nursing capstone. week 13 final project
E2002susi
5-TEMPLATE.PowerPointofCAPSTONEimplementation1.pptxCommunity Health Promotion Plan to prevent Heart Disease
Name
Problem & Significance
Community & Participant
Assessment of the Community & of the Participant
The Health Promotion Plan
Implementation of the Plan
Results
Evaluation
Implications for Nursing Practice
WHY?
Significance
The leading cause of death for Hillsborough County residents is heart disease. While the heart disease death rate has shown some improvement, it has remained the leading cause of death for years, mimicking national data. The two major forms of cardiovascular disease that make the greatest contribution to mortality are stroke and coronary heart disease. In 2017, 2,756 average annual deaths from cardiovascular disease occurred in Hillsborough County, with 1,517 people who died of coronary heart disease, and 421 who died from stroke.
The Problem
High incidence of Cardiac Diseases
Concept Map
Contribute to
Education
Lack of access to healthcare
Contribute to
Obesity
Frequent emergency hospitalizations
Forced absenteeism
Cultural lifestyle
CAD, stroke, CKD,
Result in DEATH
Elevated BP
Diabetes Mellitus
High Cholesterol
Physical inactivity
Stress
Financial problems
Windshield Survey of the community
Characteristics of the Community that are relevant to the problem
Health disparities are differences in the prevalence, incidence, mortality, burden of disease, and other adverse health conditions that exist among specific population groups. These differences exist due to underlying causes which include:
Health Disparities
• Socio-economic factors, such as income, education, poverty
• Occupational conditions, such as underemployment
• Individual health behaviors, such as high-risk behavior
• Living conditions, such as inadequate transportation and housing
• Discriminatory treatment based on gender, sexual orientation, race, disability, etc.
• Differential use of health services based on patient preferences, health insurance status,
provider bias, or the limited availability of providers
In 2017, an estimated 15.2% of the population in the county reported income in the past 12 months below the poverty level (Office of Economic and Demographic Research).
The prevalence of several acute and/or chronic health conditions in the county can also give a picture of the health status of the population. The findings from the 2017 BRFSS survey indicate that 71% of resident adults had no regular vigorous activity, 74% consumed less than 5 servings of fruits and vegetables each day, 39% were overweight, and 25% were obese.
Despite the number of health care resources in the county, 28% of adults surveyed in 2017 had no personal health care provider, which is higher than the state (23%). Hispanic women (22%) were the most likely to report the inability to access medical care when compared to White and Black women (15% and 19%).
The Participant
Demographics of the Primer Case
Hillsborough County is located midway along the west coast of Florida in the Tampa - St. Petersburg metropolitan area. One of 67 counties in Florida, with its 1,050.9 square miles in land area and a population density of 1,047.9 per square mile, Hillsborough County is the fourth largest county in the state. The population in Hillsborough County is projected to reach 1,537,290 by the year 2025.
Genogram
Characteristics of the Participant that are relevant to the problem
Subjective Assessment
Headache
Blurred vision
Tired
Objective Assessment
Vitals taken as follows:
-Temperature: 37.2°C
-Pulse rate: 83beats/minutes
-Respiration rate: 18breaths/minutes
-Blood pressure: 180/100mmHg
Gordon’s Health Patterns Assessment
| Pattern | Assessment of Participant |
| Health Perception-Health Mgmt | He perceives his health to be reasonably fair, not 100%, but fairly good for his age. Although he takes medication for the management of Hypertension (High Blood Pressure), diagnosed in 2009, he feels that it is well controlled and does not impact on his ability to perform his ADL’s. |
| Nutritional-Metabolic | During a 24 hour period he usually consumes three main meals and rarely has snacks. He has no food allergies but does modify his diet regularly based on his body image and weight fluctuations. |
| Elimination | His voiding pattern is approximately once per day dependent on his daily schedule and his fluid intake. |
| Activity-Exercise | He does not exercise. |
| Sleep-Rest | He enjoys sleeping and will generally achieve 8-9 hours per night. |
| Cognitive-Perceptual | He likes to read which he feels supports his cognitive functions. The most significant change has been his vision as he has aged. |
| Self-Perception –Self-Concept | He clearly states he doesn't feel old at 65 years however he believes his weight issues affect his ability to feel confident. He does not perceive himself as being old but tired. |
| Roles-Relationships | He is a father and grandfather. He views his primary roles at this stage of his life as being a grandfather. He does not belong to any social groups. |
| Sexuality-Reproductive | His sexual desires fluctuate over the years with highs and lows. |
| Coping-Stress Tolerance | His wife and daughters were his primary means of support during this time although he did consider accessing professional counseling. He drinks alcohol to relieve stress . |
| Values-Beliefs | His family and faith have always been the most important part of his life. |
The Plan
| Concrete steps | Who will be involved | Criteria for success |
| Assess risk or presence of conditions associated with obesity | PATIENT AND DAUGHTERS | Obesity is an added risk with high blood pressure because of the disproportion between fixed aortic capacity and increased cardiac output associated with increased body mass. |
| Assess patient and daughters understanding of direct relationship between hypertension and obesity. | Reduction in weight may obviate the need for drug therapy or decrease the amount of medication needed for control of BP. Faulty eating habits contribute to atherosclerosis and obesity, which predispose to hypertension and subsequent complications (stroke, kidney disease, heart failure). | |
| Discuss necessity for decreased caloric intake and limited intake of fats, salt, and sugar as indicated | Excessive salt intake expands the intravascular fluid volume and may damage kidneys, which can further aggravate hypertension. | |
| Establish a realistic weight reduction plan with the patient such as 1lb weight loss per wk. | Reducing caloric intake by 500 calories daily theoretically yields a weight loss of 1 lb per wk. Slow reduction in weight is therefore indicative of fat loss with muscle sparing and generally reflects a change in eating habits. | |
The Implementation
Encourage patient to maintain a diary of food intake, including when and where eating takes place and the circumstances and feelings around which the food was eaten.
Refer to dietitian as indicated.
Instruct and assist in appropriate food selections, such as a diet rich in fruits, vegetables, and low-fat dairy foods referred to as the DASH Dietary Approaches to Stop Hypertension) diet and avoiding foods high in saturated fat (butter, cheese, eggs, ice cream, meat) and cholesterol (fatty meat, egg yolks, whole dairy products, shrimp, organ meats).
Evaluating the Results
After 3 hours the patient and daughters will be able to verbalize understanding of the instructions given.
After 1 week of interventions, the client’s blood pressure will be within normal limits.
After 1 month of interventions, the client will loose 3lbs to start maintaining a healthy weight.
Evaluating the Results
Cost/Benefit & Sustainability Analysis
The Centers for Medicare and Medicaid Services (CMS) estimates Medicare beneficiaries with two or more chronic conditions accounted for 93 percent of Medicare spending in 2017, or about $276 billion.
Among hypertensive and people with elevated cholesterol, the uninsured more often had uncontrolled conditions.
Financial Implications
Direct health care spending to treat hypertension totaled $42.9 billion in 2017, with almost half ($20.4 billion) in the form of prescription drugs.
The mean expenditure per person for the treatment of hypertension was higher for Hispanics and non-Hispanic blacks ($981 and $887, respectively), than for non-Hispanic whites ($679) and non-Hispanic others ($661).
Implications for Nursing Caring
Community Nursing
Goal: Reduce prevalence of obesity in Hillsborough County
Objective: Create and implement a social marketing campaign that increases self awareness of negative consequences of being overweight/obese among a selected population of Hillsborough County residents by December 2018.
Global Nursing
Global health work is complicated by a variety of factors. First, the local environment of each target community varies widely, each presenting unique challenges to the delivery of health care. This means that education efforts must be locally conceived, tailored, and implemented. Secondly, barriers to accessing care are widespread and require innovative strategies to overcome them. Third, the healthcare field is complex in nature, requiring trained professionals and follow-up care to ensure adherence to drug regimens. In order for global health programs to be effective, these complexities must be recognized, understood and addressed.
References
Edward O’Neil Jr., A Practical Guide to Global Health Service (American Medical Association, 2006), 24.
Florida Vital Statistics: http :// www.flpublichealth.com/VSBOOK/VSBOOK.aspx
Hillsborough.floridahealth.gov | Website Review for hillsborough.floridahealth.gov. (n.d.). Retrieved from https:// www.woorank.com/en/www/hillsborough.floridahealth.gov
