By: Kristie Bruesch, Emily Gullena, Melanie Cybulski, and Brea Yang

HEART DISEASE IN WOMEN; AGE 35-55

By: Kristie Bruesch, Emily Gullena, Melanie Cybulski, and Brea Yang

Heart Disease

Heart disease is

the number one killer of women and men in the

United States

Risk Factors County population in July 2009: 41,775 (29%

urban, 71% rural)

Obesity Rates Mecosta County 30.4% State of Michigan 29.2%

Adult diabetes rate: Mecosta: 8.6% Michigan: 9.7%

City-data.com (2010). Mecosta County, Michigan (MI). Retrieved from Onboard Informatics website: http://www.city-data.com/county/Mecosta_County-MI.html

http://www.city-data.com/county/Mecosta_County-MI.html

*Michigan has the 6th worst age-adjusted CHD death rate (158.0 per 100,000 in 2005-2007) of the fifty U.S. states. The Healthy People 2010 goal for CHD deaths is 162 per 100,000, and the 2020 goal is 100.8 per 100,000.

*Most CVD risk factors in Michigan are above the national rate and are often more common among those with a lower socio-economic status.

*Coronary Heart Disease (CHD) is the most prevalent & preventable form of heart disease. Costs due to CHD in Michigan in 2007 are estimated at $5.9 billion.

Michigan Department of Community Health (2009). Heart Disease Deaths and Death Rates Mecosta County Residents, 1989-2009. Retrieved from http://www.mdch.state.mi.us/pha/osr/Chi/CRI/CriticalInd/Crico.asp?TableType=Heart%20Disease&CoName=Mecosta&CoCode=54

http://www.mdch.state.mi.us/pha/osr/Chi/CRI/CriticalInd/Crico.asp?TableType=Heart%20Disease&CoName=Mecosta&CoCode=54


MORTALITY RATE Heart Disease

Michigan: Leading Causes of Death, 2006

1,673

2,331

2,823

3,557

4,471

4,746

20,166

24,223

0 5,000 10,000 15,000 20,000 25,000 30,000

Influenza/Pnemonia

Alzheimer's disease

Diabetes

Accidents (unintentional injuries)

Chronic Lower RespiratoryDiseases

Stroke

Cancer

Heart Disease

Number of Deaths

Risk Factors for Premature Death in Michigan

U.S. Department of Health and Human Services, Health Resources and Services Administration (2000, July). Community Health Status Report Mecosta County Michigan. Retrieved from http://www.keepingkidsalive.org/about_the_program/Counties/HRSA/Mecosta.pdf

http://www.keepingkidsalive.org/about_the_program/Counties/HRSA/Mecosta.pdf

Tobacco Use-smoking causes coronary heart disease and cigarette smokers are 2–4 times more likely to develop coronary heart disease than nonsmokers.

Diet-Saturated and Trans fats increase blood cholesterol and heart attack rates.

Activity (limited recreational centers and fitness groups)-Heart disease is almost twice as likely to develop in inactive people.

Alcohol Use-Research is ongoing to clarify the relationship of alcohol and heart disease.

Coronary Heart Disease

High Blood Pressure-About 1 in 3 adults in the United States has HBP. HPB damages both the heart muscle and blood vessels, making it one of the most important causes of heart disease.

High Cholesterol-When there is too much cholesterol in your blood, it builds up in the walls of your arteries. This buildup causes "hardening of the arteries" so that arteries become narrowed and blood flow to the heart is slowed down or blocked.

.Socioeconomic Factors

Residents with income below the poverty level in 2009:

Mecosta county: 16.1% Whole state: 10.5%

Access to Health Care Services• Mecosta Population without health insurance

coverage in 2000: 13%



Socioeconomic Factors

Poverty Rates in Mecosta County, Michigan in 2005-2009 (percent below poverty level)

• People Age 65 and Older 7%• Children Under 18 Years 23%• All Families 12%• Female Householder Families 40%

U.S. Census Bureau, 2005-2009 American Community Survey. Mecosta County Michigan. Retrieved from http://factfinder.census.gov/servlet/NPTable?_bm=y&-geo_id=05000US26107&-qr_name=ACS_2009_5YR_G00_NP01&-ds_name=&-redoLog=false

http://factfinder.census.gov/servlet/NPTable?_bm=y&-geo_id=05000US26107&-qr_name=ACS_2009_5YR_G00_NP01&-ds_name=&-redoLog=false


Socioeconomic Factors

Mecosta County Vulnerable Populations

People With no High School Diploma (over the age of 25): 4,950

Unemployed Individuals: 720 People Who are Severely Work Disabled: 950 People Suffering from Major Depression: 1,970 Recent Drug Users: 2,100



Specific Groups

Mecosta County by Race

Caucasian 95.1% Black 2.4% American Indian 0.7% Asian/Pacific Islander 0.6% Hispanic Origin 1.2%



Specific Groups

Heart Disease Mortality by Age in Mecosta County 2007-2009

86.3% of total deaths Age Under 50: 3% Age 50 to 74: 24.7% Age 75 and older: 58.7%

Heart Disease Mortality U.S. 2006 26% of total deaths

Centers for Disease Control and Prevention (2010, December). Heart Disease Facts. Retrieved from http://www.cdc.gov/heartdisease/facts.htm


http://www.cdc.gov/heartdisease/facts.htm



DIAGNOSIS

Women of, Mecosta County, Michigan at risk of risk factors

for coronary artery disease related to smoking, obesity, and

lack of physical activity

Plan

To reduce incidence of risk factors through education focused on female population ages

35-55.

Access women of Mecosta County between ages 35-45

Obtain volunteers and education providers. Obtain and distribute educational materials

explaining coronary artery disease risk factors and methods of reducing risk factors.

Information provided focused on weight reduction, increasing physical activity, and smoking cessation .

Provide contact information regarding resources available in Mecosta County

Accessing Women between 35-55

Largest Employers : Ferris State University

1202 State St. Big Rapids MI 49307

Mecosta County Medical Center

605 Oak St. Big Rapids MI

Wolverine Worldwide

1005 Baldwin Big Rapids MI 49307

Accessing Women between 35-55

Businesses with female clientele in 35-55 age group Meijer

15400 Waldron Way Big Rapids MI

Walmart

21400 Perry St. Big Rapids MI 49307

Hometown Grocery

101 Northern Ave.Barryton MI 49307

The Studio

223 S. Michigan Ave. Big Rapids MI Tracy & Co. Salon

548 S. State St. Big Rapids MI Cuts Plus

8041 180th Ave Stanwood MI

•Obtain volunteers to distribute materials and provide education. • Nursing Students from Ferris State University • Public Health Nurse from Mecosta County Health Department.

•Distribute Educational Materials related to decreasing coronary artery disease risk factors at the businesses with clientele of women in age group and large employers. Information provided would focus on smoking cessation, increasing physical activity, and maintaining healthy weight.

•Provide contact information about resources available In Mecosta County for decreasing coronary artery disease risk factors.

•Mecosta County Medical Center 605 Oak St. Big Rapids MI *MCMC offers” Freedom from Smoking Program “to the public

•Mecosta County Health Department 14485 Northland Dr. Big Rapids MI•Women’s Health and Wellness Virtual Women’s Center

www.ferris.edu./health/studentlife/HCenter •www.weightwatchers.com•www.americanheart.org

http://www.ferris.edu./health/studentlife/HCenter

http://www.weightwatchers/

http://www.americanheart.org/

Interventions Monitor for symptoms of heart failure and decreased cardiac

output: listen to heart sounds, lung sounds. Note symptoms including dyspnea, orthopnea, paroxysmal nocturnal dyspnea, Cheyne-stokes respirations, fatigue, weakness, third and fourth heart sounds, crackles in lungs, increase venous pressure greater than 16 cm H2O and positive hepatojugular reflex.

Observe for chest pain or discomfort. Note location, radiating, severity, quality, duration, associated manifestations such as nausea, indigestion, and diaphoresis and also precipitating and relieving factors.

If chest pain is present, lie the client down, monitor cardiac rhythm, give oxygen, check vitals, run a monitor strip, give medication for pain, notify physician.

Monitor intake and output, urine output, client weight as needed. (Weigh the patient the same time each day).

Maintain fluid balances by administering IV fluids or diuretics as appropriate.

Monitor peripheral pulses, capillary refill, and temperature and color of extremities.

Interventions

Note results of electrocardiography and chest radiography, echocardiogram or stress test.

Watch laboratory results closely especially arterial blood gases, electrolytes including potassium, and B-type natriuretic peptide, complete blood count, sodium levels, lipid profile, and serum creatinine.

Check blood pressure, pulse rate and condition before giving ACE inhibitors, digoxin, calcium channel blockers, and beta blockers.

Administer intropic/contractility medications, vasodilators and/or vasoconstrictors.

Serve low sodium and low cholesterol meals. Assess the client daily for appropriate of activity and bed rest

orders. When getting client up, observe for symptoms of intolerance

such as nausea, pallor, dizziness, visual dimming and impaired consciousness as well as changes in vital signs.

Interventions Monitor and record the client’s ability to tolerate activity (pulse rate, blood

pressure, monitor patter, dyspnea, use of accessory muscles, and skin color before and after activity. If signs and symptoms of cardiac decompensation develop, activity should be stopped immediately: onset of chest discomfort dyspnea palpitations excessive fatigue lightheadedness confusion ataxia, pallor

cyanosis nausea or any peripheral circulatory insufficiency dysrhythmia such as supra-ventricular tachycardia, ventricular tachycardia,

exercise-induced intra-ventricular conduction defect, second- or third-degree atrio-ventricular block, frequent ventricular contracts.

Exercise hypotension (drop in systolic blood pressure of 10 mm Hg from baseline blood pressure despite an increase in workload.

Excessive rise in blood pressure (systolic >180 mm Hg or diastolic >110 mm Hg)

Inappropriate bradycardia Increased heart rate >100 beats/min

Interventions Explore barriers to medical regimen adherence. Review medication

and treatment regularly for needed modifications. Take complaints of side effects seriously and be the client advocate to address necessary changes.

Encourage family members to become CPR certified. Assess source of fears with the client. (Also assess for presence of

culture-bound anxiety and fear states such as culture beliefs, norms, and values on the client’s perspective of stressful situations).

Assess for history of anxiety or things that trigger those responses. Have the client draw the object of his or her fear if needed. Discuss the situation with the client and encourage the client to

express feelings of fear. Provide verbal and nonverbal reassurances if permission to touch or

hug and if culturally acceptable.

Interventions

Instruct client to stop activity immediately and report to the physician if the client is experiencing the following symptoms: new or worsen intensity or increased frequency of discomfort, tightness or pressure in chest, back, neck, jaw, shoulders, and/or arms; palpitations, dizziness, weakness, unusual and extreme fatigue, excessive air hunger.

Provide emotional support and encouragement to client to gradually increase activity.

Allow for periods of rest before and after planned exertion periods such as meals, baths, and treatments, and physical activity.

Instruct client and family about disease process, complications of disease process, information on medications (checking pulse rate and/or blood pressure before taking a heart medication), need for daily weight if ordered by doctor, and when to call the doctor.

Teach importance of smoking cessation and avoidance of alcohol intake

Evaluation

The client has demonstrated adequate cardio output with blood pressure within normal range, pulse rate and rhythm with the client’s baseline. Have strong peripheral pulses and ability to tolerate activity without dyspnea, syncope, and chest pain.

The client has demonstrated good respiratory function, respiratory rate, and oxygen saturation within the client’s normal baseline.

The client is free of side effects of medications used to achieve adequate cardiac output.

The client’s lab values are within normal ranges such as arterial blood gases and pH, CBC, electrolytes, BNP, serum creatinine, and lipid profile.

EVALUATION

The client has participated in prescribed physical activity with appropriate changes in heart rate, blood pressure, and breathing rate, maintains monitor patterns (rhythm and ST segment) within normal limits.

The client is aware of the symptoms of adverse effects of exercise and report onset of symptoms immediately. Maintained normal skin color and skin is warm and dry with activity.

The client has demonstrated balance of activity and rest such as taking naps to restore energy, recognize energy limitations, organize activities to conserve energy and adapt lifestyle to energy level.

The client is able to verbalize and express feelings of fears related to heart disease.

EVALUATION

The client has identify, verbalized, and demonstrated coping behaviors that has reduced fears and anxiety.

The client has explained the disease state; recognize need for medication and treatment.

The client has explained how to incorporate new health regimen into lifestyle, state the ability to deal with health situation and remain in control of life.

Local Data VS Benchmarks (Theory)

Mecosta County has a higher death rate from heart disease and when compared to the national averages. Also, Mecosta County has higher obesity rates when compared to the State of Michigan’s data. Using the general systems theory the higher rate of heart disease in Mecosta County can be explained by the external influences and by its location. Mecosta is a rural community with a larger percentage of its residents living below the poverty level, when compared to the rest of Michigan, and there is a lack of available resources. When compared with the total U.S. population rural areas have higher rates of chronic disease (Maurer, 2009). There are fewer health care providers and services in rural areas and there is a higher percentage of uninsured in rural communities (Maurer, 2009) .

Maurer, F.A., Smith, C.M. (2009). Community/public health nursing practice: Health for families and populations. St. Louis, Missouri: Saunders Elsevier

Existing Resources

Mecosta County Medical Center: a 74-bed acute-care hospital

Mecosta Health Services: Family Practice Spectrum Health Reed City Community Mental Health for Central

Michigan (CMHCM) Mecosta County Department of Human

Services Michigan Home Health Care Inc Hope House Free Medical Clinic Red Cross Weight Watchers-Mount Pleasant

What Groups May be Able to Help

Churches Public Health Services Promote and Encourage Healthy

Behaviors Assure Quality and Accessibility of

Health Services Development of Women’s Groups,

Fitness Classes, and Recreation Centers

State of Michigan; Laws and Policies

Public Awareness of Heart Disease and Stroke

MI SR 8 (2009, adopted) - Proclaims February 6, 2009, as Go Red for Women Day. Heart disease is the No. 1 cause of death among women and cardiovascular disease claims the lives of 460,000 American women every year--almost one death per minute. More women die of cardiovascular disease than the next five causes of death combined, including all forms of cancer.

HR263/SR141 (2008) - The members of [the House of Representatives] proclaim February 1, 2008, as Wear Red Day in the state of Michigan. We recognize the American Heart Association and its Go Red for Women campaign. We urge all our colleagues and Michigan citizens to wear red in recognition of their family members, friends, and neighbors who have suffered from heart disease and as a show of support in the fight against these diseases.

HR99 (2007) - The members of this legislative body commemorate May 2007 as Stroke Awareness Month and recognize the contributions it is making to educate Americans about stroke risk factors, prevention, symptom recognition, and acting fast to treat stroke. Be it further resolved, that we honor and join other organizations throughout the state and this country as they use this occasion to contribute to our citizens living healthier lives.


Prevention of Risk Factors (Nutrition, Physical Activity, Tobacco)

Tobacco Control Michigan's state employee tobacco cessation program meets all three of the

CDC guidelines that include:1) Coverage for at least four counseling sessions of at least 30 minutes; YES2) Access to smoking cessation agents, including prescriptions and nicotine replacement; YES 3) Counseling and medication coverage for at least two quit attempts annually; YES

Michigan also has a cigarette excise tax and quit line. The $2 Michigan cigarette excise tax is used to fund the tobacco control programs.

Michigan's state Medicaid tobacco cessation program covers over-the-counter and prescription products. A statewide public program is also available; coverage may vary from other programs.


Increase Early Detection and Treatment of Heart Disease and Stroke

No Policy listed at this time!!

References

Centers for Disease Control and Prevention (2010, December). Heart Disease Facts. Retrieved from http://www.cdc.gov/heartdisease/facts.htm


Maurer, F.A., Smith, C.M. (2009). Community/public health nursing practice: Health for families and populations. St. Louis, Missouri: Saunders Elsevier


http://www.cdc.gov/heartdisease/facts.htm




References

Michigan State Profile and Policy Report. (2011). Retrieved July 21, 2011, from National Conference of State Legislature: http://www.ncsl.org/default.aspx?tabid=17941

Sparks,S.& Taylor, C.(2008)Nursing Diagnosis Reference Manual (7TH Ed.) USA.Lippincott,Williams,&Wilkins.

Ignatavicius, D. D. & Workman, M. L. ((2006). Medical-

surgical nursing: critical thinking for collaborative care. (5th ed.). St. Louis, MO: Elsevier.

Ladwig, G. B. & Ackley, B. J. (2008). Mosby’s guide to nursing diagnosis. (2nd ed.). St. Louis, MO: Elsevier.

http://www.ncsl.org/default.aspx?tabid=17941

References

U.S. Census Bureau, 2005-2009 American Community Survey. Mecosta County Michigan. Retrieved from http://factfinder.census.gov/servlet/NPTable?_bm=y&-geo_id=05000US26107&-qr_name=ACS_2009_5YR_G00_NP01&-ds_name=&-redoLog=false


www.americanheart.org www.co.mecosta.mi.us www.mcmcbr.com






http://www.americanheart.org/

http://www.co.mecosta.mi.us/

http://www.mcmcbr.com/

Grade

ADPIE Group Presentation: 93 (out of 100)

Documents

By: Kristie Bruesch, Emily Gullena, Melanie Cybulski, and Brea Yang