Health Promotion Project Case Study Analysis
The case presented is that of a twenty-eight-year-old lady who gave birth four months ago and has another child aged four years. She is requesting for healthcare by calling since none of her family members has had access to care since they arrived. The presenting complaints of the baby are irritability and cold for several days. Additionally, the mother has had a positive purified protein (PPD) test. She is also interested in how to apply for family insurance as she does not live with the husband. This case presents critical topics for consideration regarding health care in the US.
Questions for Discussion
1. What is the relationship between low-income households and Tuberculosis infections?
2. What factors affect coverage of immunization among children in the US?
3. What is the role of Family Nursing Practitioners in primary prevention of illnesses?
Purified Protein Derivative Test
It refers to an extract from the Mycobacterium tuberculosis used to test if someone has been exposed to the Tuberculosis antigen either through an infection or a vaccine. The substance is injected under the skin where it forms a pale lump to establish if the body has antibodies against the tuberculosis antigen (Yang, Kruh-Garcia, & Dobos, 2012). The doctor then examines the area in forty-eight to seventy-two hours to check for an immune reaction. A strong reaction may either indicate a current infection, previous environmental exposure, or TB vaccine. Therefore, the family nurse practitioner is required to get more information as to whether the patient has had contact with a TB patient or any visit to an area with a high prevalence of the disease. This test is also known as a mantoux test. In the case presented, the woman admits to have had a positive PPD but believes she is okay. Given that she doesn’t have any documentation for immunization, it is not clear if she is infected by TB. The woman has several predisposition factors for TB infection. For instance, the fact that she is from a low-income household and has not received health care since she arrived puts her at risk of the illness. According to a report by the World Health Organization, the incidence of the disease is directly related to the per-capita GDP (Oxlade & Murray, 2012). Some of the risk factors for TB include HIV/AIDS infection, substance abuse, homelessness, and lack access to health care. Most of these factors overlap among the poor people. For instance, the patient presented comes from a poor household. She doesn’t live with the husband yet she does not work. There is a possibility that they have inadequate housing in which they may be in close contact with other TB patients. The FNP, in this case, should establish the kind of environment and housing of this patient and advise her accordingly
The study and practice of health promotion and disease prevention at the population level
Immunization Coverage in the US
Immunization among children has been lauded as one of the most effective strategies for primary prevention of illnesses. It is for this reason that the CDC and ACIP come up with annual guidelines and recommendations for immunization among children. In the case presented, the patient indicates the whole family has had immunization at home but does not have any documentation for the same. Given that one of her sons is already four years, it raises the question if immunization for all has been accomplished in the US. It is likely that the family has not received all the required vaccines given that there are no documentations of proof.
Vaccination has significantly reduced the incidence and mortality of several infectious diseases due to the government strategies targeting children and infants. According to Ventola (2016), in addition to protecting the immunized children from a disease, vaccination also promotes herd immunity in that particular population. Therefore, it is estimated that whenever a birth cohort receives immunization, over twenty million diseases and forty thousand deaths are prevented, which saves the country over seventy billion dollars (Ventola, 2016). According to the current recommendations, children should receive ten vaccines between birth and ten years. In the case of Roselinda, her four-year-old son should have already received several of them and have it documented. Some of these vaccines include those against Hepatitis A and B, Tetanus, Diphtheria, Polio, Influenza, Measles, Mumps, and Rubella. It is our role as nurses to offer education on their importance and ensure they are administered.
Despite that the patient in our case might be having unimmunized children, coverage in the US has remained high at over ninety percent for most of them (Ventola, 2016). Some of the reasons given for non-compliance include concern about the side effects of the vaccine, protesting a huge number of injections on the child, religious and cultural grounds, and lack of access due to cost. The fear of side effects has been instigated by the media reports about cases disability or autism after vaccinations. Ventola (2016) indicates that such instances may happen in extremely rare cases depending on the body's response to the drug but should never be a worry.
Health promotion research articles
Childhood Overweight and Obesity
Obesity among children and women has been documented as a healthy crisis in the US. In the case presented, the lady, as well as the child appeared overweight. Some of the risk factors associated with obesity include the environment, genetics, and behavioral tendencies (Karnik & Kanekar, 2010). Given that the mother is also overweight, there is a probability that the illness is heritable. However, other factors such as the eating habits and physical activity would determine if the child becomes obese. Therefore, it is the role of health workers to enforce interventional strategies that prevent children from becoming obese. Currently, the government of the US in conjunction with the community is engaging in campaigns aimed at creating awareness about the illness.
Roles of a Family Nurse Practitioner Regarding the Case
The reducing number of primary care physicians and the need to lead a healthy life is driving many citizens to seek the services of an FNP. These nurses have a critical role to conduct tests, treat patients, and offer health education from childhood to adulthood. In the case presented, most of the patient’s issues are solvable by a nurse practitioner. The fact that she has had a positive history of PPD calls for further TB screening by the FNP to establish the risk of developing further complications. Additionally, the family nurse is responsible for health education on how to prevent infections in their households and neighborhood. Given the interrelationship established between poverty and Tuberculosis infections, it calls for more robust preventions strategies and health education. According to dfdd, the most critical intervention for primary prevention among such communities include the BCG vaccine given to children. Based on the assertion by the woman in this case that she is not sure of the vaccines received by her children, the FNP is mandated to establish missed injections and administer appropriately. Additionally, preventive measures in the community include free air circulation and avoidance of congested area. Nurses in the family practice are mandated to conduct home visits to offer education among families on how to prevent transmission of the illness.
Another issue of concern in this case that would require the intervention of an FNP for primary prevention is the fact that this woman did not have any documentation for immunization done to her baby. Studies have also shown that these nurses and other primary care providers have a role to play in the poor intake of vaccines (Edelman, Mandle, & Kudzma, 2013). The most important factor is health education to persuade parents to have their children vaccinated. It is their role to dispel the perception that vaccines may cause disability or other health complications. Based on the role of this practice in the primary prevention of infectious diseases, they should use strategies such as maximizing patients' visits, combining vaccines to a single injection, and use of EMR for efficient documentation.
The value of family practice among nurses is based on the premises of collaborative care the effect of the family environment on one’s health (Edelman et al., 2013). While these nurses are not a replacement for physician, they offer quality care to patients at affordable rates. In a case as the one presented, the woman is from a household that is financially unstable for she was neither working nor having any support from the husband. It is for this reason that she wanted to get a family insurance. Therefore, these Nurse Practitioners have a running referral system for cases beyond their reach. For instance in this case, if the symptoms of the new born baby would persist, it may be sent for a specialist review while in hospital admission.
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