nurs 419 community health notes

8/17/2019 NURS 419 Community Health Notes

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CHAPTER 6- Environmental Health

I. Introduction

• Healthy environment is essential for optimal health andhealth care.

• We often take the environment for granted and may fail tosee the hazards in front of us.

• We get chemical, biological, and radiological exposuresthat aect our health in the air we breathe, the water wedrink, the food we eat, and the products we use.

• What environments would be of concern to you? Personal home environment, classroom environment, work environment

• urses need to know how to assess for environmentalhealth risks and develop educational and other preventiveinterventions to help individuals, families, and communitiesunderstand and, where possible, decrease the risks.

• !! scope and standards of environmental health"o #here are $% principles that comprise the standards.

#hese principles say that" &$' it is essential thatnurses know about environmental health( &)' nursesshould not use products or practices that harmhealth or the environment( &*' nurses have a right towork in a safe and healthy place and nurses andother health care professionals have the right toknow in a timely manner about any possible harmful

products, chemicals, pollutants, and hazards to whichthey may be exposed( &+' multidisciplinarycollaboration is a factor that sustains a healthyenvironment( &' the choice of materials, products,technology and practices in the environment thataect nurses is based on best practices( &- and 'nurses should respect the diversity of the peoplewhom they serve and also focus on the /uality of theenvironment in which they and their clients work andlive( &0' nurses, other health care workers, families,patients and communities have the right to know

timely information about potentially harmfulproducts( &1 and $%' nurses should participate inboth research and advocacy related to promoting asafe and healthy environment &!!, )%%' .

II. Critical Thinking Question…

• 2xplain the relationship between the environment andhuman health and disease3what factors may be aecting


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you in your own environment? Water supply (lint, !Ie"ample#, air, soil…

III. The $nvironment…

• 2verything is connected to everything else

• 2verything has to go somewhere• #oday4s solution may be tomorrow4s problem

• 2verything around us3.o 5hysical structureso Watero !iro What else???? $lectromagnetic %elds (cell phone

towers#, sites and sounds, the &uilt environment (acommunity without health care 'acilities#,neigh&orhood without sidewalks or paths and is not a

&usy street,

I. $nvironmental )ealth *ciences (don+t really need to knowspeci%cs…#

• Toxicology: the basic science that studies the healtheects associated with chemical exposures

• Epidemiology: the science that helps us understand thestrength of the association between exposures and healtheects in human populations

o 2pidemiology triangle" agent, host, and environmento 6ultidisciplinary 7 all contribute information to help

understand how and when humans may be exposedto hazardous chemicals, radiation &such as radon',and biological contaminants.

8eologists, meteorologists, and chemists allcontribute information to help understand howand when humans may be exposed tohazardous chemicals, radiation &such asradon', and biological contaminants.

o #he public health 9eld also depends on food safetyspecialists, sanitarians, radiation specialists, andindustrial hygienists.

. $nvironmental )ealth ssessment

• !ir &indoor:outdoor', water, land, or food

• http"::www.cdc.gov:nceh:data.htm

• ;hemical, biological, or radiological

http://www.cdc.gov/nceh/data.htmhttp://www.cdc.gov/nceh/data.htm


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• 2nvironmental health assessment nvestigate potential exposures

• 5resent work history

• esidence

• 2nvironmental concerns

• 5ast work history

• !ctivities

• eferrals D resources

• 2ducate

II. Conducting an $nvironmental )ealth ssessment

• ;onduct a windshield survey to assess for potentialenvironmental health risks

• Eey /uestions in any assessment should cover pastconditions in workplace, home and community"

o Fongest held Gobs, current D pasto 2xposure to li/uids, dust, mists or fumes


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o !re there any relationships between currentsymptoms and activities at work or home?

III. $nvironmental )ealth ssessment

• The Right to #no$ %a$s7reports condition of drinking

watero ;onsumer con9dence report &;;'

http"::www).epa.gov:ccr http"::www.cityofdekalb.com:Aocument;enter:

Home:iew:+*$o 6aterial Cafety Aata Cheet &6CAC'

• Ris! Assessment7determine probability of a health threatassociated with an exposure

o 5oint source79xed sites such as smoke stackso onpoint source7 vehicles &cars, buses, etc.'

• Assessing Ris!s in &ulnera'le Populations

o ;hildren" breathe more rapidly I more exposure 6ore susceptible to toxins due to smaller size Jodies work dierently than adults" blood7brain

barrier, kidneys, growing bodieso 5regnant women" eect on fetal development

I1. The /ight To 2now

• !ir7indoor air /ualityo ising incidence of asthmao ;arbon monoxide, dusts, molds, dust mites, pets,

products &aersols', tobacco smoke• Water7waste discharges into bodies of water, storm water

run o • Kood7food prep practices, pesticides, antibiotics,

irradiation, 86Bs• Fand7 Lbuilt environment4

• www.scorecard.org traces maGor pollutants let out into theair by zip codes.

1. /educing $nvironmental )ealth /isks

•

Apply the 'asic principles o" disease prevention• Ris! Communication: the right in'ormation to the right

people at the right time

• Ethics: essential for making ethical decisions regardingenvironmental health

• (overnmental Environmental Protection

http://www2.epa.gov/ccrhttp://www.cityofdekalb.com/DocumentCenter/Home/View/431http://www.cityofdekalb.com/DocumentCenter/Home/View/431http://www.scorecard.org/http://www2.epa.gov/ccrhttp://www.cityofdekalb.com/DocumentCenter/Home/View/431http://www.cityofdekalb.com/DocumentCenter/Home/View/431http://www.scorecard.org/


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o 6anages environmental exposures through thedevelopment and enforcements of standards andregulations

o 2ducates public about risks and risk reductionso 2nvironmental 5rotection !gency( Kood and Arug

!dministration( Aepartment of !griculture( localhealth department

1I. $verything 3ou 4eed To 2now &out 5ead In Water

• https"::sis.nlm.nih.gov:enviro:KlintFeadWater.pdf

• http"::www.epa.gov:Mint:Mint7drinking7water7documents

1II. dvocacy

• urses have responsibilities to be informed consumers andto be advocates for citizens in their community regardingenvironmental health issues most important thing youcan do is &e involved

• !s communicators and educators, nurses can do thefollowing"

o Write letters to local newspapers responding toenvironmental health issues aecting the community.

o Cerve as a credible source of information atcommunity gatherings, formal governmentalhearings, and professional nursing forums.

o olunteer to serve on state, local, or federalcommissions. Enow the zoning and permit laws that

regulate the eects of industry and land use on thecommunity.o ead, listen, and ask /uestions. !s informed citizens

nurses can lead in fostering community action toaddress threats to environmental health.

1III. $nvironmental 6ustice and $nvironmental )ealth 7isparities

• 2nvironmental Health disparitieso ! person of color is more likely to"

Five near a hazardous waste site or incinerator Have children who are lead poisoned

Have children with asthma &strong associationwith environmental exposures'

• Environmental Justice" e/ual protection fromenvironmental hazards for individuals, groups, orcommunities regardless of race, ethnicity, or economicstatus

https://sis.nlm.nih.gov/enviro/FlintLeadWater.pdfhttp://www.epa.gov/flint/flint-drinking-water-documentshttps://sis.nlm.nih.gov/enviro/FlintLeadWater.pdfhttp://www.epa.gov/flint/flint-drinking-water-documents


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1I. 8ni9ue $nvironmental )ealth Threats in the )ealth CareIndustry

• )ercury

• *ynthetic chemicals

o 5ersistent bioaccumulate toxins &5J#s'

o 5ersistent organic pollutants &5B5s'o Ao not break down and can be found in the body

• Health Care ithout Harm campaigno 2limination of mercury, 5; in health care industryo Aecrease incineration of medical waste

• +ioxino Jy product of combusting chlorine compoundso !lmost all women have dioxin in breast tissueo http"::www.who.int:mediacentre:factsheets:fs)):en:

1. /e'erral /esources• ,o single source o" in"ormation a'out environmental

health is availa'le, nor is there a single resource towhich individuals or a community can be referred if theysuspect an environmental problem.

• *tarting points

o #he environmental epidemiology unit or toxicologyunit of your state health department orenvironmental agency

o 2nvironmental health experts in nursing or medicalschools, or schools of public health

o !ssociation of Bccupational and 2nvironmental;linics

• >nformation is widely accessible on the >nternet, but 9ndingan actual person to assist you or the communities youserve may not be as easy.

3ou need to %gure out whom you report to i' something isn+t right

1I. /oles 'or 4urses in $nvironmental )ealth

• !ssessment

• eferral

• ;ommunity involvement and public participation

• isk communication• 2pidemiologic investigations

• 5olicy development

CHAPTER .- +isaster )anagementI. :&;ectives

http://www.who.int/mediacentre/factsheets/fs225/en/http://www.who.int/mediacentre/factsheets/fs225/en/


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• Aiscuss types of diseases including natural and human7made.

• 2valuate the eects of disasters on people and theircommunities.

• Aescribe the disaster management phases of prevent,

preparedness, response, and recovery and explain thenurse4s role in each phase.

• Aescribe the steps to take to initiate and maintain adisaster clinic.

• >dentify how community groups and other organizationssuch as the !merican ed ;ross can work together toprepare for, respond to, and recover from disasters.

II. Introduction

• #he number of disasters, both human7made and natural,

continues to increase, as does the number of peopleaected by them.• #he cost to recover from a disaster has risen sharply

because of the amount of technology that must berestored.

• urses are increasingly getting involved in disasterplanning, response, and recovery through their local healthdepartment or local government.

III.7isasters

• +isaster: any natural or human7made incident that causes

disruption, destruction, and:or devastation re/uiringexternal assistance

o ange in sizeo !re expensive &lives aected, property lost:damaged'o Aeveloping countries experience disproportionate

burden from natural disasters

• Types o" +isasters:

o atural disasterso Human7made disasterso ;hemicalo Jiologicalo adiologico uclearo 2xplosive

• There are $ays to prevent or manage ho$ peopleand their communities respond to disasters/


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o !lthough the number of disasters worldwidecontinues to grow, the number of lives lost hasdecreased.

• 0/*/ agencies1 directives1 and systems

o N.C. Aepartment of Homeland Cecurityo ational 5reparedness 8uidelineso ational esponse 5lano ational >ncident 6anagement Cystemo 5ublic Health and 6edical 5reparedness and the

ational Health Cecurity Ctrategy• !lthough natural disasters cannot be prevented, much can

be done to prevent further increases in accidents, death,and destruction after impact.

IV.7isaster !anagement Cycle

• Disaster Management begins before the disasteroccurs!

• Prevention &mitigation'o !wareness, education, surveillance, immunizations,

isolation• Preparedness7Mexibility is key for the nurseOO

o 5ersonalo 5rofessionalo ;ommunity

• Response

o apid needs assessment7establish sanitationo #riage7 red, yellow, green, deado 5sychological stress" individuals, community, D

disaster workers• Recovery

o eturning to the new normalo Bngoing community assessment

• ,H**7 reconnect public health and medical preparedness

V. 7isaster !anagement Cycle< /$*P:4*$

•National Response Frameor

o Ae9nes roles, responsibilities and relationshipscritical to emergency planning, preparedness, andresponse

o http"::www.fema.gov:pdf:emergency:nrf:nrf7core.pdf

• Emergency *upport 2unctionso http"::www.fema.gov:pdf:emergency:nrf:nrf7esf7

intro.pdf

http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdfhttp://www.fema.gov/pdf/emergency/nrf/nrf-esf-intro.pdfhttp://www.fema.gov/pdf/emergency/nrf/nrf-esf-intro.pdfhttp://www.fema.gov/pdf/emergency/nrf/nrf-core.pdfhttp://www.fema.gov/pdf/emergency/nrf/nrf-esf-intro.pdfhttp://www.fema.gov/pdf/emergency/nrf/nrf-esf-intro.pdf


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• ,ational Incident )anagement *ystemo http"::www.fema.gov:national7incident7management7

system• Response to 3ioterrorism

o 5ublic Health >nformation etwork"

http"::www.cdc.gov:phin:index.htmlo 6ay not know they have been exposed for a period

of timeo Ctress response

• Psychological *tress o" +isaster or!erso 2arly stress, burnout and delayed response

8nderstand what would &e a normal stress reaction and what wouldnot &e a normal reaction. 3ou need to look 'or the stress'ul s=s daysa'ter and weeks a'ter &ecause PT*7 is a risk that needs to &eaddressed.

VI. 7isaster !anagement Cycle< /$C:$/3 ( the hardest part…trying to get &ack to a new normal #

• ecovery is about returning to the new normal with thegoal of reaching a level of organization that is as near thelevel prior to the disaster as is possible.

• Bften the hardest part of the disastero 6ay take months to years &Eatrina'

• ecovery occurs as all involved agencies pull together torestore the economic and civic life of the community.

o 8ov4t helps with rebuilding

o eligious organizations7rebuilding, supplieso >C7how to write o losseso ;A;7continuing surveillance

VII. /ole o' the 4urse in 7isaster Preparedness

• Personal preparednesso 5ersonal checklisto 2mergency supplies kito http"::emergency.cdc.gov:preparedness:kit:disasters:i

ndex.asp•

Pro"essional preparednesso 2mergency Cupplies7license, stethoscope, J5 cu,

radio, etc.o Aisaster medical assistance teams

• Community preparedness7 warning systems, drillso ational Health Cecurity Ctrategy HCC'o Aisaster and 6ass ;asualty 2xercises

• Help initiate or update the agency4s disaster plan

http://www.fema.gov/national-incident-management-systemhttp://www.fema.gov/national-incident-management-systemhttp://www.cdc.gov/phin/index.htmlhttp://emergency.cdc.gov/preparedness/kit/disasters/index.asphttp://emergency.cdc.gov/preparedness/kit/disasters/index.asphttp://www.phe.gov/Preparedness/planning/authority/nhss/Pages/default.aspxhttp://www.fema.gov/national-incident-management-systemhttp://www.fema.gov/national-incident-management-systemhttp://www.cdc.gov/phin/index.htmlhttp://emergency.cdc.gov/preparedness/kit/disasters/index.asphttp://emergency.cdc.gov/preparedness/kit/disasters/index.asphttp://www.phe.gov/Preparedness/planning/authority/nhss/Pages/default.aspx


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• 5rovide educational programs and materials regardingdisasters speci9c to the area and organize disaster7planning meetings.

• Brganize disaster drills.

• 5rovide an updated record of vulnerable populations within

the community.• eview individual strategies.

VIII. /ole o' the 4urse in 7isaster /esponse

• #he role of the nurse in disaster response depends onnurse4s experience, professional role in a communitydisaster plan, specialty training, and special interest

• !dvocate

• !ssessment

• Nnderstand what community resources are available

o ;ommunity reactions to disastero Blder adults, children

• Bften 9rst respondero ;ase 9nding and referringo 5reventiono Health educationo Curveillanceo #riage

Highest priority given to victims who have life7threatening inGuries but who have highprobability of survival

Cecond7those with inGuries with systemiccomplications but are not yet life7threatening&can wait +7-% min'

#hose with local inGuries without immediatecomplication &can wait hours for treatment'

n o&vious &rain matter in;ury would result in a dead0 tag,

however an a&dominal in;ury is something we are more likely to &ea&le to address

I". )ow 7isasters >ect Communities

•

5eople react to the same disaster in dierent ways,depending on their age, cultural background, health status,social support structure, and general ability to adapt tocrises

• Physical and emotional e4ects depend on

o #ype, cause, and locationo 6agnitude and extent of disastero Auration of disaster


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o !mount of warning

• *tress reactions in individuals

o !dults 2arly signs" minor tremors, nausea, problems

with memory and concentration

Cuppressing guilt and anger can lead tofatigue, irritability7must 'e addressed

o ;hildren7may display regressive behaviors

• *tress reactions in the communityo Heroico Honeymoono Aisillusionmento econstruction

". *helter !anagement

•

urses make ideal shelter managers and team membersbecause they are comfortable with dealing with aggregatehealth promotion, disease prevention, and emotionalsupport

• Focal ed ;ross chapter

• urses working in shelters"o 5rovide assessments and referrals.o 6eet health care needs, such as helping clients get

prescription glasses, medications, 9rst aid, andappropriate diet adGustments.

o Eeep client records.o 2nsure emergency communications.o 5rovide a safe environment.

"I. /ole o' the 4urse in 7isaster /ecovery

• 8oal is to return to 5ne$ normal

• 5rolonged eects of disaster may intensi"y acute andchronic conditions

• Psychological e4ects:

o Hopelessness, depression, grief, suicideo 6ake referrals to mental health professionals.

• Teach proper hygiene and ma!e sure immuni7ationrecords are current

o Aisruption of public health infrastructure &sanitation,food, water, access to care' can lead to increaseddisease

• Je alert for environmental hazards.

• !ssess dangers of live or dead animals.


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• ;ase 9nding and referral

"II. /ole o' the C7C

• #he ;A; is the N.C. government agency responsible foridentifying, tracking, and controlling the spread of disease.

• With the help of the ;A;, state and local healthdepartments have created emergency preparedness andresponse plans.

• >n addition to early detection, rapid diagnosis, andtreatment with antibiotics or antivirals, these plans use twomain traditional strategiesP8uarantine and isolationPto contain the spread of illness. #hese are common healthcare practices to control the spread of a contagious diseaseby limiting peopleQs exposure to it.

• 2mergency medications are kept in the national stockpile.

• http"::emergency.cdc.gov:hazards7speci9c.asp

"III. ?ioterrorism gent Categories (@@24:W :/ )$*I, 4:TT)$ $1!#

• Jioterrorism agents can be separated into threecategories, depending on how easily they can be spreadand the severity of illness or death they cause. ;ategory !agents are considered the highest risk and ;ategory ;agents are those that are considered emerging threats fordisease

• http"::ocw.Ghsph.edu:courses:Jiological!gentsBfWater!ndK

oodborneJioterrorism:5AKs:WaterKood#error*.pdf

"IV.?ioterrorism gent< #$%E&'R( $

• #hese high7priority agents include organisms or toxins thatpose the highest risk to the public and national securitybecause"

• #hey can be easily spread or transmitted from person toperson

• #hey result in high death rates and have the potential formaGor public health impact

• #hey might cause public panic and social disruption

• #hey re/uire special action for public health preparedness.o Cmallpox, anthrax, plagueo Clostridium &otulinum neurotoxin

"V. ?ioterrorism gent< #$%E&'R( )

• #hese agents are the second highest priority because"

• #hey are moderately easy to spread

http://emergency.cdc.gov/hazards-specific.asphttp://ocw.jhsph.edu/courses/BiologicalAgentsOfWaterAndFoodborneBioterrorism/PDFs/WaterFoodTerror3.pdfhttp://ocw.jhsph.edu/courses/BiologicalAgentsOfWaterAndFoodborneBioterrorism/PDFs/WaterFoodTerror3.pdfhttp://emergency.cdc.gov/hazards-specific.asphttp://ocw.jhsph.edu/courses/BiologicalAgentsOfWaterAndFoodborneBioterrorism/PDFs/WaterFoodTerror3.pdfhttp://ocw.jhsph.edu/courses/BiologicalAgentsOfWaterAndFoodborneBioterrorism/PDFs/WaterFoodTerror3.pdf


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• #hey result in moderate illness rates and low death rates

• #hey re/uire speci9c enhancements of ;A;Qs laboratorycapacity and enhanced disease monitoring.

o Co"iella &urnetti &R fever'(o ?rucella species &brucellosis'(o ?urkholderia mallei &glanders'(o /ickettsia prowaAekii yphus fever'

"VI. ?ioterrorism gent< #$%E&'R( #

• #hese third highest priority agents include emergingpathogens that could be engineered for mass spread in thefuture because"

• #hey are easily available

• #hey are easily produced and spread

• #hey have potential for high morbidity and mortality rates

and maGor health impact.o ipah viruso Hantaviruseo #ickborne hemorrhagic fever viruseso #ickborne encephalitis viruseso Sellow fevero 6ultidrug7resistant tuberculosis

"VII. $nthra*

• #here are three types of anthrax"o *!in 9cutaneous o %ungs 9inhalation o +igestive 9gastrointestinal

• http:;;$$$/cdc/gov;anthrax;'ioterrorism;threat/html

http://www.cdc.gov/anthrax/bioterrorism/threat.htmlhttp://www.cdc.gov/anthrax/bioterrorism/threat.html


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"VIII. Bet a 2it

• #hough some people feel it is impossible to be prepared forunexpected events, the truth is that taking preparednessactions helps people deal with disasters of all sorts muchmore eectively when they do occur.

• >f disaster strikes your community, you might not haveaccess to food, water, or electricity for some time.

• Jy taking time now to prepare emergency water supplies,food supplies and disaster supplies kit, you can provide foryour entire family.

• 2ven though it is unlikely that an emergency would cut oyour food supplies for two weeks, consider maintaining asupply that will last that long.

• http"::www.ready.gov:sites:default:9les:documents:9les:checklistT$.pdf

"I". 5earn )ow to *helter in Place• UChelter7in7placeU means to take immediate shelter where

you arePat home, work, school, or in between.• >t may also mean, Useal the room(U in other words, take

steps to prevent outside air from coming in.• Focal authorities may instruct you to Ushelter7in7placeU if

chemical or radiological contaminants are released into theenvironment.

http://www.bt.cdc.gov/preparedness/kit/water/http://www.bt.cdc.gov/preparedness/kit/food/http://www.bt.cdc.gov/preparedness/kit/disasters/http://www.ready.gov/sites/default/files/documents/files/checklist_1.pdfhttp://www.ready.gov/sites/default/files/documents/files/checklist_1.pdfhttp://www.bt.cdc.gov/preparedness/kit/water/http://www.bt.cdc.gov/preparedness/kit/food/http://www.bt.cdc.gov/preparedness/kit/disasters/http://www.ready.gov/sites/default/files/documents/files/checklist_1.pdfhttp://www.ready.gov/sites/default/files/documents/files/checklist_1.pdf


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• >t is important to listen to # or radio to understandwhether the authorities wish you to merely remain indoorsor to take additional steps to protect yourself and yourfamily.

"". Protecting yoursel' i' you don+t know what the chemical is• Sou could protect yourself during a chemical emergency,

even if you didnQt know yet what chemical had beenreleased.

• Celf protection includeso 2vacuation,o Cheltering in place, ando 5ersonal cleaning and disposal of contaminated

clothing.

""I. /adiation $mergencies

• ;A; would play a key role in protecting the public healthduring and after an emergency involving radiation orradioactive materials.

• #o help people be prepared for a radiation emergency, ;A;has the following information.

• http"::emergency.cdc.gov:radiation:protectiveactions.asp

""II. Prep and Planning 'or ?ioterrorism

• http"::emergency.cdc.gov:bioterrorism:prep.asp

""III. What Can I $"pect at the )ospital…• Fong waits

• #riage

• Fimited information

http://www.bt.cdc.gov/planning/evacuationfacts.asphttp://www.bt.cdc.gov/planning/shelteringfacts.asphttp://www.bt.cdc.gov/planning/personalcleaningfacts.asphttp://www.bt.cdc.gov/planning/personalcleaningfacts.asphttp://emergency.cdc.gov/radiation/protectiveactions.asphttp://emergency.cdc.gov/bioterrorism/prep.asphttp://www.bt.cdc.gov/planning/evacuationfacts.asphttp://www.bt.cdc.gov/planning/shelteringfacts.asphttp://www.bt.cdc.gov/planning/personalcleaningfacts.asphttp://www.bt.cdc.gov/planning/personalcleaningfacts.asphttp://emergency.cdc.gov/radiation/protectiveactions.asphttp://emergency.cdc.gov/bioterrorism/prep.asp


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nurs 419 community health notes

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