Community Nurses Work for Diabetes Prevention

By Folarin Opakunle RN

One of the chronic illnesses that can be addressed in the community by the community health nurse is diabetes. This illness is on the rampage in our community and if the problem is not promptly address, we may see a decline in our workforce and overall economic growth as a result of the disease complications.

Diabetic retinopathy is the leading cause of blindness, and diabetic peripheral neuropathy is the underlying cause of non-traumatic lower-extremity amputation. Diabetic nephropathy is the leading cause of kidney failure requiring dialysis.

The community health nurse can treat clients in any of the three stages of preventive care from primary prevention care to secondary prevention, and tertiary prevention. This approach could help blunt the increase morbidity and mortality noted in our community. The primary prevention is done when the nurse educate clients on activities that can be done to prevent the disease from occurring such as proper diet, exercise, and weight loss. The primary prevention will target those who are vulnerable or those who have risk factors for developing the disease. In this stage, there is no clinical manifestation of the disease.

In the secondary preventive care, the community health nurse will screen for clients with clinical manifestation of the disease. The goal of the nurse in the stage is to have the clients get the required treatment to manage the disease.The final stage which is the tertiary prevention care, in this stage, the client has clinical manifestation, treatment is ongoing, and compliance is encouraged. The goal of the community health nurse in this stage is to maintain the clients at their highest level of functioning while preventing or minimize possible complication.

The job of community health care nurse in our community is very vital; therefore the nurses must understand the importance of cultural competency and adequately use a culturally based theory or model to guide their communication and assessment due to the diversity of our community.

References:

Clark, (2009). Community Health Nursing, 5th ed. Sudbury Mass:Pearson Publishing.

Note: This material was created by Folarin Opakunle RN with minor editing by Shirley Comer Rn. The content is intended as information only. Please consult your primary health care provider before beginning or changing your healthcare regimen.

Community Nurses can intervene in HIV

By: Patti Schassburger RN

The increase in the number of cases of HIV is a major concern within our communities. "In 2007 it was estimated that there were 2.5 million new cases of HIV worldwide, including 2.1 million adults and 420,000 children."(Piper,2008) The development and advancement of HIV/AIDS education in our community is crucial to averting the spread of HIV.

Providing the people of our community with educational information about HIV/AIDS will empower individuals with the knowledge to guard themselves from becoming an HIV statistic. Educating the community about HIV/AIDS also reduces the shame and dishonor associated with the disease. It also can reduce the prejudice that accompanies the disease. It is important that the entire community is included in the education process. HIV/AIDS does not discriminate and everyone needs to be aware of this rampant disease. "Providing the general population with basic AIDS education contributes to the spread of accurate information; promoting awareness and tackling stigma and discrimination." (avert.org)

Education about HIV/AIDS should start in the schools. Children are becoming sexually active at a younger age. We must prepare them and educate them. HIV/AIDS education should be included with sexuality education in schools. HIV/AIDS education should be provided in the workplace also.

Community nurses can reach large numbers of people in the community through use of health fairs and free lectures. "Education is a crucial factor in preventing the spread of HIV. Given the huge numbers of deaths that might still be prevented, the importance of effective education cannot be overestimated." (avert.org)

References
Piper,J.(2008)Prevention of Sexually transmitted infections in women. Infections disease clinics of North America (22),619-635.
www.avert.org (referenced 3/30/2010)

Note: This material was created by Patti Schassburger RN with minor editing by Shirley Comer Rn. The content is intended as information only. Please consult your primary health care provider before beginning or changing your healthcare regimen.

Chronic Illness and STDs

By Janella Schroeder RN

When the phrase “chronic illness” is thought of, many diseases come to mind…hypertension, diabetes, COPD, cancer…but some that might not pop in your head but can be equally devastating and equally life threatening are sexually transmitted diseases.

There are currently 4 non-curable STD’s including Herpes, Human Papillomavirus (HPV), Hepatitis, and Human Immunodeficiency Virus (HIV) which are all viral.

In order to educate patients on STD’s it is important to first understand the important facts about them.

Genital Herpes can be symptomless at first, but then develop into blisters that can break and form ulcers to the genital and anal areas caused by the herpes simplex virus (HSV-1 or HSV-2).
• It can be months to years before the blisters develop enough to cause visible ulcers, but the virus can still be contagious without obvious blisters via sexual contact (oral, genital, or anal).
• It is believed that as many as 1 in 6 Americans 14-49 have genital herpes. A definitive diagnosis can be made by culturing blister or ulcer.
• There are suppressive therapies taken daily that can reduce the number of outbreaks and lessen the risk of transmission to partners, but there is no cure for herpes.
• Condoms can reduce the risk of herpes, but not prevent it completely because the herpes may be on areas not covered by the condom.

Human Papillomavirus is the most common STD in America today with as many as 50% of those sexually active being infected. There are over 40 types of HPV that can affect the mouth, throat and genital areas of both men and women.
• Some may fight the virus on their own with no s/s, but others are unable to fight the virus and it can lead to genital warts or cancers such as cervical, penile, anal, throat, or mouth.
• HPV is passed through sexual contact (oral, anal, or genital)
• Condoms do not fully protect against HPV because it can live on areas not covered by a condom
• There is a vaccine for girls and women that protects against certain strands of HPV that cause cervical cancer and genital warts. Recently there has been a vaccine developed for boys/men to protect against certain stands that cause genital warts
• There is currently no test laboratory test for HPV, it is diagnosed only by the visualization or genital warts of when the virus has already caused cervical changes or other cancerous changes

HIV is probably the most well known STD
• HIV is transmitted through body fluids such as blood, semen, vaginal fluid, and breast milk
• HIV often has no symptoms for months to years but can still be transmitted and can be transmitted even with a condom
• It is tested for with a blood test, and should be tested on all patients seeking treatment or testing for other sexually transmitted disease
• There is no cure for HIV but there are meds to suppress the virus and help people live healthy lives for years, the medications however do not lessen the risk of passing the virus on to sexual

Hepatitis B is a liver disease can be caused by sexual contact through infected body fluids including blood, semen, vaginal fluids.
• Symptoms can take up to 6 months to appear and can include fever, fatigue, abdominal pain, loss of appetite, and jaundice.
• Hepatitis B is diagnosed with a blood test
• There is a vaccine for Hepatitis B given in 3 steps
• Treatment is supportive only for acute symptoms and select antiviral drugs are used for chronic management of hepatitis B, but there is no cure.

What you can do as a community health nurse:
 The most important preventative tool for these non-curable STD’s is EDUCATION.
 It is not enough anymore to tell patients to “get tested” or “practice safe sex” because those two things cannot prevent all STDs.
 Time must be spent with patients to educate them on the different types of STDs and the ways they are transmitted, signs and symptoms, diagnostic tests, and treatments if there are any.
 Scare tactics may be used when focusing on these four chronic STDs that have no cure and can be deadly. The attitude of many is "I will just take a pill if I catch something".
 It is still important to encourage use of condoms if the patient will be sexually active even if they do not prevent all STDs 100% because people with one STD are more susceptible for other STDs.

References:
Center for Disease Control. (2010). Retrieved March 31, 2010, from http://www.cdc.gov/

Note: This material was created by Janella Schroeder RN with minor editing by Shirley Comer Rn. The content is indented as information only. Please consult your primary health care provider before beginning or changing your healthcare regimen.

Depression and Women

By Tyonna Gilbert
Depression is a mood disorder that is very common in women. It affects your social life, your personal relationships, careers, and sense of self-worth. Most don’t get the help that they need due to the stigma that it carries. The symptoms of depression varies from person to person, the intensity of symptoms depends on how severe the depression is. Without proper treatment the symptoms can last from weeks, months, or years. Signs and symptoms of depression include:
~Feelings of guilt, hopelessness and worthlessness
~Suicidal thoughts or recurrent thoughts of death
~Sleep disturbances
~Loss of appetite
~Weight changes
~Lack of energy and fatigue
~Difficulty concentrating
Causes of depression in women are related to several factors such as biological, psychological, and social factors. Hormonal fluctuations during the menstrual cycle, pregnancy, and after childbirth can contribute to depression. Women often suffer from role strain which causes conflicting and overwhelming responsibilities in their lives. Sexual and physical abuse contributes to depression in women.
The first step in receiving treatment is to visit a doctor. Certain medications and some medical conditions can cause the same symptoms as depression. A physical examination, interview, and lab test can rule out these possibilities. Once the medical condition is rule out, the doctor can conduct a psychological evaluation or make a referral to a mental healthcare professional.
The most commonly used treatments for depression are psychotherapy and antidepressant medication, or a combination of the two. Which treatment is used depends on the nature and severity of the depression. Psychotherapy is supportive counseling which addresses the hopelessness of depression. Cognitive therapy focus on changing negative ways of thinking and behaving that contribute to depression. Interpersonal therapy helps deals with stressful relationships and how to manage them.
Medication doesn’t cure the depression; it helps you feel better by controlling the symptoms.
The medication used for depression is called antidepressants, which regulates the mood. The medication must be taken for at least three to four weeks before a therapeutic effect occurs. Medication needs to be taken even if you are feeling better, to prevent a relapse of depression.
You can maintain a normal life if you follow the treatment regimen that was prescribe to you by a mental healthcare provider.

www.psychologyinfo.com/depression/women.htm
www.helpguide.org/mental/depression_women.htm
www.nimh.nih.gov/health/publications/depression

Note: This material was created by Tyonna Gilbert RN with minor editing by Shirley Comer Rn. The content is indented as information only. Please consult your primary health care provider before beginning or changing your healthcare regimen.

When is Chubby no Longer Cute?

By: Janella Schroeder RN

Everyone loves a chubby baby…the chubbier they are, the cuter and more “healthy” they seem; but when does “chubby” become unhealthy? As cute as a chubby child may seem, it is a very startling fact that the number of children and adolescents that are considered overweight or obese has more than doubled in children aged 2-11 and tripled in adolescents ages 12-19 over the last 20 years (Center for Disease Control, 2009).

Today there is much concern over “labeling” children or causing self esteem issues, so many unhealthy weight problems dealing with children are left untouched by parents and schools. It is imperative to realize though that ignoring the problem in childhood can lead to a life full of health and emotional problems that can be detrimental. It has been shown that overweight children are almost twice as likely to be overweight as an adult and that overweight children can develop “adult” diseases like high blood pressure, diabetes, high cholesterol, sleep apnea and heart disease. The effects of being overweight are not only physical however, the emotional stress of being overweight in childhood can lead to depression, low self esteem, and can even hamper academic success (Center for Disease Control, 2009).

To put it plain and simple, being overweight is caused by an imbalance of calories eaten vs. calories burned through normal body function and everyday activity. The important issue to focus on though is what has changed in the last 20 years leading to this imbalance. There has become an overabundance of fast food and non-nutritional “junk” food consumed by children and adults alike. The increasing oversized portions served at restaurants and at home can be detrimental to a child’s weight and health. There is also a lack of physical activity both at home and school. There is an increasing lack of funding for physical education classes and sports and at home there is more time spent on sedentary activities such as TV, video games, and computer. One of the most damaging effects on a child’s weight is the lack of guidance and education on healthy lifestyle choices by both schools and parents.

So how can all this start to be reversed? The schools needs to start providing healthy and balanced lunch choices, daily physical activity for children and adolescents, and most importantly educate children on balanced eating, making healthy choices, and exercise. Some very useful information can be found at: http://www.mypyramid.gov/Kids/ and http://www.keepkidshealthy.com/welcome/TreatmentGuides/exercise.html. At home parents can start by including children in meal planning, shopping, and preparation, keeping healthy snacks in house in place of junk food, paying attention to portion sizes (not just the child’s, but theirs too…children learn by watching) and most of all encourage children to “Get up and play and hour a day” (Healthier US).

References:

Be A Player Get Up And Play An Hour A Day. (n.d.). Retrieved Feb. 22, 2010, from Healthier US: http://www.healthierus.gov/video.html

Childhood Overweight and Obesity. (2009, October). Retrieved Feb 22, 2010, from Centers for Disease Control and Prevention : http://www.cdc.gov/obesity/childhood/index.html

NOTE: This blog post reflects the work of Janella Schroeder, RN with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Crohn's Disease

By: Karlie Peters RN

Crohn’s “is a chronic inflammatory process in the gastrointestinal tract but with intermittent activation” (Crohn’s disease and IBS, 2007). Crohn’s is caused by an inflammation, which can cause “abdominal pain, severe diarrhea, and even malnutrition” (Mayo Clinic, 2009). The inflammation process can affect any aspect of the digestive system, but it is generally localized to the area of the distal parts, the ileum and colon. Crohn’s affects the deep layers of bowel tissue. “Crohn’s disease can be both painful and debilitating and sometimes may lead to life-threatening complications” (Mayo Clinic, 2009).

Signs and symptoms of Crohn’s include “diarrhea, abdominal pain and cramping, bloody stool, ulcers, reduced appetite and weight loss, fever, fatique, arthritis, eye inflammation, skin disorders, inflammation of the live or bile ducts, and even delayed growth or sexual development, in children” (Mayo Clinic, 2009).

Crohn’s disease has been linked to four components, they include “genetic predisposition to an increased intestinal permeability, an oropharyngeal bacterium that increases the mucosa; permeability of the small intestine with only a minimal inflammatory reaction, an adherent-invasive strain of Escherichia coli that penetrates the mucosa and causes an acute inflammatory reaction in the intestinal wall, and finally a secondary invasion of bacteria causing the chronic inflammatory characteristics” (Crohn’s disease and IBS, 2007).

Nurses can inform patients that the cause of Crohn’s disease is still unkown, but was previously thought of as being agitated from diet or stress. Researchers are now looking more towards a number of factors, “such as heredity and a malfunctioning immune system” (Mayo Clinic, 2009). Nurses can educate patients with the risk factors of Crohn’s disease. There are several risk factors and they include: “age, ethnicity, family history, cigarette smoking, where you live, isotretinoin (Accutane) use, and nonsteroidal anti-inflammatory drugs (NSAIDs)” (Mayo Clinic, 2009).

Teaching individuals that Crohn’s is diagnosed between in the ages of 20-30, with Caucasians having the highest risk, even those of Ashkenazi Jewish decent are even greater. Individuals whom have a close relative, like a parent or sibling, have a 1 in 5 risk. Cigarette smoking is “a determining factor for composition of the subgingival microflora” (Crohn’s disease and IBS, 2007). Lars Oble (2007) quoted that “a culture from the oral cavity of smokers showed an increased Gram-negative bacterial colonization.”

Once individuals get a general idea of the Crohn’s disease process, the individual should be identifying their own risk factors, for example, if an individual smokes, then cessation of smoking should be encouraged. Individuals should be seeking their primary physician if they are having signs and symptoms. Keeping a journal to write down all medications, a daily journal of food intake, along with personal information, such as major stresses or recent life changes, and making notes of bowel habits will help aid the physician in proper medical assistance. There are alternative medicines that include “herbal and nutritional supplements, probiotics, fish oil, and acupuncture” (Mayo Clinic, 2009). To feel in control of a disease, such as Crohn’s disease, then organizations, like Crohn’s and Colitis Foundation of America (CCFA) (888-MT-GUTPAIN) can help with providing information and accessing of support groups in the local areas.

Reference Page
Mayo Clinic. (1998-2009). Mayo Clinic. Retrieved from http://www.mayoclinic.com/ on
October, 6th 2009.
Olbe, L. (2008). Concept of Crohn's disease being conditioned by four main components,
and irritable bowel syndrome being an incomplete Crohn's disease. Scandinavian Journal of Gastroenterology, 43.

NOTE: This blog post reflects the work of Karlie Peters, RN with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

DASH Diet and Hypertension

By: Debra Minnifield, RN

The “Dash Diet”, which stands for Dietary Approaches to Stop Hypertension, is credited with effectiveness in reducing blood pressure in African Americans and older adults. The focus of the DASH diet is to lower and control blood pressure. The use of this diet could reduce blood pressure by a few points in only two weeks and reduce it eight to fourteen points over time. Its other health benefits include protection against heart disease, stroke, osteoporosis and even diabetes. Use of the DASH diet may even potentiate the action of antihypertensive medications and decrease insulin resistance.

The Dash Diet formed the basis for the new SDA My Pyramid and is recommended by:

• The National Heart, Lung, and Blood Institute

• The American Heart Association

• The 2005 Dietary Guidelines for Americans

• US guidelines for treatment of high blood pressure

The DASH diet controlling portion sizes and consists of whole grains, low fat dairy products, fish poultry, legumes fruits, and vegetables. The diet is low in saturated fat, sodium, cholesterol and total fat. However, the diet is high in protein, magnesium, calcium and potassium. Red meat and sweets may be consumed in moderation.

As advocates, nurses can educate and empower clients to take control of their health by encouraging the use of the DASH diet. Nurses should perform thorough assessments and urge patients to make lifestyle modifications, such as engaging regularly in appropriate exercise, limiting their alcohol intake and avoiding tobacco.

References:

Hypertension in African Americans. Minority Nurse (2003).

www.mayoclinic.com,retrieved October 10,2009

Note: This blog post reflects the work of Debra Minnifield, RN with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.