1. Running head: CAPSTONE PAPER 1Capstone PaperNiccole CouseUniversity of South Florida
2. CAPSTONE PAPER 2Capstone PaperThe land that would become known as Pinellas County was first discovered in 1528. The namePinellas is derived from the Spanish language meaning “Port of Pines” which describes the area back in1528. Pinellas became its own county in 1912.(Pinellas County Florida, 2012)Pinellas County is a 280square mile peninsula, surrounded by the Gulf of Mexico and the Tampa Bay with 588 miles of coastlineand 35 miles of beaches. (Pinellas County Florida, 2012) When Pinellas county was founded in 1912 thepopulation was only 13,193 (Pinellas County Florida, 2012) compared to the2010 population at 916,542(U.S. Census Bureau, 2012).Pinellas County’s annual population record shows that Pinellas County is themost densely populated county in the state of Florida. (Pinellas County Florida) In 2010, the censuslisted 3,327.5 people per square mile. (U.S. Census Bureau, 2012)Pinellas County is a destination for many tourists and retired persons. Its top businesses areinhealth, tourism, manufacturing and financial services.(Pinellas County Florida, 2012) In 2009 the topemployer in the county is the Pinellas County School District, employing 13,905 people. The secondhighest employer is the Home Shopping Network, employing 4,000 people. Also, the Pinellas CountyGovernment, employing 4,000 people, ties for second place. The highest ranking health care employer,at number nine, is Morton Plant Hospital with 2,448 employees. (Pinellas County – Largest Employers,2009)According to the 2010 census, the Florida state average percent of people living under thepoverty level is 13.8%. Pinellas County comes in just under that at 12.1% with an average householdincome of about $45,000.(U.S. Census Bureau, 2012) Another area where Pinellas County is succeedingis in education. While the Florida state percentage of high school graduates is 85.3%, Pinellas County isat 88.1%. (U.S. Census Bureau, 2012) Also, the percentage of people in Pinellas County with aneducation level of a bachelor’s degree or higher is 27.1%, putting Pinellas County higher than the
3. CAPSTONE PAPER 3Floridastate average of 25.9% The percentage of children in Pinellas County under five years old that donot speak English is 12.8%, way less than the Florida state average of 26.6%. (U.S. Census Bureau, 2012)Overview of Healthy People 2020Healthy People 2020 is an organization managed by the U.S. Department of Health and HumanServices that sets health goals for the nation to be reached in the next ten years. (U.S. Department ofHealth and Human Services, 2012) The organization gathers information from many sources andcompiles a plan to reach a targeted improvement in health status. A list of goals is created by amultitude of federal agencies. This list is then sent to the Federal Interagency Workgroup where finaldecisions are made and the new decade objectives are set.New broad topic areas emerge in everydecade objective set. The new topic areas for 2020 are adolescent health, blood disorders and safety,dementia, early and middle childhood, genomics, global health, healthcare associated infections andquality of life, health among all sexual orientations, older adults, preparedness, sleep health, and socialdeterminants of health. (U.S. Department of Health and Human Services, 2012) Along with objectives,Healthy People also creates a narrower list of the 12 leading health indicators. These are the highestpriority issues. The leading health indicators for 2020 are access to healthcare, preventative services,environmental quality, injury and violence, maternal/child health, mental health, nutritional health, oralhealth, reproductive and sexual health, social determinants, substance abuse, and tobacco. (U.S.Department of Health and Human Services, 2012) All of these areas will be measured to ensure progressin promoting health, preventing disease and disability, eliminating health disparities across thepopulation, and improving the quality of life. Along with setting objectives and goals for the nation,Healthy People also provides tools to help people reach the goals. They have a framework called MAP-ITthat sets out a course of action for individuals and communities to follow to help attain the health goals.(U.S. Department of Health and Human Services, 2012)
4. CAPSTONE PAPER 4County Strengths and WeaknessesReferencing the leading health indicators from Healthy People 2020, Pinellas County is doingabove average in a few areas. One are is access to health care. While only 69.7% of Florida adults had amedical checkup this past year, 78.8% of Pinellas county adults have had a medical checkup this pastyear. Correlating with this is that only 7.5% of Pinellas County residents believe their healthcare isaffected by their race, while 10.8% of Florida residents believe the same thing. (Cohen, Ren, & Huang,2010) This percentage disparity indicates that more residents of Pinellas County believe they arereceiving equal care than the average Floridian. Another area of strength is in preventative vaccines. InPinellas County 40.2% of adults received a flu shot this year. That is much higher than the statepercentage of 36.5%.(Cohen, Ren, & Huang, 2010) Due to the large elderly population in Florida, it isgood that these vaccines are being given because the elderly are at a higher risk for contracting the Flu.A final strength in Pinellas County is oral health. Almost eighty percent of adult Pinellas Countyresidents visited the dentist this past year and 65.9% received a cleaning. AtFlorida’s state level, only64.7% of adult Florida residents visited the dentist and only 60.9% received a cleaning. (Cohen, Ren, &Huang, 2010)PinellasCounty does well in some areas, but also does poorly in others. One area of concern isnutritional health. In Pinellas county 41.6% of adults are overweight. In contrast, only 37.8% of adults inthe state of Florida are overweight. (Cohen, Ren, & Huang, 2010) Being overweight can lead to amultitude of health issues. Another area that performs poorly is cholesterol awareness. In Pinellascounty 47.9% of adults have high cholesterol. The state of Florida has a much lower percentage of adultswith high cholesterol at 38.6%. High cholesterol puts people at risk for heart attacks and strokes. A finalarea of concern is in cardiovascular diseases. Approximately 4.4% of Pinellas County adults have had astroke, whereas only 3.5% of all Florida adults have had a stroke. Also in this category, 11.8% of Pinellas
5. CAPSTONE PAPER 5County adults have experienced a heart attack, angina, or coronary disease. This is higher than the stateof Florida’s percentage of 10.2%. (Cohen, Ren, & Huang, 2010) Hypertension rates are also higher inPinellas County at 36.6%, with the state of Florida coming in at 34.3%. (Cohen, Ren, & Huang, 2010)Due to Pinellas County having a higher percentage than the state of Florida in areas such as highcholesterol, overweight, previous strokes or heart attacks, the focus of this paper will be oncerebrovascular and cardiovascular emboli. (Cohen, Ren, & Huang, 2010) High cholesterol levels andobesity can contribute to the formation of these emboli and strokes and heart attacks can be caused bythese emboli. (Warkentin & Carter, 2010)Cerebrovascular and cardiovascular emboli can be apreventable condition that could lead to braid damage, paralysis, cardiac cell necrosis or death. There isno reason why these emboli cannot be prevented. The high percentage of high cholesterol andoverweight people may contribute to the higher incidence of strokes and heart attacks in PinellasCounty.Determinants of Health ModelMany models are used to help a community health nurse make appropriate diagnoses,interventions, and prevention measures. One community health model is the Determinants of healthModel. This model incorporates factors beyond the individual that lead to health status. The modelintegrates factors such as human biology, health system, environment and lifestyle. It takes blame off ofthe individual and allows for other causes of disease to be explored. (Clark, 2008)Atherosclerosis is the precursor to emboli formation. Plaque builds up in the vessel and canbreak off and lodge itself in a smaller vessel creating ischemia and cell death. According to an article byDegnan and Gillard, 2012, Atherosclerosis has an ebb and flow quality. Plaque is deposited and thenbroken down. The article states that all people go through the buildup and break down of plaque in thevessels, but not everyone experiences symptoms, such as emboli formation. He illustrates that it is likelythat“individuals who experience symptoms lack reparative mechanisms.” (Degnan & Gillard, 2012, p.
6. CAPSTONE PAPER 61)For some biological reason some people with atherosclerosis are unable to break down the plaqueformations putting them at higher risk for emboli formation.Several environmental factors can contribute to plaque breaking away from a vessel. One studystates that the risk for forming emboli fluctuates during certain activities. (Putting heart attack, stroketriggers in perspective, 2011) These activities that can heighten the risk of emboli formation are calledtriggers, or “a physical or emotional jolt that sparks a sudden change in the cardiovascular system.”(Putting heart attack, stroke triggers in perspective, 2011, p. 2) Such triggers are physical activity, anger,stress, air pollution, heavy meals, caffeine and cocaine use. (Putting heart attack, stroke triggers inperspective, 2011)Lifestyle risk factors include diet high in fat and cholesterol, sedentary lifestyle, obesity, andcigarette smoking, and diabetes. (Warkentin & Carter, 2010) While some risk factors cannot be changed,such as family history, others can. Making dietary changes, quitting smoking and exercising can greatlyreduce chances of a stroke or heart attack. Also by visiting the doctor regularly and having onescholesterol levels checked frequently can help prevent attacks. (Warkentin & Carter, 2010)Lifestylesshould be adjusted if a person is shown to be at risk for atherosclerosis, but is also a healthy change forall.Population DiagnosisPinellas County adults at risk for cerebrovascular andcardiovascular embolirelated to poor dietand lack of exercise as evidenced by 47.9% of adults with high cholesterol, 41.6% of adults that areoverweight, 4.4% of adults that have had a stroke, and 11.8% of adults that have had a heart attack orangina.(U.S. Census Bureau, 2012)Intervention WheelThe intervention wheel was created by the Minnesota Department of Health. The wheel lists 17different interventions that are broken down into levels of intervention such as individual/family,
7. CAPSTONE PAPER 7community and system levels. It is a tool intended to help public health nurses develop appropriateinterventions at multiple levels. (Clark, 2008) The wheel would aid in identifying specific and relevantinterventions for the goal of decreasing the stroke rate in Pinellas County.Levels of PreventionThere are three levels of prevention. Primary prevention seeks to keep a disease process fromoccurring. Education and vaccinations are examples of primary prevention. Secondary prevention isaimed at identifying the disease process early on and beginning treatment. Screenings, treatment,medications and lifestyle changes are examples of secondary prevention. Tertiary prevention consists ofrehabilitation and education. The goal of tertiary prevention is to prevent relapse. (Clark, 2008)Primary PreventionThe precursor to heart attacks and strokes is often atherosclerosis. ( McGill, McMahan &Gidding, 2009) Atherosclerosis is commonly progressive and can start at a very young age. In order toget ahead of the disease progression, primary prevention should be instituted in schools. Thisprevention method would need to be system-wide. School boards and school nurses would bestakeholders in this program. Children need to be educated on proper diet and exercise regimens. Theschool board can pass regulations that ensure meals served in the cafeteria are healthy and reform canbe made to the physical education program to promote more exercise. School nurses can aid ineducation and monitoring of effectiveness. An article by McGill, McMahan and Gidding, 2009, suggestthat primary prevention should begin in childhood. They suggest that Pediatricians should be monitoringthe child’s diet, exercise and present risk factors.The article by McGill, McMahan, and Gidding, 2009,also states that The American Academy of Pediatrics has issued recommendations for exercise toprevent obesity and the complications it causes, such as recommending monitoring and treatment fordyslipidemia and lowering the age that toddlers can switch from whole milk to low fat milk. Milk cannow be switched at one year instead of two.( McGill, McMahan & Gidding, 2009) “Ultimately, however,
8. CAPSTONE PAPER 8effective prevention of adult disease requires a massive cultural change.” ( McGill, McMahan & Gidding,2009, p. 4)Secondary PreventionSecondary prevention would be aimed at the individual. Screening is a type of secondaryprevention that can be noninvasive and very helpful to identifying presence or progression of a disease.It is suggested that every adult 20 years of age and older receive a full lipid panel. (Glassberg & Rader,2008) Medications are another form of secondary prevention. Lipid modifying drugs such as statins areused to lower low-density lipoproteins which can lead to atherosclerosis, stroke, and heart attack.(Glassberg & Rader, 2008) People with low level or intermediate risk should keep their LDL levels below100 mg/dl and those diagnosed with atherosclerosis should have LDL levels below 70 mg/dl. (Glassberg& Rader, 2008)Tertiary PreventionTertiaryprevention would also be aimed at the individual. It would be the individual’sresponsibility to adhere to the medications to prevent another cardiovascular incident. For so long,Aspirin has been the main medication used in tertiary prevention of heart attacks and strokes. ( Wald &Wald, 2009) There is a new pill on the market called the Polypill. ( Wald & Wald, 2009) It is designed totarget and reduce multiple risk factors. It “has the potential to reduce the incidence of heart attacks andstroke by about 80%.”( Wald & Wald, 2009, p. 1) Tertiary prevention would also come back full circle toprimary prevention and diet and exercise recommendations should be made. The community healthnurse could help evaluate adherence to medications and assist in forming healthy lifestyle changes.ConclusionThe intervention with the most potential for change would be the primary prevention proposal.To truly fix the problem, it needs to never happen. If more people understood the impact of diet andexercise on their health, maybe statistics would change. Diet and exercise does more than make one
9. CAPSTONE PAPER 9look good on the outside; it keeps the inside functioning properly. School systems need to reform themeals served to ensure maximum nutrition. Vending machines should be banned from campuses toremove the temptation to snack on bad foods. Physical education should be a bigger part of thecurriculum and benefits of diet and exercise should be taught. Also, the community of parents andteachers need to be educated on the disease process and how to prevent it. If these changes are made,the Pinellas county statistics for stroke, heart attack, and cardiovascular disease should drop.
10. CAPSTONE PAPER 10ReferencesClark, M.J. (2008). Community health nursing: Advocating for population health. (5thed.)Upper SaddleRiver, NJ: Pearson Prentice Hall.Degnan, A.J., &Gillard, J.H. (2012) Improving atherosclerosis risk assessment: Looking beyond plaqueaccumulation to imaging of embolization and healing.Future Neurology, Vol 7(1). Retrieved fromhttp://metalib.fcla.edu.ezproxy.lib.usf.edu/V/8U3F911NGV5J8CPE3GVN64LT82H6QM1BRA92DMDERD7JLQFR51-08488?func=meta-3&short-format=002&set_number=000731&set_entry=000002&format=999Glassberg, H. & Rader, D.J. (2008) Management of Lipids in the Prevention of Cardiovascular Events.Annual Review of Medicine, 59(1). Doi 10.1146/annurev.med.59.121206.112237. Retrieved fromhttp://www.annualreviews.org.ezproxy.lib.usf.edu/doi/full/10.1146/annurev.med.59.121206.112237McGill, H.C., McMahan, A.C., & Gidding, S.S. (2009) Are pediatricians responsible for prevention of adultcardiovascular disease?Nature Clinical Practice Cardiovascular Medicine, vol. 6(1) Retrievedfromhttp://go.galegroup.com.ezproxy.lib.usf.edu/ps/retrieve.do?sgHitCountType=None&sort=DA-SORT&inPS=true&prodId=HRCA&userGroupName=tamp44898&tabID=T002&searchId=R1&resultListType=RESULT_LIST&contentSegment=&searchType=AdvancedSearchForm&currentPosition=1&contentSet=GALE%7CA191351086&&docId=GALE|A191351086&docType=GALE&role=Pinellas County Florida (2012). Retrieved from http://www.pinellascounty.org/default.htmPinellas County – Largest Employers. (2009)Suncoast Jobs. Retrieved fromhttp://suncoastemployers.com/#pinellas
11. CAPSTONE PAPER 11Putting heart attack, stroke triggers in perspective. (2011)Harvard Heart Letter. Retrieved fromhttp://harvardpartnersinternational.staywellsolutionsonline.com/HealthNewsLetters/69,H1211cU.S. Census Bureau: State and County QuickFacts. (2012). Retrieved fromhttp://ehis.ebscohost.com.ezproxy.lib.usf.edu/ehost/pdfviewer/pdfviewer?sid=f7a33b55-c875-48bf-80ba-8a205fdaa125%40sessionmgr104&vid=1&hid=102http://quickfacts.census.gov/qfd/states/12/12103.htmlU.S. Department of Health and Human Services. (2012) Healthy People 2020. HealthyPeople.gov.Retrieved from http://www.healthypeople.gov/2020/default.aspxWald, D.S., & Wald, N.J. (2009) The polypill in the primary prevention of cardiovascular disease.Fundamental and Clinical Pharmacology. Retrieved fromhttp://onlinelibrary.wiley.com.ezproxy.lib.usf.edu/doi/10.1111/j.1472-8206.2009.00795.x/fullWarkentin, D.L., & Carter, A. (2010) Atherosclerosis: Adult Health Advisor. Clinical Reference Systems,vol. 2010(1). Retrieved fromhttp://metalib.fcla.edu.ezproxy.lib.usf.edu/V/XQPCJ93S5TU8E8YURXYPE12C913BXMM8DNI26RXINBUBF91F1G-02946?func=meta-3&short-format=002&set_number=004005&set_entry=000002&format=999Yu, B., Cohen, K., Ren, C., & Huang, Y. (2010)2010 Florida Behavioral Risk Factor Surveillance System(BRFSS) Data Report. Retrieved fromhttp://www.doh.state.fl.us/Disease_ctrl/epi/BRFSS_Reports/2010/Pinellas.pdf