Introduction to:PUBLIC HEALTH NURSING

Objectives

• Define Public Health• Discuss Public Health and Community Health• Review the relationship of Practical Nursing and

Public Health with “Healthy People 2020”• Introduction of the concept of

terrorism/bioterrorism• Introduction of the role of the LPN in Public

Health and disaster response

Public Health Nursing• “Public Health” is what we as a society do collectively to

assure the conditions in which people can be healthy. (Institute of Medicine, 1988)

• The science of Public Health and Public Health Nursing are civic enterprises and are inseparable from social and environmental factors.

• PH nursing has gone through a number of reforms in both practice and financing. Today, included in PH are the CDC and American Red Cross

History of Public Health

Brief History of Public Health Brief History of Public Health

18601860’’ss--7070’’s s –– Germ TheoryGerm Theory 1872 1872 –– APHA FoundedAPHA Founded 1887 1887 –– Hygienic Lab (NIH)Hygienic Lab (NIH) 1893 1893 –– Lillian Wald Lillian Wald –– NurseNurse’’s Settlements Settlement 1906 1906 –– Pure Food and Drug ActPure Food and Drug Act 1925 1925 -- TB VaccinationsTB Vaccinations 1929 1929 -- Penicillin DiscoveredPenicillin Discovered 1932 1932 –– Tuskegee StudyTuskegee Study 19401940’’s s –– Penicillin used to combat diseasePenicillin used to combat disease 19501950’’s s –– Plethora of new medicationsPlethora of new medications

1849 – John Snow

1955 – Polio Vaccine Released1964 – SG Report on Smoking1965 – Medicare/ Medicaid1970’s – WHO declares Smallpox eradicated1975 – Nurse Training Act1990’s – HIV/AIDs

Health Care Timeline: http://www.fin343.org/Student%20Presentations/2001/gotimeline.htm

Center for Disease Control

1854 – Florence Nightingale

PUBLIC HEALTH NURSING

• Public Health Achievements– Vaccinations– Motor Vehicle Safety– Control of Infectious Disease– Mother /Baby Health– Floridation of Drinking Water– Recognition of tobacco use as a health

hazard

Levels of Public Health

Levels of Public HealthLevels of Public Health

Institute of Medicine

Center for Disease Control and Prevention

Federal

Regional

State

Local

Environmental Protection Agency

Human Resources & Services Administration

National Institute on Health

United StatesDepartment of Health and Human Resources

(Region 9)

State of Nevada Department of Health and Human Services

Clark County Health District Washoe County Health District County HealthOfficer

PUBLIC HEALTH NURSING

• Preventive Care– Three levels of prevention are described as a

conceptual guide for community practice

1. PRIMARY PREVENTION = the first defense against community disease. It is the highest priority in preventing disease and injury• Achieved through “General Health Promotion”

measures– Eg. A variety of lifestyle behaviors– Eg. Health Education

PUBLIC HEALTH NURSING

1. PRIMARY PREVENTION (cont.)

– The specific protection activities are related to preventing specific diseases

• Eg. Immunization to build immunity• Eg. Chemoprophylaxis to prevent the onset of

disease in exposed persons

2. SECONDARY PREVENTION provides for early detection (when primary prevention fails and infection occurs).

- Screening - Management of disease progression

(related to diagnosing and treating)

Public Health Safety

Secondary Prevention (cont.)

Note: Screening may be part of other community activities or may target a specific population or location where high risk individuals work or live.

PUBLIC HEALTH NURSING

3. TERTIARY PREVENTION (when efforts to prevent and detect disease early are not always successful.)

• Tertiary Prevention and Care are provided for people who suffer ongoing, long term physical and emotional challenges from communicable diseases.

• Focus the prevention and management of complications of the side effects of treatment as well as reducing potential harm to others.

PUBLIC HEALTH NURSING

• Public Health Nurses:– Assist clients with lifestyle changes– Making arrangements for rehabilitative or

home-based services– Communication with other health care

providers re: medication changes or simplifying treatment regimens

– Planning with family/friends for ongoing support when disease progression requires a higher level of care.

Public Health Safety

• NATURAL DISASTERS– Caused by either nature (e.g. hurricane) or emerging

diseases (e.g. Avian Influenza, “Swine” Flu)• Note: Some viruses jump the “species barrier” from animals

to human. Once a new disease is introduced into a suitable human population, it spreads rapidly because there is little or no immunity

– Usually unpreventable– Often occur in the same geologic areas because they

are related to weather patterns or the physical characteristics of a region

Public Health Safety

• MAN-MADE DISASTERS– Human generated– Can be accidental or intentional

• Accidental – major industrial accidents– unplanned release of nuclear energy– Chemical spills (local hazmat response)

• Deliberate – Terrorest bombings– Intentional release of hazardous chemicals

» E.g. Anthrax

Public Health SafetyTerrorism/Bioterrorism

• Members of the general public have more readily understood the value of strong public health and public health nursing because of attention from natural and man-made disasters.

Public Health Safety

• TERRORISM – The act of terror is designed to injure and kill– To instill fear and insecurity in a community– Creates a climate of fear and panic– Domestic Terrorism:

• Activities that involve acts dangerous to human life• Violation of the criminal laws of the USA• Appear to be intended to intimidate or coerce a

civil population

Public Health Safety

– Domestic Terrorism (cont.)• Eg. Mass destruction, assassination, kidnapping

– International Terrorism is outside the territorial jurisdiction of the United States or transcends the national boundaries in terms of the means by which they are accomplished

• Targets may be persons or locales

Public Health Safety

• Bioterrorist Attack– Overt (announced) – Covert (unannounced)– Most likely would involve the use of biological

agents

Public Health Safety

• Bioterrorism = biological weapons = “germ warfare”

• PH definition: The “use of microorganisms or toxins derived from living organisms to produce death or disease in humans, animals, or plants.

• 3 groups: Bacterial Agents, Viral Agents, Biological Toxins

Public Health Safety

– 3 Routes of exposure: Inhalation, contact (skin), gastrointestinal

• May be hours or days before the effects of a biological incident are known

• Detection of a biological outbreak depends on nurses and health care providers who can correctly identify s/sx of such agents

• Their responsibility is to notify public health officials who will initiate an investigation to determine the source.

Chemical Terrorism

• Agents that may be used in “chemical” terrorism:– Pulmonary agents: includes chlorine (Cl)

pulmonary edema in 2 -> 24 hrs. after exposure

– Incapacitating Agents: • BZ (a glycolate anticholinergic compound) and

agent 15 (Iraqi version of BZ) impair victims by understimulation of organs, hyperthermia, hallucinations, altered perceptions and erratic behavior

Chemical Terrorism– Cyanide agents can be ingested or inhaled

• Sx. Severe respiratory distress w/o cyanosis

– Nerve agents: Taubin (GA), Sarin (GB) and Sonan death in a matter of minutes

• Sx. Include increased saliva production, chest pressure, rhinorrhea, vomiting, muscle weakness, incontinence and convuslsions

• Sx. May appear up to 10hrs following low exposure

– Vesicant Agents: eg. Sulfur Mustard• More lethal than pulmonary or cyanide agents

because remain in environment for weeks continuing exposure

Chemical Terrorism

– Vesicant Agents cont.• Affect the skin, eyes, and airway; large doses

damage bone marrow.• Can cause vesicles that progress to severe tissue

necrosis and sloughing.• Sx. occur in 4-8 hrs. but cellular damage occurs in

2 minutes.

Terrorism by Nuclear Exposure

• Terrorism by Nuclear Exposure– Attack on a domestic nuclear weapon facility– “Dirty Bomb”– Source of radiation on the contaminated

patient – on body or clothing: ingested or absorbed through skin opening

– Radiation measures:• Gy = gray = 100rad

Nuclear Exposure cont.

• Terrorism by Nuclear Exposure cont.– Less than 0.75 Gy absorbed: usually no

symptoms– More than 8 Gy absorbed: fatal– More than 0.75 Gy absorbed: can develop

acute radiation syndrome:• Hematopoietic: deficiency of WBCs and platelets

– Which can lead to bleeding, anemia, and infection

Nuclear Exposure cont.

• Acute Radiation Syndrome cont.– Gastrointestinal: loss of mucosal barrier and

cells lining the intestine fluid/electrolyte loss, vomiting and diarrhea

– Cerebrovascular/central nervous system: cerebral edema, hyperpyrexia, hypotension, confusion, and disorientation

– Skin: loss of epidermis and possibly the dermis

Terrorism/Bioterrorism

• Nursing Role:

• Features that should alert nurses to the possibility of a bioterrorism-related outbreak include: Rapidly increasing incidence of a disease An unusual increase in the number of people

seeking care An endemic disease rapidly emerging at an

uncharacteristic time or in an unusual pattern

Nursing Role cont.

• Features cont. Lower attack rates among patients who had

been indoors compared with people who had been outdoors

Clusters of patients arriving from a single locale

Large number of rapidly fatal cases

Nursing Process

• LPN will be involved in:– The care planning process to develop care

priorities• Use clinical maps

– Assessment reduce risk for injury– Patient safety

Nursing Diagnosis

• Risk for falls/injury

• Impaired physical mobility

• Alteration in skin integrity

• Write a nursing diagnosis for: Radiation Exposure, risk for others

Healthy People 2020

Vision

• A society in which all people live long, healthy lives.

Healthy People 2020 Mission• —Healthy People 2020 strives to: • Identify nationwide health improvement priorities;• Increase public awareness and understanding of the

determinants of health, disease, and disability and the opportunities for progress;

• Provide measurable objectives and goals that are applicable at the national, state, and local levels;

• Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge;

• and Identify critical research, evaluation, and data collection needs.

Healthy People 2020