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Community Health Nursing Tasks Community Health Nursing Tasks A. Selected Communicable Disease (Measles) Three studies regarding the outbreak of measles in certain areas are to be discussed. The three studies concurred that the outbreaks are caused by two interacting factors: the introduction of measles by unknowingly-infected patients into an area where measles are not endemic; and the presence of highly-susceptible people, which are the under-vaccinated or unvaccinated members of the population (Parker, et al., 2006, Sugerman, et al., 2010, and van den Hof, et al., 2001)…
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Community Health Nursing Tasks Community Health Nursing Tasks A. Selected Communicable Disease (Measles) Three studies regarding the outbreak of measles in certain areas are to be discussed. The three studies concurred that the outbreaks are caused by two interacting factors: the introduction of measles by unknowingly-infected patients into an area where measles are not endemic; and the presence of highly-susceptible people, which are the under-vaccinated or unvaccinated members of the population (Parker, et al., 2006, Sugerman, et al., 2010, and van den Hof, et al., 2001). The movement of populations from low-density to high-density also increased chances of introducing infections such as measles into high-density populations, causing even greater outbreaks due to the large probable numbers of susceptible people. The associated epidemiological indicators of measles were the same in all three studies, regardless of the different places where the outbreak occurred. The symptoms associated with the disease were: the presence of fever and rash; diarrhea and vomiting; complications such as pneumonia and encephalitis; and death if not treated promptly (Parker, et al., 2006, Sugerman, et al., 2010, and van den Hof, et al., 2001). Additional tests such as the detection of anti-measles immunoglobulin M (IgM) in the blood of the patients also confirmed the infection in patients that are under suspicion of carrying the virus. In all three studies, the rate of infection after being exposed to the measles virus ranged from 75% to 94%, with the high rates being attributed to the parents not letting the children receive any vaccinations (Sugerman, et al., 2010). Due to parents choosing not to have their children vaccinated out of fear of the possible adverse effects, this further increased the population’s susceptibility despite the governments’ efforts of providing vaccinations against the disease (Parker, et al., 2006). Also, the high-susceptibility of children below two years of age to measles despite vaccinations added to the high infection rates in the populations, apart from the low number of vaccine coverage (van den Hof, et al., 2001). The combined interaction of an unsuspecting infected person into a densely-populated area with considerable numbers of people without vaccine or any other form of resistance to measles was the reason for the outbreaks’ occurrences. The 1999-2000 measles outbreak in the Netherlands detected the D6 measles virus strain, the most common strain across Europe, and introduced by a patient asymptomatic to the disease. A year after the outbreak, along with proper vaccination and containment, no other outbreak happened again, which proved the theory of measles not being an endemic in The Netherlands (van den Hof, et al., 2001). Similarly in the cases of measles outbreak in San Diego and two unnamed counties in Indiana and Illinois, respectively, the measles virus was introduced when vacationers from Europe harbored the virus and incubated it long enough to introduce an outbreak where some members of the population did not have proper or complete vaccines against it (Parker, et al., 2006, and Sugerman, et al., 2010). Due to being unfamiliar with the symptoms of measles, it took a bit longer for those that got infected to seek professional help, and the disease was initially not contained properly, thus spreading the virus and causing the outbreak. A possible pattern of outbreak can be deduced using the recent data of the World Health Organization (WHO) in the spread of measles worldwide. It can be seen in the data surveillance that the places where measles are found to be endemic and have high rates are in the European Union, in East and Southeast Asia, as well as some parts of Africa (see figure 1). Figure 1. The spread of the measles virus from endemic places such as Europe to places where it is said to have been eradicated by vaccination (WHO, 2012). The blue circles indicate the places that the three studies indicated the measles virus got imported to, while the yellow arrows show the route of the virus. This shows how the spread from areas with high rates of measles infections move towards places with low rates of infection, in this case, from greater Europe to the Netherlands, San Diego, Illinois and Indiana. The outbreak of measles in my community could cause high rates of infection, clinic consultations, possible spread of panic if the situation gets alarming, as well as an increase in inpatient admissions. This could make the healing and containment process difficult because many patients must be put under observation or quarantine to prevent further spread of the disease. Also, if the health care facilities are not fully prepared with vaccines and drugs to address measles complications, it is expected that there would be high demands for these, and it would take the outbreak longer to subside. B. Appropriate Protocol for Reporting SARS Outbreak In the given situation of being a community nurse having to report a possible outbreak, before releasing any information to the general public, several tests must first be made by the local Disease Control Centers. This would include novel air sampling, surface swabbing, and virological testing via reverse-transcriptase PCR of samples from the places where the suspected carriers of SARS could have stayed (Booth et al., 2005). After confirmation of the entry of SARS into the community by the local Disease Control Centers and tallying how many people tested positive for the disease versus the number of that went to the healthcare facility for checkup and affirmation of the disease’s identity, the possibility of an outbreak may now be released to the public. Also, preventive measures for the further spread of SARS such as proper hygiene, vaccinations, early consultations to physicians upon suspecting of harboring the disease, as well as making air filtration much more efficient could help prevent a greater outbreak of SARS (Booth et al., 2005). C. Modification of Care for Asthmatic Patients In the given scenario where care for patients with lung problems must be modified due to the increase of air pollutants, the most susceptible members of the population must first be identified. It has been established that the most likely to suffer from exposure to highly-polluted air are the elderly, the infants, persons with cardiopulmonary disease, people that suffer pneumonia, influenza, asthma, as well as those who have been exposed to pollutants at the longest time (Pope, 2000). After identifying the populations with the high-susceptibility rates, their living conditions would be put into consideration. These patients would be identified based on the results of radiological and laboratory tests. Those with decreased lung function, increased occurrences of lower respiratory symptoms such as asthma, and increase in records of outpatient and inpatient visits would be considered as candidates for the highly-susceptible members of the populace needing modification of care (Pope, 2000). Patients outside the hospital living in places with large quantities of air particulates such as highly-urbanized areas must be given other aids such as facial masks aside from the usual medications, in the case that the suggestion of relocation to a place with lower rates of air pollution is not feasible for them. For inpatient settings, administering non-invasive ventilation aside from medication and providing these regularly, as well as keeping them in rooms with air filters could help in alleviating the onset of asthma or other breathing difficulties, as well as supplying additional oxygen. Lastly, assessment of the conditions of the patients would be done in order to check whether the modified care improved their conditions or not. If there is no improvement, care conditions would be changed and patient conditions re-assessed for improvement. References Booth, T., Kournikakis, B., Bastien, N., Ho, J., Kobasa, D., Stadnyk, L., . . . Plummer, F. (2005). Detection of airborne severe acute respiratory sydrome (SARS) coronavirus and environmental contamination in sars outbreak units. The Journal of Infectious Diseases, 191(9): 1472-1477. de Hof, S., Meffre, C., Conyn-van Spaendonck, M., Woonink, F., de Melker, H., & van Binnendijk, R. (2001). Measles outbreak in a community with very low vaccine coverage, the Netherlands. Emerging Infectious Diseases, 7(3): 594-598. Parker, A., Staggs, W., Dayan, G., Ortega-Sanchez, I., Rota, P., Lowe, L., . . . LeBaron, C. (2006). Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the united states. Journal of Medicine, 355(5): 447-455. Pope, C. I. (2000). Epidemiology of fine particulate air pollution and human health: biologic mechanisms and who's at risk? Environmental Health Perspectives, 108(4):713-723. Sugerman, D., Barskey, A., Delea, M., Ortega-Sanchez, I., D., B., Ralston, K., . . . LeBaron, C. (2010). Measles outbreak in a highly-vaccinated population, San Diego, 2008: role of the intentionally undervaccinated. Pediatrics, 125(4): 747-755. World Health Organization, WHO. (2012, October 25). Measles Surveillance Data. Retrieved from WHO - Immunization, Surveillance, Assessment and Monitoring Web site: Read More
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