prevention control of chronic non-communicable diseases

8/3/2019 Prevention Control of Chronic Non-Communicable Diseases

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Adelaida L. Mayeta-Peart

Dr. Feleta Wilson


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Understand the term chronic non-

communicable Discuss characteristics of chronic non-

communicable diseases

Review some communicable diseases


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Non-communicable diseases are a serious

threat to global well-being, They present a growing economic and social

challenge for many developed and developing

countries.


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Diseases of long duration and generally slow

progression.

By far the leading cause of mortality in the world,

representing 60 % of all deaths.


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Not infectious

May result from genetic or lifestyle factors Illness caused by something other than a

pathogen

It might result from hereditary factors, improper

diet, smoking, or other factors

Those resulting from lifestyle factors are

sometimes called diseases of affluence


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No single necessary agent

Seldom agent-disease specificity

Intervention often based on risk factors as causes areunknown

Long latency period

May require multiple exposure to same or multiple agents

Most often produces chronic diseases Acquired immunity unlikely


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Hypertension

Diabetes

Cardiovascular disease

Physical inactivity & unhealthy diets

Cancer Mental health problems

Asthma

Cerebrovascular accident (CVA)

Atherosclerosis

Allergy

osteoarthritis

osteoarthritis , etc


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Unhealthy diets (especially those which have a

high content in fats, free sugars and salt)

Physical inactivity


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Physical inactivity and unhealthy diets are majorcontributors to overweight (Body Mass Index: 25

29.9) and obesity (BMI greater than 30). Extra body weight increases the risk of serious

health consequences such as:

- Cardiovascular disease (mainly heart disease and

stroke)- Diabetes

- Breast, colon and endometrial cancers


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Children are also affected. It is estimated that, in

2005, at least 20 million children under the age of5 years were overweight.

Childhood obesity is associated with a higher

chance of premature death and disability in

adulthood.


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Tobacco use

Physical inactivity Unhealthy diet

Over 80% of cardiovascular disease deaths take

place in low-and middle-income countries and

occur almost equally in men and women.


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Coronary heart disease (heart attacks)

Cerebrovascular disease Raised blood pressure (hypertension)

Peripheral artery disease

Rheumatic heart disease Congenital heart disease

Heart failure


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Cardiovascular diseases affect many people in

middle age, very often severely limiting theincome and savings of affected individuals and

their families.


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Interruption of the blood supply to a part of the

brain and the development neurological deficits Prevention-To prevent stroke causes must be

identified:

- Hypertension

- Atherosclerosis(narrowing of the arteries by fattydeposits)


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A stroke cannot be controlled; but some of the

causes can be prevented or controlled e.g.- Obesity

- Hypertension

- Diabetes


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Chronic disease that occurs when the pancreas

does not produce enough insulin (a hormone thatregulates blood sugar/ carbohydrate

metabolism) or alternatively, when the body

cannot effectively use the insulin it produces

Characterized by hyperglycemia and glycosuriaresulting from inadequate production or

utilization of insulin


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Heterogeneous group of disorders of

carbohydrates, fat and protein metabolism,characterized by chronic hyperglycemia,

degenerative vascular changes and neuropathy

It accelerates degenerative changes throughout

the body by widespread vascular changes in thelarge and small blood vessels


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Cannot be cured however hyperglycemic agents

can be used to lower the blood glucose, therebyeffecting acceptable levels of blood glucose and

therefore, control


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In order to prevent a condition, the cause must

be identified. In Diabetes mellitus the possiblecauses are:

- Destruction of Beta cells

- Retarded release of insulin


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Correcting hyperglycemia & glycosuria

Maintaining normal weight Encouraging appropriate activity (exercises)

Encouraging healthy eating habits


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Trained nurse (PHN/nurse educator) Engage educate and empower patient to

manage diabetes and impact of disease on

patient and family

Based on trust and partnership between publichealth centre (PHN/ health care team), patient

and family

Patient determine agreed targets

Continuity and access


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Case study

Mr. R. is 45 yrs old and self employed. He hasbeen diagnosed with Diabetes mellitus, however

he does not understand why he must make so

many new changes to his lifestyle as he is really

comfortable with his life now. He does notexercise and he hates vegetables. However his

family is concerned as he is constantly in and out

of hospital and he is the breadwinner for the

family


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Use the nursing process addressing issues

a) Assessb) Diagnose

c) Plan strategies to address problem

d) Implement plane) Evaluate such plan


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Sickle-cell anemia: life-long blood disordercharacterized by red blood cells that assume an

abnormal, rigid, sickle shape

The sickle shape occurs because of a mutation in

the hemoglobin gene

Life expectancy is shortened, an average lifeexpectancy of 42 and 48 years for males and

females, respectively.


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Stroke: result from a progressive vascularnarrowing of blood vessels, preventing oxygenfrom reaching the brain. Cerebral infarction

occurs in children, and cerebral hemorrhage inadults.

Cholelithiasis (gallstones) and cholecystitis,which may result from excessive bilirubinproduction and precipitation due to prolongedhaemolysis


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Jaundice: May occur due to the inability of theliver to effectively remove bilirubin from the

filtering of damaged red blood cells out of the

blood supply as well as blocks in the organ's

blood supply

Avascular necrosis (aseptic bone necrosis) of thehip and other major joints, which may occur as a

result of ischemia.


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Decreased immune reactions due tohyposplenism (malfunctioning of the spleen).

Priapism and infarction of the penis


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Sickle-cell conditions are inherited from parentsin much the same way as blood type, hair color

and texture, eye color, and other physical traits.

The types of hemoglobin a person makes in the

red blood cells depend on what hemoglobin

genes are inherited from his parents.


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If one parent has sickle-cell anemia (SS) and theother has sickle-cell trait (AS), there is a 50%

chance of a child's having sickle-cell disease (SS)

and a 50% chance of a child's having sickle-cell

trait (AS).

When both parents have sickle-cell trait (AS), achild has a 25% chance (1 of 4) of sickle-cell

disease (SS), as shown in the diagram.


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Sickle-Cell Disease


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Proliferation of cells whose unique trait- loss ofnormal controls results on unregulated growth,

lack of differentiation , local tissue invasion and

metastasis (spread from one organ to another

non-adjacent organ)


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Advocate for reduction of salt consumption

Advocate for reduction of saturated fat

consumption

Advocate to limit intake of free sugars

Promote increase consumption of fruits andvegetables

Encourage achievement of a healthy weight

Encourage practice of adequate levels of physicalactivity.


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Ensure that physical environments for walking,cycling and other forms of physical activity are

accessible to and safe for all

Introduce transport policies that promote active

and safe methods of traveling to schools andworkplaces, such as walking or cycling

Improve sports, recreation and leisure facilities

Increase the number of safe spaces available foractive play

For diet and physical activity interventions that


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Monitor tobacco use and encourage tobacco-prevention policies

Protect people from tobacco smoke in publicplaces and workplaces

Offer help to people who want to stop usingtobacco

Warn people about the dangers of tobacco

Enforce bans on tobacco advertising, promotion

and sponsorship


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Raise tobacco taxes and prices.

Promote and support exclusive breastfeeding forthe first six months of life and promote programs

to:

a) ensure optimal feeding for all infants and young

children;

b) develop a national policy and action plan on

food and nutrition, with an emphasis on national

nutrition priorities


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Establish and implement food-based dietaryguidelines and support the healthier composition

of food by:

Promoting healthy diet

Reducing salt levels

Eliminating industrially produced trans-fatty

acids

Decreasing saturated fats


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Ms . L. S, age 58, and Ms. R. W, age 67, are sisters

who live together in a small rural town.They are

both retired high school teachers. Ms. L. S has

retired early due to advanced osteoporosis. Ms.R. W has osteoarthritis.The two sisters have

requested information from the community

health center about managing their mobility

concerns and have expressed interest inincreasing their exercise.


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They are both being seen by the family physicianand managed with a pharmacological treatment

plan.The physician has advised them to exercise

more and increase their flexibility through

weight training. Both sisters are optimistic andenthusiastic about gaining greater control in

their lives through self management.


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What should the nurse keep in mind as he

develops a plan of care with these clients?

What aspects of chronic illness influence the

health goals of these clients?


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Chronic disease is characterized by periods ofremissions and exacerbations, depleted or

inadequate coping mechanisms, and by fatigue,

factors which must be considered by the nurse in

planning their care.


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Realistic goals can be set with the clients whenconsidering the long term progression of these

debilitating diseases.

Quality of life and control related to the

promotion of autonomy are important aspects to

promote health in these clients.


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The community health nurse may intervene tofacilitate use of adaptive coping mechanisms and

incorporate social support into the sisters plan of

exercise.

Examples include seeking group exercise classes

designed for elder women with arthritis andspiritual support through their church groups.

prevention control of chronic non-communicable diseases

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