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Nightingale's Theory of Environment

answer

Highlights the relationship between an individual's environment and health. Depicts health as a continuum. Emphasizes preventative care.

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Health belief model

answer

purpose is to predict or explain health behaviors. Preventative health to avoid disease. Emphasizes change at the individual level.

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Milo's framework for prevention

answer

Complements the health belief model. Emphasizes change at the community level. Identifies relationship between health deficits and availability of health-promoting resources. Theorizes that behavior changes within a large number of people can ultimately lead to social change.

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Community or population

answer

an aggregate who shares one or more personal characteristics within the community is the client in community health nursing

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community-based nursing

answer

focus: individuals and families Activities: management of acute and chronic conditions where individuals, families, groups live, work and attend schools.

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Community-oriented nursing

answer

Focus: at risk individuals, families, groups. Community. Activities: determining the health needs of a community, and intervening at the individual, family, and group level to improve the collective health of the community.

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Community health nursing practice

answer

Focus: synthesis of nursing and public health theory. Activities: Promote, preserve, and maintain the health of populations by the delivery of health services to individuals, families, and groups in order to impact "community health"

question

Public health nursing practice

answer

Focus: synthesis of nursing and public health theory Activities: promote, preserve, and maintain the health of populations through disease and disability prevention and health protection of the community as a whole. Core functions: systematic assessment of the health of populations development of policies to support the health of populations ensuring that essential health services are available to all persons

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Autonomy

answer

individuals select those actions that fulfill their goals

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nonmaleficence

answer

no harm is done when applying standards of care

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beneficence

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to do good and max benefits

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distributive justice

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fair distribution of the benefits and burden in society

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Advocacy

answer

the nurse plays the role of informer, supporter, and mediator for the client. Clients are responsible for their own health.

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Epidemiology

answer

study of health-related trends in populations for the purposes of disease prevention, health maintenance, and health protection. Relies on statistical evidence to determine the rate of spread of disease and the proportion of people affected. BROAD understanding of the spread, transmission, and incidence of disease and injury.

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Epidemiology

answer

study of the relationships among an agent, a host, and an environment (epidemiological triangle)

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Agent

answer

animate or inanimate object that causes disease

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host

answer

living being that is affected by the agent

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environment

answer

setting or surrounding that sustains the host

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Incidence

answer

number of new cases of disease

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Prevalence

answer

number of existing cases of disease in the population

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Crude mortality rate

answer

number of deaths divided by the population total

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infant mortality rate

answer

number of infant deaths before 1 year of age in a year divided by the numbers of live births in the same year time 1,000

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Epidemic

answer

when the rate of disease exceeds the usual level of the condition in a defined population

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Primary prevention

answer

Prevention of the initial occurrence. Education, immunizations, prenatal classes.

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Secondary prevention

answer

limiting severity and adverse effects. Screenings, community assessments.

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Tertiary prevention

answer

Recovery after an illness. Nutrition counseling, case management, exercise for hypertensive clients.

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Access to health care

answer

is impacted by the availability of services in a community, as well as individual, family, and community circumstances

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world health organization

answer

provides daily information regarding the occurrence of internationally important diseases. Establishes world standards for antibiotics and vaccines. Primarily focuses on health care workforce and education, environment, sanitation, infectious diseases, maternal and child health, and primary care.

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Federal health agencies

answer

U.S. department of health and human services -under direction of the secretary of health -funded through federal taxes Consists of Children and Families, community living, Medicare and medicaid, HIPPA, SSI, AFDC

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Medicare

answer

older than 65 and receiving social security, have been receiving disability benefits for 2 years, have amytrophic lateral sclerosis, and receive disability benefits, or have kidney failure and be on maintenance dialysis or had a kidney transplant to qualify. Part A - hospital care, home care, limited skilled nursing care Part B - medical care, diagnostic services, physiotherapy Part C - Medicare advantage plan - is a combo of Part A and Part B and is provided through a private insurance company Part D - Prescription drug coverage

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Medicaid

answer

coverage for low socioeconomic status and children, through the federal and state governments. Eligibility is based on household size and income. Priority to children, pregnant women, and those who are disabled.

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State departments of Health

answer

Manages women, infants and children (WIC) program oversees children's health insurance program, which offers expanded health coverage to uninsured children whose families do not qualify for Medicaid. Establishes public health policies. Provides assistance to public health departments. Responsible for the administration of the medicaid program. Reports notifiable communicable disease within the state to the CDC.

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State boards of nursing

answer

development and oversight of the state's nurse practice act. Licensure of registered and licensed practical nurses. Oversight of the state's schools of nursing.

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Local health department

answer

primary focus is the health of its citizens. offer various services and programs. Report notifiable communicable diseases to state departments of health. funded through local taxes with support from federal and state funds.

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informant interviews

answer

direct discussion with community members for the purpose of obtaining ideas and opinions from key informants. Strengths: no cost Limitations: built-in bias

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Community forum

answer

open public meeting Strengths: community input Limitations: challenging to get participation

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Secondary data

answer

use of existing data (death statistics, birth statistics, census data, mortality, health records) Strengths: ability to trend health issues over time Limitations: data might not represent current situation

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Participant observation

answer

observation of formal or informal community activities. Negative - bias, time-consuming

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windshield survey

answer

descriptive approach that assesses several community components by driving through a community.

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Focus groups

answer

directed talk with a representative sample.

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surveys

answer

specific questions asked in a written format.

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windshield survey components

answer

people place location of health services natural environment housing social systems

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analysis of community assessment data

answer

Gather collected data assess completeness of data ID and generate missing data synthesize data and id themes ID community needs and problems ID community strengths and resources

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home health nurse

answer

nursing care to clients were they reside. this includes traditional homes, assisted living facilities, and nursing homes. Functions as education, provider of skilled nursing interventions, and coordinator of care.

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Home health nurses skills

answer

skilled assessment, wound care, lab draws, med education and administration, parenteral nutrition, IV fluids and medication, central line care urinary catheter insertion and maintenance. Must also evaluate the living environment for safety, paying close attention rugs, electrical outlet, and extension cords, use of oxygen, safety devices in the bathroom. Also educate the client when to contact ER.

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Hospice nurses

answer

enhances the quality of life through the provision of palliative care, supporting the client and family through the dying process, and providing bereavement support to the family following the client's death. Relief of pain and suffering and enhance of QOL. The hospice nurse may work with the family for up to 1 year following the death of a client.

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Occupational health nurse

answer

assess the ricks for work-related illness and injury, plan and deliver health and safety services in the workplace, facilitate health promotion activities that lead to a more productive workplace

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Occupational health

answer

occupational host - worker characteristics, such as job inexperience, age, and pregnancy occupational agent - biological agents (viruses, bateria, fungi, pathogens), chemical (smoke), mechanical agents (musculoskeletal or other strains from repetitive motions, poor workstation worker fit, lifting heavy loads), physical agents (temperature extremes, vibrations, noise, radiation, lighting), physiological agent (threats to psychological or social well-being resulting in work-related stress, burnout, and violence) Occupational environment factors - physical (heat, odor, pollution), social (sanitation, overcrowding) psychological (addictions, stress)

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Occupation health nurses's roles

answer

Primary prevention- teaching good nutrition and knowledge of health hazards, immunizations, and use of protective equipment Secondary prevention- ID workplace hazards, early detection through health surveillance and screening, counseling and referral Tertiary prevention- restoration of health through rehab

question

OSHA

answer

develops and enforces workplace health regulations to protect the safety and health of workers

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NACOSH (national advisory committee on occupational safety and health)

answer

gathers data on the incidence and prevalence of occupational illness and injury. Prevention education related to occupational injury and illness, as well as determining hazards associated with new workplace technologies.

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Faith community nurse

answer

work with a group of clients who share common faith traditions. Circle model of spiritual care: CIRCLE Caring Intuition Respect for religious beliefs and practices Caution Listening Emotional support

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Missionary nurse

answer

seeks to promote health and prevent disease by meeting spiritual, physical , and emotional needs of people across the globe.

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Parish nurse

answer

promotes the health and wellness of populations of faith communities. The population often includes church members and individuals and groups in the geographical community.

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School nurse

answer

case manager - coordinates comprehensive services for children who have complex health needs. Community outreach - strives to meet the needs of all school-age children by cooperative planning and collaboration between the educational system. Consultant - assists students, families, and personnel in information gathering and decision-making about a variety of health needs and resources. Counselor - supports students on health needs direct caregiver - provides nursing care to all ill or injured children at school health educator - helps prepare children, families, school personnel and the community to make well-informed health decisions

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Homicide

answer

often related to substance use, usually committed by someone known to the victim. Abuse often precedes homicide within families. Increasing among adolescents

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Assault

answer

males more likely to be assaulted, youths at higher risk

question

Rape

answer

majority of violence against women is intimate partner violence. Incidence occurs higher in cities, between 8 pm-2 am, on weekends, and in summer months

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Suicide

answer

women report attempting suicide more often than men. Rates are highest in men and individuals over the age of 65. Risk factors for suicide include depression or other mental disorders, substance use and intimate partner issues.

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Abuse

answer

Neglect: lack of physical care, such as food, shelter, hygiene. Emotional are (interacting with child), education for child, needed health or dental care.

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Potential for abuse

answer

Hx or being abused or exposed to violence, low self-esteem, fear and distrust of others, poor self-control, inadequate social skills, minimal social support, immature miscarriage, weak coping skills.

question

Recognize child abuse

answer

unusual fear of the nurse, injuries not mentioned in hx, fractures including older healed fractures, subdural hematoma, trauma to genitalia, malnourishment or dehydration, inappropriate dress for weather conditions, considered to be a "bad child"

question

Recognize elder abuse

answer

unexplained physical injuries, physical neglect, rejection of assistance by caregiver, financial mismanagement, withdrawal.

question

Social and Community factors Influencing Violence

answer

work stress, unemployment, media exposure to violence, crowded living conditions, poverty, feelings of powerlessness, social isolation, lack of community resources

question

Substance use disorders

answer

Denial: defensiveness, lying about use, minimize use, blaming use, intellectualizing.

question

alcohol use

answer

depressant, dulls the senses to outside stimulation and sedates the inhibitory centers in the brain.

question

alcohol use in body

answer

body burns about 0.5 oz of alcohol per hr. alcohol withdrawal appears within 4 to 12 hours.

question

alcohol withdrawal

answer

irritability, tremors, nausea, vomiting, headaches, diaphoresis, anxiety, sleep disturbances, tachycardia, elevated blood pressure. Use benzodiazepines for symptoms.

question

Smoking

answer

nicotine creates feeling of alertness and energy.

question

Prevention

answer

Primary- increasing public awareness Secondary- identify at risk individuals and assist them to reduce sources of stress. screen for substance use. Tertiary- refer client to community groups, AA. Provide emotional abusers including positive reinforcement.

question

Mental health

answer

High risk substance use disorders, high suicide risk.

question

Mental health prevention

answer

Primary- educate populations regarding mental health issues, teach stress-reduction techniques, parenting classes. Secondary- screen to detect mental health disorders, conduct crisis intervention Tertiary- medication monitoring, interventions, referrals

question

Communicable diseases

answer

Leading causes of death are acute respiratory infections (pneumonia and influenza), AIDS, diarrheal diseases, tuberculosis, malaria, measles.

question

Populations at risk for Communicable diseases

answer

young children, older adults, immunosuppressed clients, clients who have a high-risk lifestyle, international travelers, health-care workers

question

Airborne

answer

Measles, chickenpox, tuberculosis, pertussis, influenza

question

Foodborne

answer

Salmonellosis, Hepatitis A, Trickinosis, E.coli

question

Waterborne

answer

cholera, Typhoid fever, bacillary dysentery, Diardia Iamblia

question

Vector-borne

answer

Lyme disease, rocky mountain spotted fever, malaria

question

Direct contact

answer

Sexually transmitted infections (HIV , gonorrhea, syphilis, genital herpes, hepatitis B, C, D), infectious mononucleosis, enterobiasis (pinworm), Impetigo, lice, scabies

question

Portals of entry

answer

respiratory passages, GI, Skin, mucous membranes, genitourinary tract, eyes, blood vessels

question

Portals of exit

answer

respiratory secretions, feces, blood, semen, vaginal secretions, saliva, skin lesion exudates

question

Herd immunity

answer

protection due to the immunity of most community members making exposure unlikely

question

Natural immunity

answer

Natural defense mechanisms of the body to resist antigens or toxins

question

Acquired immunity

answer

develops through actual exposure to the infectious agent

question

Active immunity

answer

production of antibodies by the body in response to infection or immunization with a specific antigen

question

Passive immunity

answer

transfer of antibodies to the host either transplacentally from mother to newborn, or through transfusions of immunoglobulins, plasma proteins, or antitoxins

question

Primary prevention

answer

prevent the occurrence of infectious disease, educate the public regarding the need for immunizations, counsel clients traveling to other countries about protection from infectious disease. Refer to immunizations.

question

Secondary prevention

answer

increase early detection through screening and case finding, refer suspected cases of communicable disease for diagnostic confirmation and epidemiological reporting, provide post exposure prophylaxis (hep A, rabies), quarantine clients

question

Tertiary prevention

answer

Decrease complications and disabilities due to infectious diseases through treatment and rehab.

question

Disaster prevention

answer

Activities to prevent natural and man-made disasters, increase surveillance, improve inspections and airport security, strengthening public health processes such as immunizations, isolation, and quarantine. Strengthen barriers to prevent flooding and teaching methods of preventing communicable disease transmission. ID and assess population populations at risk.

question

Disaster preparedness

answer

Stem from threats and vulnerabilities identified in the prevention level, and should coordinate community efforts as well as outline specific roles of local agencies. This level of management includes preparedness of natural or man-made disasters. Create an action plan and determine alternative methods of communication, highlight evacuation plans, ID local and distant meeting places, disaster kit. Set up communication protocol; should provide access to American Red Cross, and state and federal government agencies. Disaster drills.

question

Disaster response

answer

FEMA, CDC, U.S. Department of Homeland Security, American Red Cross, Office of Emergency Management, public health system. If a federal emergency is declared, the National Response Framework is activated and provides direction for an organized, effective national response.

question

Disaster recovery

answer

Begins when danger no longer exists and needed representatives and agencies are available to assist with rebuilding. Communicable disease and sanitation are important aspects of disaster recovery.

question

Phases of emotional reaction during a disaster

answer

Heroic - intense excitement and concern for survival. Rush for assistance. Honeymoon- affected individuals being to bond and relive their experiences. Disillusionment - responders may experience depression and exhaustion. Delays in receiving aid. Reconstruction- involves adjusting to a new reality and continued rebuilding of the area. Counseling may be needed.

question

Bioterrorism Category A biological agents

answer

highest priority, posing risk to national security because easily transmitted and have high mortality rates. Ex: smallpox (variola), botulism, anthrax, tularemia, hemorrhagic viral fevers, plague

question

Category B biological agents

answer

second-highest priority because they are moderately easy to disseminate and have high morbidity(disease) rates and low mortality (death) rates. Ex: typhus and cholera

question

Category C biological agents

answer

third-highest priority, emerging pathogens that can be engineered for mass dissemination because they are easy to produce, and/or have a potential for high morbidity and mortality rates. Ex: hantavirus

question

Anthrax

answer

headache, fever, muscle aches, chest discomfort, severe dyspnea, shock. Give: IV Cipro

question

Botulism

answer

difficulty swallowing, weakness, nausea, vomiting, difficulty breathing. Give: airway management, antitoxin, eliminate the toxin, supportive care

question

Smallpox

answer

high fever, fatigue, severe headache, rash (BEGINS of face and tongue, quickly spreads to trunk, arms, legs, hands, feet) then turns into pus-filled lesions, vomiting. Give: treatment - no cure, supportive care- hydration, pain meds, antipyretics. Prevention: vaccine (10 years of immunity)

question

Ebola

answer

fever, hemorrhage, vomiting, diarrhea, cough, jaundice, shock. Treatment: no cure, airway management, dialysis, supportive care. Prevention: avoidance of contaminated items/animals

question

Bioterrorism Primary prevention

answer

Prepare with drills, vaccines, and ensuring availability of antibiotics for exposure prophylaxis. design a response plan, id the chain of command, define nursing roles, set up protocols.

question

Bioterrorism Secondary prevention

answer

early recognition, activate response plan, implement infection control measures - decontamination, protective equipment, SCREEN the populations for exposure, assist and educate the population regarding symptom identification and management, monitor mortality and morbidity.

question

Bioterrorism tertiary prevention

answer

Rehab of survivors, monitor medication regimens and referrals, evaluate effectiveness of the bioterrorism plan

question

Characteristics of successful partnerships

answer

shared power, shared goals, integrity, flexibility, negotiation

question

Consultant

answer

specialized knowledge who provides expert advice, services, or information. -seek expertise from health care professionals -seek expertise from health care professionals -seek expertise of other nurses -incorporate recommendations from a consultant -coordinate recommendations from multiple consultants -serve as expert witness -serve as a consultant regarding the health care needs of individuals

question

Referrals

answer

to assist in restoring, maintaining, or promoting health.

question

Referral process

answer

engage in working relationship with client establish criteria for the referral explore resources accept the client's decision to use a given resource (autonomy) make the referral facilitate the referral evaluate the outcome

question

Case management

answer

Promotes interprofessional services and increased client/family involvement decreases cost by improving client outcomes provides education to optimize health participation advocate for services and client rights

question

Telehealth

answer

useful in rural areas.

question

Telehealth physical data

answer

BP, weight, Blood O2, Blood glucose, HR, temp, ECG results

question

Telehealth audio data

answer

Voice conversation, heart sounds, lung sounds, bowel sounds

question

Telehealth visual data

answer

images of wounds, images of surgical incisions

question

Change agents

answer

advocate for needed change at local, state, federal level

question

Lobbyists

answer

persuade of influence legislators. Lobbying may be implemented by an individual, or collectively through professional nursing associations.

question

Coalitions

answer

facilitation of goal achievement through the collaboration of two or more groups

question

Public office

answer

serving society and advocating for change by influencing policy development through public service

question

Contact for non-biological or chemical incident

answer

Office of Emergency Management

question

Contact when local abilities are unable to properly respond to an incident

answer

The federal emergency management agency

question

American Red Cross

answer

Support emergency rescue and recovery services and is contacted when additional resources are needed by the community.

question

U.S. Department of Homeland Security

answer

Contact in response to threats and hazards by acts of terrorism

question

Small pox

answer

eradicated worldwide since late 1970s, people who were immunized against smallpox before 1982 are now considered to be unprotected, unlike chickenpox, the vesicles of smallpox are more abundant on the face.

question

Pediculosis capitis (head lice)

answer

Nits that are shed into the environment are capable of hatching for up to 10 days. Pets do not transmit or carry lice.

question

Scabies

answer

Appear as grayish brown, threadlike burrows on the skin. Require private room.

question

Self breast exam

answer

Monitor for any change in size, contour, dimpling. Perform exam every month, 2 to 3 days after your period. Use finger pads of the three middle fingers.

question

Pneumonic Plague

answer

no precautions other than protective.

question

Meningococcal conjugate

answer

immunization given at 11-12 years of age

question

Herpes zoster

answer

given at 60 years or older

question

Rotavirus

answer

given during first year of life

question

Chemical in eyes

answer

nurse starts to flush the clients eyes with tepid water - secondary prevention

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