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The children in the local school district have poor dental health. They have multiple dental caries and lack knowledge about proper dental hygiene. The community is a low-income area. Most children come from working households and are eligible for the school lunch program.

1. What are some local resources in your state for assisting with the dental health of children?

As you continue to work with these children it becomes apparent that the need for dental services exceeds the amount that can be provided through local charitable means. You elect to find a national resource for this care.

2. Identify national resources for improving the dental health of children.

3. The providers who are working with these children report that restorative care is not sufficient to protect the dental health of this

population. They recommend additional efforts be added to this program.

4. What other factors contribute to poor dental care in this population?


The Griffin family is made up of a mother, father, 3 male children: ages 7 months, 4 years old, and 1.5 years old, and the maternal grandmother. Both parents are educated, employed, and work outside of the home. The grandmother speaks only Russian and helps to care for the children. Lately, the 1.5 year old has been acting out violently against all family members. The parents’ guilt for being away from home causes them to ignore the inappropriate behaviors. The grandmother has been feeling overwhelmed by the children but says nothing out of fear that she might lose her standing in the family.

1. What are the pathological characteristics of this family?

As the population health nurse caring for this family you understand the need to also determine the family’s strengths before proceeding with intervention.

2. What strengths do you assess in this family?

When a family is in crisis, they often use defense mechanisms to cope with stress.

3. Identify and explain the coping mechanisms used by this family.


You have just accepted your first job as a case manager. You are told you will be responsible for both case management and disease management.

1. How does case management differ from disease management?

One of your first assignments is to develop a population-based case management program for victims of domestic violence.

2. How should you begin this process


Personal goals & objectives due.

You are in the drive-up area of the emergency department helping to unload a laboring woman brought by private vehicle. As you are helping the woman into a wheelchair a bus pulls into the drive-up next to you. The driver stumbles out of the bus and collapses on the pavement. You notice that the bus is filled with people who are panicking and displaying signs of dyspnea.

1. What is your immediate action?

As you process the scene you realize that this bus may have been the target of a biochemical attack. The semi-conscious bus driver says someone threw a “smoking canister” through a bus window.

2. What possible biochemicals could be responsible for the above scenario?

The occupants of the bus begin to spill out of the door and enter the emergency department, screaming for help.

3. What do you do now?

It becomes apparent that a serious situation is occurring when a second bus pulls up to the emergency department with similarly affected people. You notice that hospital employees and visitors who have arrived to see what is happening now look sick as well.

4. What special actions must be taken when a health care facility is at risk in a disaster?


Journal entry: Members of ethnic cultural groups have been shown to have poorer health care outcomes than others in the U.S. population. In part, this is due to lack of access to care due to financial constraints. Even when members of these groups have health insurance, however, their health outcomes tend to be less favorable than among Caucasian members of the population with similar forms of healthcare coverage.

1. What other factors might be contributing to these differential outcomes?

2. Which of these factors arise out of ethnic cultures and which arise out of the dominant culture or the culture of the health care system?


Mrs. Hefner is a 40-year-old female who lives with her 16-year-old son and 18-month-old daughter. Mrs. Hefner has been separated from her husband for 1 year. Throughout her marriage she and her husband used marijuana occasionally and drank only on weekends. Lately, she reports finding herself using both wine and marijuana nightly to help her fall asleep. She admits that her husband would binge drink on weekends but never touched alcohol during the week. Mr. Hefner has another family to support now and has been giving her less and less financial assistance. Mrs. Hefner works part-time to be able to care for her children. Daycare is too expensive and Mrs. Hefner is concerned about the minor trouble her 16-year-old has been getting into at school and in the neighborhood.

1. Is substance abuse an issue in this family? Why or why not?

Mrs. Hefner comes to the community free-clinic asking for help. As the nurse, you begin to develop a plan of care for this family.

2. List the actual and potential problems in this scenario.

Mrs. Hefner says, “I’m so glad I heard about this clinic. I have been so worried, but I didn’t know where to go for help.”

3. What referrals would you make in this situation?


Journal Entry: Population health nurses may be utilized in local public health clinics that provide services such as immunization and family planning. They may function as home health nurses.

How do you think community resources are best used: in clinic activities or in home health activities?

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