Question

Write a paper (2,000-2,500 words) in which you apply the concepts of epidemiology and nursing research to a communicable disease. Refer to "Communicable Disease Chain," "Chain of Infection," and the CDC website for assistance completing this assignment.

Communicable Disease Selection

Choose one communicable disease from the following list:

Chickenpox

Tuberculosis

Influenza

Mononucleosis

Hepatitis B

HIV

Ebola

Measles

Polio

Influenza

Epidemiology Paper Requirements

Address the following:

Describe the communicable disease (causes, symptoms, mode of transmission, complications, treatment) and the demographic of interest (mortality, morbidity, incidence, and prevalence). Is this a reportable disease? If so, provide details about reporting time, whom to report to, etc.

Describe the determinants of health and explain how those factors contribute to the development of this disease.

Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. (The textbook describes each element of the epidemiologic triangle). Are there any special considerations or notifications for the community, schools, or general population?

Explain the role of the community health nurse (case finding, reporting, data collecting, data analysis, and follow-up).

Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organization(s) contributes to resolving or reducing the impact of disease.

Discuss a global implication of the disease. How is this addressed in other countries or cultures? Is this disease endemic to a particular area? Provide an example

Answer 1

Tuberculosis is an infectious disease that usually affects the lungs. Compared with other diseases caused by a single infectious agent, tuberculosis is the second biggest killer, globally. Tuberculosis or TB, as it’s commonly called is a contagious infection that usually attacks the lungs. It can also spread to other parts of the body, like the brain and spine. A type of bacteria called Mycobacterium tuberculosis causes it. Through the air, just like a cold or the flu. When someone who’s sick coughs, sneezes, talks, laughs, or sings, tiny droplets that contain the germs are released. If you breathe in these nasty germs, you get infected. TB is contagious, but it’s not easy to catch. The germs grow slowly. You usually have to spend a lot of time around a person who has it. That’s why it’s often spread among co-workers, friends, and family members.

A TB infection doesn’t mean you’ll get sick. There are two forms of the disease:

Latent TB: You have the germs in your body, but your immune system stops them from spreading. The bacteria remain in the body in an inactive state. They cause no symptoms and are not contagious, but they can become active. That means you don’t have any symptoms and you’re not contagious. But the infection is still alive in your body and can one day become active. If you are at high risk for re-activation — for instance, you have HIV, your primary infection was in the last 2 years, your chest X-ray is abnormal, or you are immunocompromised, your doctor will treat you with antibiotics to lower the risk for developing active TB.  

Active TB disease: The bacteria do cause symptoms and can be transmitted to others. This means the germs multiply and can make you sick. You can spread the disease to others. Ninety percent of adult cases of active TB are from the reactivation of a latent TB infection. About one-third of the world's population is believed to have latent TB. There is a 10 percent chance of latent TB becoming active, but this risk is much higher in people who have compromised immune systems, i.e., people living with HIV or malnutrition, or people who smoke.

Diagnosis

To check for TB, a doctor will use a stethoscope to listen to the lungs and check for swelling in the lymph nodes. They will also ask about symptoms and medical history as well as assessing the individual's risk of exposure to TB. The most common diagnostic test for TB is a skin test where a small injection of PPD tuberculin, an extract of the TB bacterium, is made just below the inside forearm. The injection site should be checked after 2-3 days, and, if a hard, red bump has swollen up to a specific size, then it is likely that TB is present. Unfortunately, the skin test is not 100 percent accurate and has been known to give incorrect positive and negative readings.

However, there are other tests that are available to diagnose TB. Blood tests, chest X-rays, and sputum tests can all be used to test for the presence of TB bacteria and may be used alongside a skin test. Multidrug-resistant TB (MDR-TB) is more difficult to diagnose than regular TB. It is also difficult to diagnose regular TB in children.

Treatments

The majority of TB cases can be cured when the right medication is available and administered correctly. The precise type and length of antibiotic treatment depend on a person's age, overall health, potential resistance to drugs, whether the TB is latent or active, and the location of infection (i.e., the lungs, brain, kidneys).

People with latent TB may need just one kind of TB antibiotics, whereas people with active TB (particularly MDR-TB) will often require a prescription of multiple drugs.

Antibiotics are usually required to be taken for a relatively long time. The standard length of time for a course of TB antibiotics is about 6 months.

TB medication can be toxic to the liver, and although side effects are uncommon, when they do occur, they can be quite serious. Potential side effects should be reported to a doctor and include:

• Dark urine
• Fever
• Jaundice
• Loss of appetite
• Nausea and vomiting

It is important for any course of treatment to be completed fully, even if the TB symptoms have gone away. Any bacteria that have survived the treatment could become resistant to the medication that has been prescribed and could lead to developing MDR-TB in the future.

Directly observed therapy (DOT) may be recommended. This involves a healthcare worker administering the TB medication to ensure that the course of treatment is completed.

Causes

The Mycobacterium tuberculosis bacterium causes TB. It is spread through the air when a person with TB (whose lungs are affected) coughs, sneezes, spits, laughs, or talks.

TB is contagious, but it is not easy to catch. The chances of catching TB from someone you live or work with are much higher than from a stranger. Most people with active TB who have received appropriate treatment for at least 2 weeks are no longer contagious.

Since antibiotics began to be used to fight TB, some strains have become resistant to drugs. Multidrug-resistant TB (MDR-TB) arises when an antibiotic fails to kill all of the bacteria, with the surviving bacteria developing resistance to that antibiotic and often others at the same time.

MDR-TB is treatable and curable only with the use of very specific anti-TB drugs, which are often limited or not readily available.

Prevention

A few general measures can be taken to prevent the spread of active TB.

• Avoiding other people by not going to school or work, or sleeping in the same room as someone, will help to minimize the risk of germs from reaching anyone else.
• Wearing a mask, covering the mouth, and ventilating rooms can also limit the spread of bacteria.

Vaccination

In some countries, BCG (Bacille Calmette-Guerin) injections are given to children to vaccinate them against tuberculosis. It is not recommended for general use in the U.S. because it is not effective in adults, and it can adversely influence the results of skin testing diagnoses.

The most important thing to do is to finish entire courses of medication when they are prescribed. MDR-TB bacteria are far deadlier than regular TB bacteria. Some cases of MDR-TB require extensive courses of chemotherapy, which can be expensive and cause severe adverse drug reactions in patients.

Risk factors

People with compromised immune systems are most at risk of developing active tuberculosis. For instance, HIV suppresses the immune system, making it harder for the body to control TB bacteria. People who are infected with both HIV and TB are around 20-30 percent more likely to develop active TB than those who do not have HIV.

Tobacco use has also been found to increase the risk of developing active TB. About 8 percent of TB cases worldwide are related to smoking.

People with the following conditions have an increased risk:

• diabetes
• certain cancers
• malnutrition
• kidney disease
• Also, people who are undergoing cancer therapy, anyone who is very young or old, and people who abuse drugs are more at risk.
• Travel to certain countries where TB is more common increases the level of risk, too.

Complications

If left untreated, TB can be fatal. Although it mostly affects the lungs, it can also spread through the blood, causing complications, such as:

• Meningitis: swelling of the membranes that cover the brain.
• Spinal pain.
• Joint damage.
• Damage to the liver or kidneys.
• Heart disorders: this is more rare.

Symptoms

While latent TB is symptomless, the symptoms of active TB include the following:

• Coughing, sometimes with mucus or blood
• Chills
• Fatigue
• Fever
• Loss of weight
• Loss of appetite
• Night sweats

Tuberculosis usually affects the lungs, but can also affect other parts of the body. When TB occurs outside of the lungs, the symptoms vary accordingly. Without treatment, TB can spread to other parts of the body through the bloodstream:

• TB infecting the bones can lead to spinal pain and joint destruction
• TB infecting the brain can cause meningitis
• TB infecting the liver and kidneys can impair their waste filtration functions and lead to blood in the urine
• TB infecting the heart can impair the heart's ability to pump blood, resulting in a condition called cardiac tamponade that can be fatal

Social determinants

Social determinants play an important role in the epidemiology of tuberculosis (TB) and are considered under the pillar ‘Bold policies and supportive systems’ of the End TB Strategy, the global strategy and targets for TB prevention, care and control. The upstream determinants at the top of the causal pathway linking poverty and low socio-economic status to the factors that directly increase the risk of being infected (exposure to infectious sources) or developing TB (impairment of the immune defense system). Growing consensus indicates that progress in tuberculosis control in the low- and middle-income world will require not only investment in strengthening tuberculosis control programs, diagnostics, and treatment but also action on the social determinants of tuberculosis. Poverty is a powerful determinant of tuberculosis. Crowded and poorly ventilated living and working environments often associated with poverty constitute direct risk factors for tuberculosis transmission. Undernutrition is an important risk factor for developing active disease. Poverty is also associated with poor general health knowledge and a lack of empowerment to act on health knowledge, which leads to risk of exposure to several tuberculosis risk factors, such as HIV, smoking and alcohol abuse.

Poverty alleviation reduces the risk of tuberculosis transmission and the risk of progression from infection to disease. It also helps to improve access to health services and adherence to recommended treatment. Actions on the determinants of ill health through “health-in-all-policies” approaches will immensely benefit tuberculosis care and prevention. The required social, economic and public health policies include those that:

• pursue overarching poverty reduction strategies and expanding social protection;
• reduce food insecurity;
• improve living and working conditions;
• improve environment and living conditions in prisons and other congregate settings;
• address the social, financial, and health situation of migrants; and
• promote healthy diets and lifestyles, including reduction of smoking and harmful use of alcohol and drugs.

Addressing the social determinants of health is a shared responsibility across disease programmes and other stakeholders within and beyond the health sector.

The Epidemiologic Triangle
The Epidemiologic Triangle is a model that scientists have developed for studying health problems. It can help your students understand infectious diseases and how they spread.

The Triangle has three corners (called vertices):

• Agent, or microbe that causes the disease (the “what” of the Triangle)
• Host, or organism harboring the disease (the “who” of the Triangle)
• Environment, or those external factors that cause or allow disease transmission (the “where” of the Triangle)

An outbreak or an epidemic exists when there are more cases of a particular disease than expected in a given area, or among a specific group of people, over a particular period of time. Another other term you might come across is endemic, when a population has a high level of the disease all the time. For example, giardiasis and even malaria are endemic in parts of the world.
The mission of an epidemiologist is to break at least one of the sides of the Triangle, disrupting the connection between the environment, the host, and the agent, and stopping the continuation of disease.

Roles and Responsibilities of Nurses

The ability of nursing to progress, as knowledge and human health experiences change, makes it a dynamic and multifaceted profession. In summary, nursing may be defined as a profession that addresses human responses to the full range of health experiences by:

• Integrating objective and subjective information about humans
• Applying scientific knowledge to diagnosis and treatment
• Developing a caring relationship that fosters health and healing

The nursing process is the problem-solving method used in nursing practice. Its holistic perspective serves as a tool for evaluating and improving care. In addition, it helps avoid duplications and omissions while contributing to comprehensive and consistent care.

Assessment is the systematic collection and analysis of data culminating in a nursing diagnosis. Assessment is the initial phase of the nursing process and is identified by the American Nurses. Association as the first standard for professional nursing practice (1996). It is a continuous aspect of the nursing process and involves collaboration with patients, caregivers, and healthcare providers who contribute to the patients’ care. After information about a patient’s health situation is obtained, analyzed, and documented, the nurse makes a nursing diagnosis. The nursing diagnosis is a statement of clinical judgment that conveys the nursing assessment. It provides the basis for the selection of nursing strategies to achieve patient care outcomes for which the nurse is accountable. During the diagnostic phase, data are analyzed and interpreted. Conclusions are drawn regarding patients’ needs, problems, concerns, or human responses. Nursing diagnostic statements are identified and documented and provide direction for the remainder of the nursing process. They serve as the basis for planning, implementing, and evaluating care.

The most widely accepted structure for the nursing diagnostic statement is that advocated by the North Atlantic Nursing Diagnosis Association (NANDA). Regardless of the selected structure, the diagnostic statement should include the following components:

• Statement of human response
• Statement of nursing judgment
• Conclusion based on nursing assessment
• Reference to a health experience
• Two-part statement that includes etiology

The first part of the statement communicates the functional behaviors that can be improved through nursing actions. These behaviors may promote, protect, maintain, or restore health. Modifiers for the first part of the diagnostic statement may be “alteration in” or “potential alteration of”. The second part of the diagnostic statement identifies the causes or factors that nurse works to improve or influence. This part of the statement describes factors that contribute to the current healthcare situation. The following are examples of nursing diagnostic statements that may be typical of those used in nurse case management of TB:

• Potential alteration in health maintenance related to a multiple drug regimen
• Alteration in health maintenance related to non-adherence to the TB treatment regimen

The first example acknowledges that TB medications, if not carefully monitored, may have deleterious
effects. The second nursing diagnosis identifies a change in a patient’s usual health pattern when the TB treatment regimen is not followed. Both diagnoses imply the nursing action to be taken, the desired patient behaviors, and the expected outcomes.

The planning component of the nursing process involves the establishment of intervention strategies. In the planning process, it is necessary that all interventions include:

• Stated outcomes (criteria for evaluation) with a time frame for achievement
• Indication of how achievement of the expected outcome will be measured

Steps in the planning phase include:

• Prioritizing the nursing diagnoses
• Identifying expected outcomes and discussing them with the patient when possible
• Writing the nursing orders, i.e., nursing behaviors that will help the patient achieve the identified outcomes
• Recording the diagnoses, nursing strategies, and expected outcomes in an organized nursing care plan

The third phase of the nursing process is implementation, the execution and completion of nursing strategies identified in the planning phase. Implementation requires communication of the plan to all participants involved in the patient’s care, including the patient and family. The plan of care may be carried out by members of the health team, the patient, the patient’s family, and/or other caregivers. During this phase, the nurse continues to assess the patient and record progress. Documentation verifies that the plan has been implemented and can be used to identify the standard of care and evaluate the plan’s effectiveness.

Evaluation is the final, ongoing phase of the nursing process that documents both the patient responses and the extent to which the expected outcomes have been achieved. The nurse assesses the patient’s progress using expected outcomes as criteria for evaluation. Corrective measures and revisions to the care plan are employed, if needed. The importance of documentation at each stage of the nursing process has been discussed. From the initial assessment through the final evaluation, the nurse must record relevant observations and interactions. Not only does accurate and detailed documentation influence patient care, but it serves to legitimize the contributions made by nursing.