Non Communicable Diseases

Abeer Fayez Qato

• Seminar Objectives Non communicable Diseases

(NCDs)- Introduction - Definition- Types of (NCDs)- How to Prevent - 1- Primary- 2- Secondary- 3- Tertiary- Summary

- conclusion- The Role of community Health nurse

in Prevention and treatment - Evidence Based Article.

Outline:

- Identify the definition of Non communicableDiseases (NCDs).

- Identify Types of Non-Communicable diseases.

- Identify the role of community nurse in primary, secondary and tertiary prevention.

By the end of this Seminar, the students will be able to :

Objective

Non communicable Diseases (NCDs)

Also known as chronic diseases, are not passed from person to person. They are of long duration and generally slow progression. They are non-contagious diseases usually associated with lifestyle. They are, therefore, largely preventable.

Who is at risk to such disease:

NCDs are often associated with older age groups90% occurred in low- and middle-income countries.Children, adults and the elderly are all vulnerable to the risk factors that contribute to non communicable diseases, whether from unhealthy diets, physical inactivity, exposure to tobacco smoke or the effects of the harmful use of alcohol.

Statistics around the world • Tobacco accounts for almost 6 million

deaths every year (including over 600 000 deaths from exposure to second-hand smoke). • About 3.2 million deaths annually can be attributed to insufficient physical activity.• Approximately 1.7 million deaths are attributable to low fruit and vegetable consumption.• Half of the 2.3 million annual deaths from harmful drinking are from NCDs.

Types of Non-Communicable diseases

Main types of (NCDs) are:

1.cardiovascular diseases (like heart attacks and stroke)

2. Hypertension

3.cancers

4.chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma)

.

Types of Non-Communicable diseases

Main types of (NCDs) are:

5.diabetes

6. Hyper lipid

7. Obesity

8. Smoking

Cardiovascular Disease

- Stroke

- Heart failure

Stroke

Stroke

Definition:sometimes referred to as a cerebrovascular accident (CVA), is the

rapid loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage.[1] As a result, the affected area of the brain cannot function, which might result in an inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field

Prevention

Because stroke may indicate underlying atherosclerosis, it is important to determine the patient's risk for other cardiovascular diseases such as coronary heart disease. Conversely, aspirin confers some protection against first stroke in people who have had a myocardial infarction or those with a high cardiovascular risk In those who have previously had a stroke, treatment with medications such as aspirin, clopidogrel and dipyridamole may be given to prevent platelets from aggregating.

Risk Factors

- The most important modifiable risk factors for stroke are high blood pressure and atrial fibrillation. Other modifiable risk factors include high blood cholesterol levels, diabetes, cigarette smoking (active and passive), heavy alcohol consumption and drug use, lack of physical activity, obesity, processed red meat consumption and unhealthy diet.

Heart Failure

Often called congestive heart failure (CHF) or congestive cardiac failure (CCF), occurs when the heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body. Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition is diagnosed by patient physical examination and confirmed with echocardiography. Blood tests help to determine the cause.

Causes

1.Ischaemic heart disease 62%2.Cigarette smoking 16%3.Hypertension (high blood pressure) 10%4.Obesity 8%5.Diabetes 3%6.Valvular heart disease

Diagnosis

- Imaging - Echocardiography is commonly used to support a clinical

diagnosis of heart failure. - Chest X-rays - Electrophysiology - An electrocardiogram (ECG/EKG) - Blood tests

Risk factors

- High blood pressure. Your heart works harder than it has to if your blood pressure is high.

- Coronary artery disease. Narrowed arteries may limit your heart's supply of oxygen-rich blood, resulting in weakened heart muscle.

- Heart attack. Damage to your heart muscle from a heart attack may mean your heart can no longer pump as well as it should.

- Diabetes. Having diabetes increases your risk of high blood pressure and coronary artery disease.

Prevention

Lower risk of getting heart disease by making lifestyle changes.

Control certain health problems, such as high blood pressure and diabetes.

Recommended Related to Heart Failure

Edema Overview

Prevention Don't smoke. If you smoke, quit. Smoking

greatly increases your risk for heart disease. Avoid secondhand smoke too.

Lower cholesterol. If you have high cholesterol, follow doctor's advice for lowering it. Eating a heart-healthy diet-such as exercising, and quitting smoking will help keep cholesterol low.

Hypertension

Hypertension is defined as a systolic blood pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mmHg based on the average of two or more accurate blood pressure measurements taken during two or more contacts with a health care provider

Hypertension

Hypertension may be primary, which may develop as a result of environmental or genetic causes, or secondary, which has multiple etiologies, including renal, vascular, and endocrine causes. Primary or essential hypertension accounts for 90-95% of adult cases, and a small percentage of patients (2-10%) have a secondary cause. Hypertensive emergencies are most often precipitated by inadequate medication or poor compliance.

Hypertension

Most individuals diagnosed with hypertension will have increasing blood pressure (BP) as they age. Untreated hypertension is notorious for increasing the risk of mortality and is often described as a silent killer. Mild to moderate hypertension, if left untreated, may be associated with a risk of atherosclerotic disease in 30% of people and organ damage in 50% of people within 8-10 years after onset.

Death from ischemic heart disease or stroke increases progressively as BP increases. For every 20 mm Hg systolic or 10 mm Hg diastolic increase in BP above 115/75 mm Hg, the mortality rate for both ischemic heart disease and stroke doubles.

Patient Education

*Hypertension is a lifelong disorder. For optimal control, a long-term commitment to lifestyle modifications and pharmacologic therapy is required. Therefore, repeated in-depth patient education and counseling not only improve compliance with medical therapy but also reduce cardiovascular risk factors.

*Various strategies to decrease cardiovascular disease risk include the following:

Patient Education

*Prevention and treatment of obesity: an increase in body mass index (BMI) and waist circumference is associated with an increased risk of developing conditions with high cardiovascular risk, such as hypertension, diabetes mellitus, impaired fasting glucose, and left ventricular hypertrophy.

Patient Education

*Appropriate amounts of aerobic physical activity *Diets low in salt, total fat, and cholesterol *Adequate dietary intake of potassium, calcium, and magnesium *Limited alcohol consumption

Patient Education

*Avoidance of cigarette smoking *Avoidance of the use of illicit drugs, such as cocaine

CANCER

What Is Cancer?

Cancer is a class of diseases characterized by out-of-control cell growth. There are over 100 different types of cancer, and each is classified by the type of cell that is initially affected.

Cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumors (except in the case of leukemia where cancer prohibits normal blood function by abnormal cell division in the blood stream). Tumors can grow and interfere with the digestive, nervous, and circulatory systems, and they can release hormones that alter body function. Tumors that stay in one spot and demonstrate limited growth are generally considered to be benign.

Cancer Epidemiology

Cancer Epidemiology although cancer affect people of all ages,

most cancer occur in people older than 65 years of age.

overall, the incidence of cancer is higher in men than in women.

Higher in industrial nations.

Cancer Epidemiology

In Female In male

WHO

Cancer Epidemiology

Jordanians: Age group and Gender: A total of (4798) new cases of cancer were recorded among

Jordanian in the year 2009, of these, 2280 cases (47.5 %) were males and (2518) cases (52.5 %) were females .

The male to female ratio for cancer cases in Jordan was 0.90: 1; it’s slightly less than the ratio in 2008 (0.97:1).

Distribution of cancer cases by age group shows that about 42.6 % of the cases occurred in the age 60 years and above. In this age group cancer is more in males (55%) than females (45%). on the other hand cancer in females predominate (61%) in the age group 30-59 years compared with cancer in males (39%) and this is mostly due to high incidence of breast cancer in this age group, while in the age group 0-29 years males (52%) were slightly more than female

Cancer Epidemiology

What causes cancer?

Cancer is ultimately the result of cells that uncontrollably grow and do not die. Normal cells in the body follow an orderly path of growth, division, and death. Programmed cell death is called apoptosis, and when this process breaks down, cancer begins to form. Unlike regular cells, cancer cells do not experience programmatic death and instead continue to grow and divide. This leads to a mass of abnormal cells that grows out of control.

Risk Factors

Non modifiable Aging “The most significant risk factor

is age” Genetics

Risk Factors

Modifiable Tobacco smoking, which is strongly associated with lung cancer,

mouth, and throat cancer Drinking alcohol, which is associated with a small increase in oral,

esophageal, breast, liver and other cancers a diet low in fruit and vegetables, physical inactivity, which is associated with increased risk of colon,

breast, and possibly other cancers obesity , which is associated with colon, breast, endometrial, and

possibly other cancers sexual transmission of human papillomavirus , which causes

cervical cancer and some forms of anal cancer.Other lifestyle and environmental factors known to affect cancer risk

(either beneficially or detrimentally) include the use of exogenous hormones (e.g., hormone replacement therapy causes breast cancer), exposure to ionizing radiation and ultraviolet radiation, and certain occupational and chemical exposures.

Detection

In many cases, the sooner cancer is diagnosed and treated, the better a person's chance for a full recovery.

Often a doctor can find early cancer during a physical exam or with routine tests

Imaginig ( X-Ray, CT scan, MRI, Ultrasound ) Endoscopy Tissue samples The only absolutely certain way to diagnose

cancer is to take a cell sample (a process called a Biopsy )

Tests on blood and other samples

Prevention of Cancer

Primary Prevention Is concerned with reducing the risk of disease through

health promotion strategies.1/3 Cancer cases can be prevented through health

promotion program.The role of community health nursing is essential to

reduce cancer prevalence; through:1- Help patient avoid known carcinogens.2- encourage client to make dietary and lifestyle

changes ( smoking cessation, decrease calories intake, increase physical activity)

3- Nurses use their teaching and counseling skills to provide patient education and support public education.

Prevention of Cancer

Secondary prevention Secondary prevention program promote

screening and early detection activities such as breast and testicular self examination.

Cancer test such as mammogram, digital rectal examination.

In-depth screening and follow up for people who are at high risk.

The Role of nurse in Cancer treatment

direct patient care; documentation in the medical record; participation in therapy; symptom management; organization of referrals to other

healthcare providers; both patient and family education;

The Role of nurse in Cancer treatment

as well as counseling throughout diagnosis, therapy, and follow up.

The nurse should serve as the patient's first line of communication.

Ideally, the patient and family should feel free to contact the oncology nurse by phone during the entire treatment program.

Many patients travel long distances, so the importance of communication by telephone must be emphasized. It allows continuous patient communication, early recognition of emergencies, and regular emotional

support.

Chronic Respiratory Diseases

-Chronic Obstructed Pulmonary Disease (COPD) -Asthma

(COPD) Definition

Is a progressive disease that makes it hard to breathe. "Progressive" means the disease gets worse over time.

COPD can cause coughing that produces large amounts of mucus (a slimy substance), wheezing, shortness of breath, chest tightness, and other symptoms.

(COPD)Risk factors

1- Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke.

2- Long-term exposure to other lung

irritants—such as air pollution, chemical fumes, or dust—also may contribute to COPD.

(COPD)Risk factors

3- Rarely, a genetic condition called alpha-1 antitrypsin deficiency may play a role in causing COPD.

4- Some people who have asthma can

develop COPD.

(COPD)Risk factors

5- Most people who have COPD are at least 40 years old when symptoms begin. Although uncommon, people younger than 40 can have COPD. For example, this may happen if a person has alpha-1 antitrypsin deficiency, a genetic condition.

(COPD)Prevention

Prevent COPD Before It Starts

1. The best way to prevent COPD is to not start smoking or to quit smoking. Smoking is the leading cause of COPD. If you smoke, talk with your doctor about programs and products that can help you quit.

(COPD)Prevention

Prevent COPD Before It Starts

2. If you have trouble quitting smoking on your own, consider joining a support group. to help people quit smoking. Ask for support.

3.Also, try to avoid lung irritants that can contribute to COPD.

(COPD)Prevention

Prevent Complications and Slow the Progress of COPD

The most important step you can take is

to quit smoking. Quitting can help prevent complications and slow the progress of the disease. You also should avoid exposure to the lung irritants.

(COPD)Prevention

Prevent Complications and Slow the Progress of COPD

Follow your treatments for COPD exactly

as your doctor prescribes. They can help you breathe easier, stay more active, and avoid or manage severe symptoms.

(COPD)Prevention

Prevent Complications and Slow the Progress of COPD

Talk with your doctor about whether and

when you should get flu (influenza) and pneumonia vaccines. These vaccines can lower your chances of getting these illnesses, which are major health risks for people who have COPD.

(COPD)Prevention

Living With COPD COPD has no cure yet. However, you can

take steps to manage your symptoms and slow the progress of the disease. You can:

1. Avoid lung irritants2. Get ongoing care3. Manage the disease and its symptoms4. Prepare for emergencies

(COPD)Prevention

Living With COPD Manage the disease and its symptoms1- Do activities slowly.2- Put items that you need often in one place

that's easy to reach.3- Find very simple ways to cook, clean, and do

other chores. For example, you might want to use a small table or cart with wheels to move things around and a pole or tongs with long handles to reach things.

(COPD)Prevention

Living With COPD Manage the disease and its symptoms4- Ask for help moving things around in

your house so that you won't need to climb stairs as often.

5- Keep your clothes loose, and wear clothes and shoes that are easy to put on and take off.

2. Asthma

What Is Asthma?

Is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning.

Who Is at Risk for Asthma?

1- Asthma affects people of all ages, but it

most often starts during childhood. In the United States, more than 25 million people are known to have asthma. About 7 million of these people are children.

Who Is at Risk for Asthma?

2- Young children who often wheeze and

have respiratory infections—as well as certain other risk factors—are at highest risk of developing asthma that continues beyond 6 years of age. The other risk factors include having allergies, eczema (an allergic skin condition), or parents who have asthma.

Who Is at Risk for Asthma?

3- Among children, more boys have asthma

than girls. But among adults, the disease affects men and women equally. It's not clear whether or how sex and sex hormones play a role in causing asthma.

Who Is at Risk for Asthma?

4- Most, but not all, people who have

asthma have allergies. 5-Some people develop asthma because of

contact with certain chemical irritants or industrial dusts in the workplace. This type of asthma is called occupational asthma.

How Can Asthma Be Prevented?

You can’t prevent asthma. However, you can take steps to control the disease and prevent its symptoms.

For example: 1-Learn about your asthma and ways to

control it. 2-Follow your written asthma action plan. Get regular checkups for your asthma.

How Can Asthma Be Prevented?

3-Use medicines as your doctor prescribes. 4-Identify and try to avoid things that make your

asthma worse (asthma triggers). However, one trigger you should not avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.

Diabetes Mellitus

Diabetes Mellitus

• Occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. This leads to an increased concentration of glucose in the blood (hyperglycemia).

Diabetes Mellitus

• Type 1:(previously known as insulin-dependent or childhood-onset diabetes) is characterized by a lack of insulin production.

• Type 2:(formerly called non-insulin-dependent or adult-onset diabetes) is caused by the body’s ineffective use of insulin. It often results from excess body weight and physical inactivity.

Diabetes MellitusRisk factors

1-People of South Asian, African, African-Caribbean, Polynesian, Middle-Eastern and American-Indian descent are at greater risk of type 2 diabetes, compared with the white population.

2-People who are obese, are inactive or have a family history are also at increased risk of type 2 diabetes.

Diabetes MellitusRisk factors

*Weight The more fatty tissue you have, the more

resistant your cells become to insulin.

*Inactivity The less active you are, the greater your

risk. Physical activity helps you control your weight and good health

Decreasing the risk of diabeticHelps you to deal with stress and improve

mood .

Diabetes MellitusRisk factors

2-dietary factors3- Family history. Your risk increases if a

parent or sibling has type 2 diabetes.

Diabetes Mellitusmanagment

4-*foot care:1. Is very important to check your leg daily2. Keep clean and soft3. Breathable shoes4. Report any change

Checking your blood sugar: Frequency and time of day Hyper( polyuria ( frequency

urination) , polydipsia( increase thirst ) Polyphagia ( increase hungry).

Hypo ( lightheadness ,confusion ,sweating , pounding in HR)

Prevention

• Healthy lifestyle choices can help you prevent type 2 diabetes. Even if you have diabetes in your family, diet and exercise can help you prevent the disease. If you've already been diagnosed with diabetes, the same healthy lifestyle choices can help you prevent potentially serious complications.

Prevention

• Eat healthy foods. Choose foods low in fat and calories. Focus on fruits, vegetables and whole grains.

• Get physical. Aim for 30 minutes of moderate physical activity a day. Take a brisk daily walk.

• Lose excess pounds.

hyperlipidemia

abnormally elevated levels of any or all lipids and/or lipoproteins in the blood.[1] It is the most common form of dyslipidemia (which includes any abnormal lipid levels).

Obesity

*Obesity: is a medical condition in which excess

body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems

.People are considered obese when their body mass index (BMI), a measurement obtained by dividing a person's weight in kilograms by the square of the person's height in metres, exceeds 30 kg/m2

Risk factors

1. Obesity increases the likelihood of various diseases

2. heart disease

3. type 2 diabetes

4. obstructive sleep apnea

5. certain types of cancer

6. osteoarthritis.

excessive food energy intake lack of physical activity genetic susceptibility endocrine disorders medications psychiatric illness.

Role of nursing health education

Dieting and physical exercise are the mainstays of treatment for obesity. Diet quality can be improved by reducing the consumption of energy-dense foods such as those high in fat and sugars, and by increasing the intake of dietary fiber.

Anti-obesity drugs may be taken to reduce appetite or inhibit fat absorption together with a suitable diet.

gastric balloon may assist with weight loss, or surgery may be performed to reduce stomach volume and/or bowel length.

Smoking

Risks to your health Smoking causes about 90% of lung cancers. It also causes cancer in many other parts of

the body, such as the: throat voice box (larynx) esophagus (the tube between your mouth

and stomach) bladder Kidney , liver , stomach pancreas

Risks to your health

Smoking damages your heart and your blood circulation, increasing the risk of conditions such as:

coronary heart disease  heart attack stroke

Summary :

Nurses Play a central role in health service delivery, promotion, prevention, treatment and rehabilitation in areas of great health need, where they may be the only frontline providers of health, especially in remote areas Since in most countries nurses and midwives form the bulk of the clinical health workforce, developing and strengthening human resources for health means recognizing that nursing services play a vital role in improving health service delivery

References - Medical Surgical book

- Medscape

- Wiki (http://www.nhs.uk/chq/Pages/2344.aspx?CategoryID=53)

_ who

-CDC

Article Prevalence of Selected Chronic, Noncommunicable

Disease Risk Factors in Jordan: Results of the 2007

Jordan Behavioral Risk Factor Surveillance Survey.

AbstractIntroductionNon-communicable diseases (NCDs) are the leading cause of illness and death in Jordan. Since 2002, the JordanMinistry of Health, in cooperation with the World Health Organization and the Centers for Disease Control andPrevention, established the Jordan Behavioral Risk Factor Surveillance Survey to collect information on many of thebehaviors and conditions related to NCDs. The objectives of this study were to describe the prevalence of selected NCDrisk factors and the relationship between body mass index and selected health conditions among a nationallyrepresentative sample of Jordanian adults aged 18 years or older.

MethodsWe used a multistage sampling design to select 3,688 households, from which we randomly selected and interviewed 1adult aged 18 years or older. A total of 3,654 adults completed the survey. We randomly selected a subsample of 889interviewed adults and invited them to visit local health clinics for a medical evaluation; we obtained measurements,

including fasting blood glucose and blood lipids, from 765 adults. Data were collected between June 1, 2007, andAugust 23, 2007.

Results: Nearly one-third of participants smoked cigarettes, 18% reported having

been diagnosed with high blood pressure, and10% reported frequent mental distress. Compared with survey participants

who did not participate in the medicalevaluation, those who participated were more likely to self-report high blood pressure, high blood cholesterol, anddiabetes and report lower levels of health-related quality of life. Among participants of the medical evaluation, anestimated 11% reported they had been diagnosed with diabetes by a health professional, and 19% were diagnosed withdiabetes according to laboratory testing. Approximately one-third of participants of the medical evaluation were eitheroverweight (30%) or obese (36%). In the fully adjusted model, obese participants of the medical evaluation were nearly

3 times as likely to have high blood pressure and more than 2 times as likely to have high blood cholesterol as normal weightparticipants.

Conclusion

Diabetes, high blood pressure, high cholesterol, and obesity are a public health concern in Jordan. Adequate and

continuous monitoring of NCD risk factors in Jordan is needed, and the surveillance findings should be used in health

promotion and disease prevention activities.

Mohannad Al-Nsour, MD, MSc; Meyasser Zindah, MD; Adel Belbeisi, MD; Raja Hadaddin, MD;

David W. Brown, DSc, MScPH, MSc; Henry Walke, MD, MPH.