Nursing Capstone Paper

Nursing Capstone Paper

Nursing Capstone Paper

The land that would become known as Pinellas County was first discovered in 1528. The name Pinellas is derived from the Spanish language meaning “Port of Pines” which describes the area back in 1528. Pinellas became its own county in 1912. (Pinellas County Florida, 2012) Pinellas County is a 280 square mile peninsula, surrounded by the Gulf of Mexico and the Tampa Bay with 588 miles of coastline and 35 miles of beaches.  (Pinellas County Florida, 2012) When Pinellas county was founded in 1912 the population was only 13,193 (Pinellas County Florida, 2012) compared to the 2010 population at 916,542 (U.S. Census Bureau, 2012). Pinellas County’s annual population record shows that Pinellas County is the most densely populated county in the state of Florida. (Pinellas County Florida)   In 2010, the census listed 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 are in health, tourism, manufacturing and financial services.  (Pinellas County Florida, 2012) In 2009 the top employer in the county is the Pinellas County School District, employing 13,905 people.  The second highest employer is the Home Shopping Network, employing 4,000 people. Also, the Pinellas County Government, 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 the poverty level is 13.8%. Pinellas County comes in just under that at 12.1% with an average household income of about $45,000. (U.S. Census Bureau, 2012) Another area where Pinellas County is succeeding is in education. While the Florida state percentage of high school graduates is 85.3%, Pinellas County is at 88.1%. (U.S. Census Bureau, 2012) Also, the percentage of people in Pinellas County with an education level of a bachelor’s degree or higher is 27.1%, putting Pinellas County higher than the Florida state average of 25.9% The percentage of children in Pinellas County under five years old that do not speak English is 12.8%, way less than the Florida state average of 26.6%. (U.S. Census Bureau, 2012)

Nursing capstone paper example

Overview of Healthy People 2020

Healthy People 2020 is an organization managed by the U.S. Department of Health and Human Services that sets health goals for the nation to be reached in the next ten years.  (U.S. Department of Health and Human Services, 2012) The organization gathers information from many sources and compiles a plan to reach a targeted improvement in health status. A list of goals is created by a multitude of federal agencies. This list is then sent to the Federal Interagency Workgroup where final decisions are made and the new decade objectives are set. New broad topic areas emerge in every decade 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 and quality of life, health among all sexual orientations, older adults, preparedness, sleep health, and social determinants 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 highest priority 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, oral health, 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 progress in promoting health, preventing disease and disability, eliminating health disparities across the population, 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-IT that 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)

County Strengths and Weaknesses

Referencing the leading health indicators from Healthy People 2020, Pinellas County is doing above average in a few areas. One are is access to health care. While only 69.7% of Florida adults had a medical checkup this past year, 78.8% of Pinellas county adults have had a medical checkup this past year.  Correlating with this is that only 7.5% of Pinellas County residents believe their healthcare is affected 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 are receiving equal care than the average Floridian.  Another area of strength is in preventative vaccines.    In Pinellas County 40.2% of adults received a flu shot this year. That is much higher than the state percentage of 36.5%. (Cohen, Ren, & Huang, 2010) Due to the large elderly population in Florida, it is good 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 County residents visited the dentist this past year and 65.9% received a cleaning. At Florida’s state level, only 64.7% of adult Florida residents visited the dentist and only 60.9% received a cleaning. (Cohen, Ren, & Huang, 2010)

Pinellas County does well in some areas, but also does poorly in others.  One area of concern is nutritional health. In Pinellas county 41.6% of adults are overweight. In contrast, only 37.8% of adults in the state of Florida are overweight. (Cohen, Ren, & Huang, 2010) Being overweight can lead to a multitude of health issues.  Another area that performs poorly is cholesterol awareness. In Pinellas county 47.9% of adults have high cholesterol. The state of Florida has a much lower percentage of adults with high cholesterol at 38.6%. High cholesterol puts people at risk for heart attacks and strokes. A final area of concern is in cardiovascular diseases.  Approximately  4.4% of Pinellas County adults have had a stroke, whereas only 3.5% of all Florida adults have had a stroke. Also in this category, 11.8% of Pinellas County adults have experienced a heart attack, angina, or coronary disease. This is higher than the state of Florida’s percentage of 10.2%. (Cohen, Ren, & Huang, 2010) Hypertension rates are also higher in Pinellas 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 high cholesterol, overweight, previous strokes or heart attacks, the focus of this paper will be on cerebrovascular and cardiovascular emboli. (Cohen, Ren, & Huang, 2010) High cholesterol levels and obesity can contribute to the formation of these emboli and strokes and heart attacks can be caused by these emboli. (Warkentin & Carter, 2010) Cerebrovascular and cardiovascular emboli can be a preventable condition that could lead to braid damage, paralysis, cardiac cell necrosis or death. There is no reason why these emboli cannot be prevented.  The high percentage of high cholesterol and overweight people may contribute to the higher incidence of strokes and heart attacks in Pinellas County.

Determinants of Health Model

                Many models are used to help a community health nurse make appropriate diagnoses, interventions, and prevention measures. One community health model is the Determinants of health Model.  This model incorporates factors beyond the individual that lead to health status. The model integrates factors such as human biology, health system, environment and lifestyle. It takes blame off of the 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 can break off and lodge itself in a smaller vessel creating ischemia and cell death. According to an article by Degnan and Gillard, 2012, Atherosclerosis has an ebb and flow quality. Plaque is deposited and then broken down. The article states that all people go through the buildup and break down of plaque in the vessels, but not everyone experiences symptoms, such as emboli formation. He illustrates that it is likely that “individuals who experience symptoms lack reparative mechanisms.” (Degnan & Gillard, 2012, p. 1) For some biological reason some people with atherosclerosis are unable to break down the plaque formations putting them at higher risk for emboli formation.

Several environmental factors can contribute to plaque breaking away from a vessel.  One study states that the risk for forming emboli fluctuates during certain activities. (Putting heart attack, stroke triggers in perspective, 2011) These activities that can heighten the risk of emboli formation are called triggers, 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 in perspective, 2011)

Lifestyle risk factors include diet high in fat and cholesterol, sedentary lifestyle, obesity, and cigarette 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 greatly reduce chances of a stroke or heart attack. Also by visiting the doctor regularly and having ones cholesterol levels checked frequently can help prevent attacks. (Warkentin & Carter, 2010) Lifestyles should be adjusted if a person is shown to be at risk for atherosclerosis, but is also a healthy change for all.

Population Diagnosis

                Pinellas County adults at risk for cerebrovascular and cardiovascular emboli related to poor diet and lack of exercise as evidenced by 47.9% of adults with high cholesterol, 41.6% of adults that are overweight, 4.4% of adults that have had a stroke, and 11.8% of adults that have had a heart attack or angina. (U.S. Census Bureau, 2012)

Intervention Wheel

                The intervention wheel was created by the Minnesota Department of Health. The wheel lists 17 different interventions that are broken down into levels of intervention such as individual/family, community and system levels.  It is a tool intended to help public health nurses develop appropriate interventions at multiple levels.  (Clark, 2008) The wheel would aid in identifying specific and relevant interventions for the goal of decreasing the stroke rate in Pinellas County.

Levels of Prevention

                There are three levels of prevention. Primary prevention seeks to keep a disease process from occurring. Education and vaccinations are examples of primary prevention. Secondary prevention is aimed at identifying the disease process early on and beginning treatment. Screenings, treatment, medications and lifestyle changes are examples of secondary prevention. Tertiary prevention consists of rehabilitation and education. The goal of tertiary prevention is to prevent relapse. (Clark, 2008)

Primary Prevention

                The 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 to get ahead of the disease progression, primary prevention should be instituted in schools.  This prevention method would need to be system-wide. School boards and school nurses would be stakeholders in this program. Children need to be educated on proper diet and exercise regimens.  The school board can pass regulations that ensure meals served in the cafeteria are healthy and reform can be made to the physical education program to promote more exercise. School nurses can aid in education and monitoring of effectiveness.  An article by McGill, McMahan and Gidding, 2009, suggest that primary prevention should begin in childhood. They suggest that Pediatricians should be monitoring the 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 to prevent obesity and the complications it causes, such as recommending monitoring and treatment for dyslipidemia and lowering the age that toddlers can switch from whole milk to low fat milk. Milk can now be switched at one year instead of two. ( McGill, McMahan & Gidding, 2009) “Ultimately, however, effective prevention of adult disease requires a massive cultural change.” ( McGill, McMahan & Gidding, 2009, p. 4)

Secondary Prevention

Secondary prevention would be aimed at the individual. Screening is a type of secondary prevention 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 are used 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 below 100 mg/dl and those diagnosed with atherosclerosis should have LDL levels below 70 mg/dl. (Glassberg & Rader, 2008)

Tertiary Prevention

                Tertiary prevention would also be aimed at the individual. It would be the individual’s responsibility 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 to target and reduce multiple risk factors. It “has the potential to reduce the incidence of heart attacks and stroke by about 80%.” ( Wald & Wald, 2009, p. 1) Tertiary prevention would also come back full circle to primary prevention and diet and exercise recommendations should be made. The community health nurse could help evaluate adherence to medications and assist in forming healthy lifestyle changes.


The 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 and exercise on their health, maybe statistics would change.  Diet and exercise does more than make one look good on the outside; it keeps the inside functioning properly.  School systems need to reform the meals served to ensure maximum nutrition. Vending machines should be banned from campuses to remove the temptation to snack on bad foods. Physical education should be a bigger part of the curriculum and benefits of diet and exercise should be taught. Also, the community of parents and teachers 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.

Nursing Capstone Paper

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