HIV test next day wont be
reliable
Prodromal period: few S&S begin to appear, malaise
Active period: full S&S appear from mild-severe—fatal
Convalescent phase: S&S begin to subside individual begins to feel better, still carrier
CDC: responsible for programs to prevent/control communicable disease
Measles: highly contagious, respiratory disease affects child-adults, may also get ear
infection or pneumonia, aerosol droplets (coughing, breathing, sneezing) or contact, S&S:
fever, sneezing, cough, conjunctivitis, small white inside cheese, red blotchy rash over the
body, MMR 2 dose immunization (measles epidemic)
Salmonella(bacterial disease): onset 48 hrs, S&S: H/A, abd pain, diarrhea, N/V, fever,
dehydration, fecal-oral transmission,, From an infected animal or worker – on veggies
from animal run off onto the food, pooping in the fields (Reptiles, iguanas, turtles,
poultry, cattle, swine, rodents, dogs, cats may carry the disease)
E. Coli: enterohemorrhagic strong toxin, eating undercooked meat, Beef, alphalpa
sprouts, apple cider, melons, lettuce, municipal water, unpasteurized milk, ready to eat
salads, cheese, packaged cookie dough, pizza, flour, and tacos, S&S: Bloody diarrhea, adb
cramps, can cause ARF, Children and older adults at highest risk – can cause ARF
(hamburger, soft eggs)
Lyme Disease: vector borne (tick, deer, mice, raccoons, opossums),
northeast/Minnesota/Wisconsin/midatlantic state/pacific, late spring, summer, early fall,
outdoor activity in wooded area increase risk, S&S: flu like, stiff neck, muscle pain, may
develop arthritis, lymphedema, Treatment: tetracycline, PCN (10-14days) Prevention:
avoid ticks, wear protective clothing, deet sprays (avoid under 2) reapply q2hrs, inspect
immediately, permethrin sprayed on clothing, know how to remove
Malaria: blood borne, human-human (drug users can develop from sharing needles,
other-infant), travels to liver-reporoduce and enter bloodstream and infect rbc, risk
children and travelers, S&S: chills, fever, H/A, muscle pan, anemia, hepatomegaly,
splenomegaly (most common world wide), antimalarial treatment-prophylactic, 1-3 wks
prior to travel then 4-6 weeks after
Primary prevention: receiving immunizations(ex. tetanus), Secondary prevention:
screenings(ex. tb test, xray)
Ch. 27 TB: Not easy to catch: must breathe same air for hours, HIV & TB correlated (get
tested for TB if + HIV)
At risk expose: contact with infected ppl, born in high risk areas, elderly, low income,
healthcare, prisons
At risk develop: HIV, cancer, previous infection, IV substance, diabetes, severe kidney
disease
S&S: serious cough, pleurisy, coughing up blood/phlegm, weakness, fatigue, loss of
weight/appetite, chills fever, blood in urine, back pain, night sweats (THINK kidney)
Elderly: mental status change, anorexia, may need 2 step PPD
Screening: hospitals, prisons, nursing homes, homeless
TB tests: PPD/Mantoux- admin 2-4 in below elbow, wheel 6-10mm, read 48-72hrs, >5mm
facilities, AIDS facilities +, >15 no risk factors +, if + chest xray
Treatment: make sure they take all their meds with active TB(teach about importance of
taking med to avoid resistance), latent doesn’t have to take. 6-9 month therapy. INH
therapy can cause peripheral neuropathy is common side effect: take Vitamin B6, take all
meds same schedule, don’t cancel appt, ade rest, nutrition, avoid alc, DOT-watch pt
swallow med, must be specially trained to observe. Tertiary prevention: DOT for TB
treatment. >10 mm induration + TB
Ch. 27 HIV, Hep, STI
HIV: Primary infection/acute HIV infection (within 1 month): blood tests are usually not a
reliable for recent exposure, wait 3 months. Can be transmitted w.o symptoms. Most
people don’t recog symp as HIV & don’t seek treatment. TB & HIV linked S&S:
Lymphadenopathy, myalgia, sore throat, lethargy, rash fever. Antibodies occur 6-12
weeks. Can be asymptomatic. Highly active antiretroviral therapy (HAART). Aids can take
up to 10 years w.o intervention, at risk for infections. Transmitted through blood, semen ,
seminal fluids, rectal fluids, vaginal secretions, breast milk(not by sitting next) young
black gay/bi men. HIV testing: antibody test blood or oral fluids(EIA, ELISA), can test
anonomously d/t possible drug use/scared. AIDS: diagnosis CD4 T-lymphocytes drop to
less than 200/ml. HIV prevention PrEP (Truvada): oral med, must be HIV –, effectiveness
dependent on adherence. HIV children: cant control body secretions, chickenpox
STI’s: High risk factors: <25 y.o, minority group, urban setting, impoverished Bacterial:
usually treatable with antibiotic; however, antibiotic-resistant forms of STDs are
emerging (e.g., gonorrhea, syphilis, chlamydia) Viral: cannot be cured (e.g., herpes
simplex virus; human papillomavirus infection; genital herpes)
Chlamydia: genitourinary tract, rectum, conjunctivitis in babies. Via vaginal, anal, oral
transmission, mostly unaware of symptoms, recommended annual testing, most common
report STI. Can cause problems in infants born to infected mothers
Gonorrhea: highest incidence in AA, person in southern us, 15-25 y.o, dysuria, white
yellow discharge, epididymis swollen, women asymptomatic-can lead to PID infertility.
Obtain sex hx, inform partners, obtain cultures, report to CDC. Yellow, green discharge
penis.
Syphilis: infects moist mucosal or cutaneous membranes spread through direct contact
(mother-fetus) Primary-bacteria produce infection (chancre) at site of contact (lasts 3-6
weeks), Canchre - usually single lesion begins as a macula progresses to a papule then
ulcerates, Genital, vaginal, anal, oral. Secondary-organism enters the lymph system and
spreads throughout the body – (non-itchy rash body), palms, feet. Fever, swollen lymph
nodes, sore throat, muscle aches, fatigue. Tertiary-can lead to blindness, congenital
damage, cardiovascular damage, or syphilitic psychosis, Lesions of the mucus
membranes, difficult coordination, paralysis, numbness, blindness, dementia. Congenital-
transmission through the placenta (stillbirth, blindness, deafness, deformities, death-
signs jaundice, skin rash, hepatomegaly, pseudoparalysis of an extremity)
HPV (genital warts): clustered cauliflower like lesions. Need to inform that there is no
safe sex, asymptomatic, can clear on it owns within a few years, HPV and cervical cancer
link, Prevention: vaccines, three shots, 11-12, can still be given 13-26, condoms are not
full proof- don’t cover entire area. Incurable and chronic.
Herpes Simplex Virus (HSV-2): infect genital/nongenital sites, 14-49, no cure, direct
exposure, can remain latent, S&S: painful lesions ulcerate and crust within 1-4 days,
itching, pain, dysuria, Can spread when lesions are active or when asymptomatic, can
Rifampin: turns urine orange, Seasonal affective disorder: effects people in winter months more, can
spread to other areas, can lead to miscarriage, premi. make depressed. INH: active TB, Vit B6 for peripheral neuropathy”
Hep A: most risk travelers, kids in areas with high rates, IV drug users, men-men Rubella (German Measles): worldwide, risk to travelers, moderately infective through
intercourse, caregivers of HAV. Who lives with you, where are you employed, sexual inhalation/contact person, incubation average 14 days, S&S: lymphadenopathy, fever, rash(fine/pink),
contacts? Hep B: decrease due to vaccine but no treatment if contracted, risk same as A, malaise, treatment is supportive, MMR vaccine
STDS’s, georgraphic areas prevelant, health care works, hemo pts, inmates/prisoners, Pertussis (Whooping cough): risk in infants, travelers, highly contagious through inhalation/contact,
Acute: flu like symptoms, jaundice, N, fever, joint pain, Chronic: lifelong, risk S&S: milk URI-paroxysmal cough, vomiting, treatment: mycins, prophylactic treatment for fam mem,
other contacts, 5 doses dTaP, school nurses need be on lookout
immunocompromised, S&S: anorexia, hepatomegaly, jaundice. Vaccine: 3 series, birth- Influenza: viral, airborne survives on inanimate surfaces for hours, mortality in immunocompromised
6months-1. Hep C: most common chronic blood borne, leading cause liver disease, at elderly/children, types: A (worldwide-mutates and can be hard for immunization), B (regional), C
risk-HCW, infants born to infect moms, drug users, sex w. multiple part, hemodialysis, (epidemic, but less common/mild), vaccines are educated guesses, Oct-Mar, 6 months of age >,
donor recipients. Primary prevention: screening blood products. Secondary: screening pregnant women, people >50,
suspected pt. S&S: fatigue, anor, malaise, weight loss, right-sided pain, jaundice, elevated Rocky Mountain Spotted Fever: southeast/Midwest, caused by dog ticks, S&S: mod-high fever, severe
ALTS-lead to cirrhosis H/A, chills, deep muscle pain, malaise, 50% have rash
Zika Virus: spread like dengue, west nile, chikungunya, mosquitos, S&S: fever, muscle aches, eye pain,
a/w Guillain-Barre, pregnant can be born with microcephaly, no vaccine, antiviral treatment
Rabies: animal-humans, very serious spread to brain/spinal cord, no treatment, S&S: fever, cough, sore
throat, restlessness, hallucinations, seizures/coma/death, prophylactic treatment: post exposure
immunoglobulin vaccine series of IM injection