NR 503 Week 5: Infectious Disease Paper

Chamberlain University NR 503 Week 5: Infectious Disease Paper– Step-By-Step Guide

This guide will demonstrate how to complete the Chamberlain University NR 503 Week 5: Infectious Disease Paper   assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NR 503 Week 5: Infectious Disease Paper              

Whether one passes or fails an academic assignment such as the Chamberlain University NR 503 Week 5: Infectious Disease Paper  depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NR 503 Week 5: Infectious Disease Paper              

The introduction for the Chamberlain University NR 503 Week 5: Infectious Disease Paper  is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NR 503 Week 5: Infectious Disease Paper              

After the introduction, move into the main part of the NR 503 Week 5: Infectious Disease Paper assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NR 503 Week 5: Infectious Disease Paper              

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NR 503 Week 5: Infectious Disease Paper              

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NR 503 Week 5: Infectious Disease Paper

Description of tuberculosis

Tuberculosis (TB) is a contagious, life-threatening infectious disease that primarily affects the lungs and is caused by the mycobacterium germ (Delogu, Sali, and Fadda, 2013). General symptoms are a wracking cough, extreme weakness and fatigue, coughing up blood or phlegm (sputum), marked weight loss, fever and chills, profuse sweating, and severe chest pain while breathing or coughing (CDC: Signs and symptoms, 2016). A skin test or TB blood test are used to determine if a person has tuberculosis.

The TB mode of transmission occurs when a person with TB coughs, sneezes, speaks, or opens his or her mouth; mycobacterium germs are released into the air and remain for hours— even days (CDC: How TB spreads, 2016). Complications of pulmonary TB include structural, metabolic, vascular, and infectious conditions (Shah & Reed, 2014). An acute complication of TB is sepsis (Shah & Reed, 2014). Chronic complications are pulmonary mycetoma or focal neurologic deficits from tuberculomas; pulmonary complications include hemoptysis (coughing up blood) or pneumothorax (collapsed lung) (Shah & Reed, 2014). TB is treated with or more first-line drugs for 6 to 12 months: isoniazid (INH), rifampin (RIF), ethambutol (EMB), and/or pyrazinamide (PZA) (CDC: Treatment for TB disease, 2016). If the strain of TB is resistant to first-line drugs, second-line group 2 drugs are given (CDC: Treatment for TB disease, 2016). Other TB drugs are categorized as second-line groups 3 and 4, and third-line group 5. The vaccine for TB is Bacille Calmette–Guèrin (BCG) (CDC: Treatment for TB disease, 2016).

Demographic of interest

The global mortality rate for tuberculosis is more than 50 percent in patients who do not receive adequate treatment (Adigun & Bhimji, 2018). The CDC (2018) reports the morbidity of TB as 10.4 million people around the world of which the mortality was 1.7 million (Adigun & Bhimji, 2018). The morbidity of TB cases in the U.S. was 9,547 cases reported in the U.S. in 2015, of which 470 people died; of the 9, 272 TB cases reported in 2016, the CDC has yet to compile mortality rates (CDC, 2017). The incidence rate for TB cases in the United States is 3.0 per 100,000 in 2015 and 2.9 per 100,000 in 2016 (CDC: TB Incidence…, 2017). WHO (2017) estimates the global incidence rate for TB decreases 1.5 percent every year; the prevalence of TB in the U.S. in 2015 was 0.00002974 percent in a population of 321 million; in 2016, the prevalence was 0.0000287058 in a population of 323.4 million people (Adigun & Bhimji, 2018). 

Determinants of health/host, agent, environmental factors

Common TB determinants of health are socioeconomic factors, physical environment, and individual behaviors. Poverty is one of the leading social determinants of TB, as it determines the conditions in which people live. Undernutrition is also another risk factor for developing the disease. Malnutrition leads to secondary immunodeficiency, which amplifies a person’s susceptibility for TB infection (Narasimhan et al., 2013).  Smoking and alcohol abuse also increase a person’s chances of getting TB because these behaviors cause other medical conditions that weaken the immune system. Smoking damages the lungs in many ways, and people who smoke are 40 – 60 percent more likely to develop pulmonary TB, the leading form of the condition (Narasimhan et al., 2013). Excessive alcohol consumption damages the body and interferes with TB treatment drugs. People who have been diagnosed with cancer, diabetes, Crohn’s disease, chronic obstructive pulmonary disease, HIV/AIDS, or other medical conditions that attack the immune system are at great risk to contract TB. These conditions cause an already compromised immune system to become defenseless against TB (Narasimhan et al., 2013).

Host factors for TB are general health practices, attitude about healthcare providers, psychological states, social status, previous exposure to disease, race, genetic diseases. The causative agent for TB is the mycobacterium tuberculosis microbe. Environmental factors that promote TB are poorly ventilated, crowded, filthy home and work environments. Settings that have a lot of air pollution, geographic areas with a high incidence of TB, or work environments with high levels of airborne or released toxins promote growth of the mycobacterium tuberculosis germ. 

Role of the FNP

If FNPs want to effectively help communities eliminate and prevent tuberculosis outbreaks, FNPs must understand and practice current CDC and WHO approved TB screening procedures, treatment guidelines, and community engagement methods. Case finding methods should include retrieving relevant TB source documents from local, national, and state health agencies, such as disease indices and pathology reports that identify reportable cases. FNPs should also go out in the community and collect data about members who have been treated for TB or who can recount stories of interactions with people who have been diagnosed with TB. FNPs can utilize their informatics and research skills to analyze their findings and experiences then compile them into a report. Once these experiences and evidence-based practices have been presented to the right sources, TB resources and clinical care for at risk populations will be more readily accessible.

References

Adigun R, Bhimji SS. (2018 Apr 20). Tuberculosis. In: StatPearls (Internet). Available from: 

Centers for Disease Control and Prevention (CDC). (2016, March 17). Tuberculosis (TB): Signs & symptoms. Available from https://www.cdc.gov/tb/topic/basics/signsandsymptoms.htm

Centers for Disease Control and Prevention (CDC). (2016, July 26). How TB spreads. Available from https://www.cdc.gov/tb/topic/basics/howtbspreads.htm

Centers for Disease Control and Prevention (CDC). (2016, August 11). Treatment for TB Disease. Available from https://www.cdc.gov/tb/topic/treatment/tbdisease.htm

Centers for Disease Control and Prevention (CDC). (2017, November 13). Reported tuberculosis in the United States, 2016. Available from https://www.cdc.gov/tb/statistics/reports/2016/table1.htm

Centers for Disease Control and Prevention (CDC). (2017, November 13). TB incidence in the United States, 1953-2016. Available from https://www.cdc.gov/tb/statistics/tbcases.htm

Delogu, G., Sali, M., & Fadda, G. (2013). The Biology of Mycobacterium Tuberculosis

Infection. Mediterranean Journal of Hematology and Infectious Diseases, 5(1), e2013070. http://doi.org/10.4084/MJHID.2013.070

Narasimhan, P., Wood, J., MacIntyre, C. R., & Mathai, D. (2013). Risk Factors for Tuberculosis.

Pulmonary Medicine, 2013, 828939. http://doi.org/10.1155/2013/828939

Shah, M., & Reed, C. (2014). Complications of tuberculosis. Current Opinion in Infectious Diseases, 27(5), 403-410. doi: 10.1097/QCO.0000000000000090

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Sample Answer 2 for NR 503 Week 5: Infectious Disease Paper

Analysis of Pertussis Disease

Introduction

Pertussis, known as whooping cough, is an airborne respiratory tract infection caused by the Gram-negative bacterium Bordetella Pertussis. The illness lasts for weeks, and an infected person experiences repeated coughs that end with a gasping whoop sound (a sudden, deep inspiration). Pertussis vaccines have been developed for years and are used globally. However, the pathogen is active and circulates worldwide, causing infant mortality and morbidity. This paper analyzes Pertussis disease, determinants of health related to its development, epidemiology triad, and NPs’ role in curbing the illness. The study will improve people’s knowledge of pertussis and help them understand the importance of effective measures to reduce its prevalence.

Analysis of Pertussis Infection

Pertussis is transmitted through coughing or sneezing droplets from an infected person during the early stages. The infection is highly contagious, with epidemic peaks every 2-5 years, and causes disease in ≥ 80% of close contacts (Decker & Edwards, 2021). Once infected, the incubation period averages one to two weeks, when the bacteria invade the respiratory mucosa. The infection increases mucus secretion, which is thin at the beginning, and later becomes viscid and tenacious. Pertussis lasts approximately 6 to 10 weeks and comprises three stages: Catarrhal, Paroxysmal, and Convalescent. The catarrhal stage is highly contagious and characterized by sneezing, lacrimation, runny nose, and a cough that lasts one to two weeks. In the paroxysmal stage, a person experiences severe and repeated coughing, followed by a whoop. Besides, people expel viscid mucus, salivate, teary eyes, exhaustion, and vomit. In infants, choking spells are more common than whoops. The convalescent stage begins within four weeks of infection and lasts up to three weeks. A person experiences a lessened cough and is no longer contagious. However, one should be careful as the body is susceptible to other respiratory infections, which could prolong the recovery period.

Pertussis affects subjects of all ages but mainly infants and young children. Between 2008 and 2011, pertussis was the major cause of death for children under three months in the United States of America. According to Tandy and Odoi (2021), pertussis incidence from 2000 to 2016 was highest in the central mid-west areas with records of 11.9 per 100,000 and Rocky Mountain with 11.5 per 100,000. The incidence was low in South Atlantic with records of 2.5 per 100,000, and in Southeastern areas, recording 3.1 per 100,000. Concurrently, between 2000 and 2017, the CDC recorded 307 reported deaths from pertussis, and children below two years accounted for 84% of these deaths (Havers et al., 2021). The statistics indicate that demographic differences and vaccine coverage influence pertussis epidemics. Immunization and prevention help reduce pertussis prevalence.

Infants, older children, and adults with pertussis face challenges due to a lack of oxygen. Infants develop brain damage, seizures, pneumonia, apnea, convulsions, and death. On the other hand, older children and adults experience pneumonia, urinary incontinence, difficulty sleeping, and rib fracture. Parents should monitor their children carefully; if symptoms persist, they should contact the doctor.

Pertussis can be prevented using acellular pertussis vaccine. Children should be vaccinated at 2, 4, and 6 months. Furthermore, they should be given booster vaccines at 18 months, 4 to 6 years, and 11 years to increase resilience (Duarte et al., 2021). Older children and adults should also receive booster vaccines to improve their immunity and reduce complications. Furthermore, pregnant women should receive a booster to protect their newborns. People should protect each other and prevent bacteria from spreading by observing health safety measures.

Pertussis is treated with antibiotics, including erythromycin, azithromycin, and trimethoprim. In Infants, excess mucus could be removed through suction. However, seriously ill infants should be hospitalized for oxygen and tracheostomy intubation. Isolation is recommended until antibiotics have been given for five days or at least four weeks until symptoms have subsided. Patients require supportive care and should be kept in a quiet room with minimal disturbance. Early treatment helps prevent the illness from spreading.

Determinants of Health

The environment and circumstances determine people’s health. Factors such as location, environment, income, education, relationships, gender, social support networks, and access to healthcare considerably impact health. Hence, the determinants of health include the social and economic environment, the physical environment, and the individual’s characters and behaviors (Duarte et al., 2021). Individuals, especially those in impoverished neighborhoods, have limited access to affordable healthcare, lack adequate knowledge of the illness, and lack social support networks. Some factors influence the access to pertussis diagnosis and treatment, predisposing individuals to spread the disease.

Determinants of health deny disadvantaged populations the opportunity to attain their full health potential. Besides, health disparities within social groups facilitate social disadvantages, including unequal access to healthcare, lower vaccination rates among minority populations, stigma, and racism (Duarte et al., 2021). For instance, an infected pregnant woman residing in a poorly populated area with uneducated family members is at high risk of spreading the bacteria to many people, including the unborn child. Hence, moving action on high-priority health issues helps attain the HP2020 goals. HP2020 objectives address determinants of health to promote healthy development across all life stages. Recognizing the factors that facilitate the prevalence of pertussis would help communities make appropriate choices eliminating health disparities to attain full health potential.

Epidemiological Triad

Epidemiologists use an epidemiological triad tool to help them understand how diseases spread. The tool consists of an external agent, host, and environment (Jia et al., 2020). In understanding how pertussis is transmitted, the agent is theBordetella Pertussis bacteria. The bacteria are transmitted to a host or the organism that carries the disease, in this case, a person. The environment is the factor that fosters the spread of the illness, such as the temperature of a place, which could facilitate an agent’s ability to thrive, lack of adequate medical facilities, poverty, and illiteracy. If the infected person is a father to a three-week-old baby who is not vaccinated, lacks education, and lives in a crowded place, the infant will be infected. Thus, the environment is where the host and agent meet, contributing to the spread of the disease.

Role of the NP

A nurse practitioner (NP) should work across all healthcare settings to control, prevent, manage and treat infectious illnesses. An NP should operate with great autonomy to prevent the transmission of infectious diseases. Nurses should use learned skills to identify potentially contagious patients and isolate them to contain the illness and prevent transmissions. Besides, they should use evidence-based practice to diagnose and manage patients’ ailments. NPs are responsible to the public and must report incidences of an infectious disease to the appropriate authorities for an immediate action plan. Besides, they must use the leadership framework to educate the population and ensure all individuals’ safety (Benson et al., 2021). The leadership framework allows them to combine the role of providers, educators, mentors, researchers, and advocates. NPs provide safe, high-quality, patient-centered care to achieve improved healthcare outcomes.

Conclusion

Pertussis is a vaccine-preventable disease but continues to be a major cause of mortality and morbidity, especially among children. Understanding the disease helps the population to embrace effective measures to reduce its prevalence. Efforts to eradicate pertussis have increased as the government and the healthcare sector seek to achieve health equity by addressing economic, social, and environmental factors influencing health.

References

Benson, A. R., Peters, J. S., Kennedy, C., & Patch, M. (2021). In service to others: APRNs as serving leaders during the COVID-19 pandemic. The Online Journal of Issues in Nursing, 27(1).https://doi.org/10.3912/OJIN.Vol27No01PPT54.

Decker, M. D., & Edwards, K., M. (2021). Pertussis (Whooping Cough). The Journal of Infectious Diseases, 224(4), S310–S320. https://doi.org/10.1093/infdis/jiaa469.

Duarte, R., Aguiar, A., Pinto, M., Furtado, I., Tiberi, S., Lönnroth, K., & Migliori, G. B. (2021). Different disease, same challenges: Social determinants of tuberculosis and COVID-19. Pulmonology, 27(4), 338-344. https://doi.org/10.1016/j.pulmoe.2021.02.002.

Havers, F.P., Moro. P. L., Hariri. S. & Skoff. T. (2021). Epidemiology and prevention of vaccine preventable diseases. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/pubs/pinkbook/pert.html.

 Jia, P., Dong, W., Yang, S., Zhan, Z., Tu, L., & Lai, S. (2020). Spatial lifecourse epidemiology and infectious disease research. Trends in Parasitology, 36(3), 235-238. https://doi.org/10.1016/j.pt.2019.12.012.

Tandy, C. B., & Odoi. A. (2021). Geographic disparities and socio-demographic predictors of pertussis risk in Florida. PeerJ, 9, e11902. https://doi.org/10.7717/peerj.11902.

Sample Answer 2 for NR 503 Week 5: Infectious Disease Paper

Introduction

Infectious diseases have an immense burden on the global population. Nurses and other healthcare providers play a crucial role in preventing and managing infectious disease outbreaks. Herpes zoster is the infectious disease of focus in this paper. Herpes zoster is a viral infection that develops from the reactivation of an infection by varicella zoster virus, which causes chickenpox. Chickenpox occurs in children while herpes zoster occurs in the elderly or adults. Reactivation of the varicella virus occurs in situations such as immunosuppression, emotional stress, and the use of medications that depress the immune system, acute or chronic illness, malignancy, and exposure to the varicella virus (van Oorschot et al., 2021).

Patients with herpes zoster present to the hospital with a range of symptoms. They include pain, tingling, or itching of the skin. They also complain of painful rashes and blisters on one side of the body especially on the torso and face. There are also flu-like symptoms such as chills, headache, fever, and stomach upsets. Patients might experience dysesthesias and shock-like sensations. An infected person spreads herpes zoster through direct contact. One is infected with direct contact with virus particles in the rash during the blister phase or inhaling virus particles in the air. Herpes zoster is associated with several complications. They include postherpetic neuralgia, herpes zoster opthalmicus, and disseminated zoster (CDC, 2023). Antiviral therapy is the most appropriate treatment for herpes zoster. Acyclovir, valacyclovir, and famciclovir are the commonly used antiviral drugs for herpes zoster.

One in every three people in the USA has a lifetime risk of developing herpes zoster. About 1 million people in America get herpes zoster annually. Unlike other infectious diseases, ethnic minority groups have been found to have low rates of herpes zoster. For example, the incidence rate of herpes zoster in African Americans is lower by 65-75% (Klaric et al., 2019). The mortality rate due to herpes zoster is low. For example, statistics show that about 96 people die yearly with herpes zoster considered the underlying cause (CDC, 2023).

Determinants of Health

Determinants of health are factors in the social, economic, and physical environment and a person’s characteristics and behaviors that influence health. Factors such as environments where people reside, grow, work, interact with others, and genetics influence health. Determinants of health influence herpes zoster in a population. Evidence shows that increased age, female gender, white ethnic backgrounds, and moderate physical activity are associated with increased odds of being affected by herpes zoster. The elderly are highly at risk of herpes zoster because of their decreasing immunity. Individuals born to a family with a history of herpes zoster are also increasingly at risk of developing it (Cadogan et al., 2022).

 In another study, the risk of herpes zoster was found to be high among individuals with malignancies, physical trauma, and small risk in those with psychological stress and comorbidities such as rheumatoid arthritis, diabetes, renal disease, cardiovascular diseases, systemic lupus erythematosus, and inflammatory bowel disease. The study also showed that the black race has the lowest rate of herpes zoster as compared to American Whites (Marra et al., 2020). The odds of herpes zoster have also been found to increase with higher poverty levels, more democratic voters, and lack of internet access. The odds decrease with high health literacy levels. Vaccination status also predicts the risk of herpes zoster (Shuvo et al., 2021).

Epidemiological Triad

The epidemiological triangle is a model that can be used to understand herpes zoster. The epidemiological triangle is a model that shows the cause and transmission of infectious disease. It has three parts including agent, host, and environment, which form the tree vertices of the triangle. The agent refers to the cause of an infectious disease. The agent in herpes zoster is the varicella zoster virus. Agent factors such as virulence determine the risk of herpes zoster development and reactivation of the virus. Environment refers to the internal and external factors that predispose an individual to herpes zoster. Environmental factors play a role in herpes zoster. For example, exposure to the Aberdeen pesticide dumps site has been postulated to increase the risk of herpes zoster. The risk is attributable to immunosuppression of the population, which leads to viral reactivation. Living in an overcrowded environment may play a role due to the increased risk of inhaling infected particles. Residing in care homes has also been identified as a risk factor for herpes zoster (van Oorschot et al., 2021). Elderly patients in care homes have a high rate of herpes zoster because of stress and immunosuppression.

The host refers to an individual who carries the disease and spreads it to others. Several host factors contribute to herpes zoster. They include age, gender, disease status, immune status, ethnicity, and family history. For example, immunosuppressed individuals due to malignancies and use of medications can develop it due to the reactivation of the virus. African Americans have the lowest rate and risk of herpes zoster. The elderly and children are likely to be affected by herpes zoster because of their immune status (Patil et al., 2022). Vaccination status also influences since vaccines offer immunity against varicella herpes zoster virus.

Role of the Nurse Practitioner

Nurse practitioners play several roles in the prevention and management of infectious diseases such as herpes zoster. According to the American Association of Nurse Practitioners (AANP), nurse practitioners perform a range of roles that include assessing, performing, ordering, supervising, and interpreting laboratory and diagnostic tests, diagnosing, treating, and care coordination. They also counsel and educate patients and their families as well as communities (aanp.org, n.d.). Nurse practitioners also promote accountability and responsibility in their roles.

The above roles apply to the prevention and management of herpes zoster. For example, nurse practitioners educate patients, families, and communities about the prevention of herpes zoster through interventions such as vaccination. They also order diagnostic and laboratory investigations that would aid diagnosis and treatment of herpes zoster and its associated comorbidities. Nurse practitioners also screen patients for herpes zoster and their associated risk factors and implement interventions to prevent disease occurrence. The nurse practitioner’s role also includes data collection on herpes zoster, analysis, monitoring, communication, and surveillance to determine the need for health promotion interventions (Ha et al., 2019). Nurse practitioners must be champions and advocates of evidence-based practice in their institutions by ensuring the use of best practices in infectious disease detection, prevention, and management.

Conclusion

In summary, herpes zoster is a viral disease caused by the reactivation of varicella herpes zoster. The epidemiologic triangle can be used to understand the cause and spread of herpes zoster in the population. Determinants of health play a role in the development and spread of herpes zoster. Nurse practitioners are crucial in detecting, preventing, and managing herpes zoster in a population.

References

aanp.org. (n.d.). Scope of Practice for Nurse Practitioners. American Association of Nurse             Practitioners. Retrieved October 7, 2023, from https://www.aanp.org/advocacy/advocacy-resource/position-statements/scope-of-practice-for-nurse-practitioners

Cadogan, S. L., Mindell, J. S., Breuer, J., Hayward, A., & Warren-Gash, C. (2022). Prevalence    of and factors associated with herpes zoster in England: A cross-sectional analysis of the Health Survey for England. BMC Infectious Diseases, 22(1), 513.            https://doi.org/10.1186/s12879-022-07479-z

CDC. (2023, June 5). Clinical Overview of Herpes Zoster (Shingles) | CDC.             https://www.cdc.gov/shingles/hcp/clinical-overview.html

Ha, D. R., Forte, M. B., Olans, R. D., OYong, K., Olans, R. N., Gluckstein, D. P., Kullar, R.,       Desai, M., Catipon, N., Ancheta, V., Lira, D., Khattak, Y., Legge, J., Nguyen, K. B., Chan, S., Mourani, J., & McKinnell, J. A. (2019). A Multidisciplinary Approach to   Incorporate Bedside Nurses into Antimicrobial Stewardship and Infection Prevention.           The Joint Commission Journal on Quality and Patient Safety, 45(9), 600–605.          https://doi.org/10.1016/j.jcjq.2019.03.003

Klaric, J. S., Beltran, T. A., & McClenathan, B. M. (2019). An Association Between Herpes        Zoster Vaccination and Stroke Reduction Among Elderly Individuals. Military Medicine,            184(Supplement_1), 126–132. https://doi.org/10.1093/milmed/usy343

Marra, F., Parhar, K., Huang, B., & Vadlamudi, N. (2020). Risk Factors for Herpes Zoster            Infection: A Meta-Analysis. Open Forum Infectious Diseases, 7(1), ofaa005.     https://doi.org/10.1093/ofid/ofaa005

Patil, A., Goldust, M., & Wollina, U. (2022). Herpes zoster: A Review of Clinical Manifestations            and Management. Viruses, 14(2), Article 2. https://doi.org/10.3390/v14020192

Shuvo, S., Hagemann, T., Hohmeier, K., Chiu, C.-Y., Ramachandran, S., & Gatwood, J. (2021). The role of social determinants in timely herpes zoster vaccination among older           American adults. Human Vaccines & Immunotherapeutics, 17(7), 2043–2049.   https://doi.org/10.1080/21645515.2020.1856598

van Oorschot, D., Vroling, H., Bunge, E., Diaz-Decaro, J., Curran, D., & Yawn, B. (2021). A       systematic literature review of herpes zoster incidence worldwide. Human Vaccines &            Immunotherapeutics, 17(6), 1714–1732. https://doi.org/10.1080/21645515.2020.1847582

Week 6: Evaluation of an Epidemiological Disease or Problem 

For most people, arthritis is a health condition associated with people over the age of 65. The stiff, inflamed joints and nagging aches and pains are just seen as side effects of aging and years of wear and tear on the body. While arthritis is a health condition that results from inflammation of the joints and causes chronic pain, it is not just a health condition that affects elderly people. Arthritis can develop in children, teenagers, even adults in their twenties and thirties. As a long-term care nurse for over 15 years, my familiarity with the effects of arthritis in patients living in long-term care (LTC) facilities settings is considerable. Residents suffering from chronic arthritis find it extremely difficult to lift items, open doors, walk long distances, and perform activities of daily living (ADL): bathing, getting dressed, using the toilet, eating, transferring oneself to or from the bed or chair, or generally participating in activities that require strength and flexibility. Millions of people suffering from arthritis do not live in LTC facilities, so they do not have nursing assistance to help them with their ADLs or instrumental activities of daily living (IADLs): housework, grocery shopping, driving, caring for pets, etc.  On the other hand, millions of arthritis sufferers are forced to give up their independence every year and move into long-term care facilities as they find they are no longer able to perform normal daily functions due to the pain and discomfort caused by their arthritis.  

The Georgia Department of Public Health (GDPH) reports that arthritis is the predominant reason for disability in the United States and Georgia, affecting over 53 million people across the nation (Bayakly, 2015). In 2013, one in four adults in Georgia, ranging in ages from 18 to 85, were reported to have been diagnosed with arthritis by their primary care physicians (Bayakly, 2015). With the average age of onset arthritis reported to be 47 years old, cost-effective evidence-based strategies are needed to treat LTC patients suffering with arthritis (Tavakoli, Akwara, Kish, 2018). This paper will examine the prevalence of osteoarthritis (OA) and rheumatoid arthritis (RA) and describe their backgrounds. The paper will also discuss surveillance methods, provide an epidemiology analysis of OA and RA, and explain how they are diagnosed. Lastly, this paper will reflect on what actions can be taken to address OA and RA as a family nurse practitioner.   

Background of arthritis 

Arthritis is a degenerative joint disease that causes swelling, tenderness, and pain of the joints. Arthritis may affect one joint and cause occasional discomfort, but it often times affects multiple joints in the body and decreases mobility. People of all ages can develop arthritis; however, their chances increase as they grow older. The Centers for Disease Control and Prevention (2018) report there are over 100 types of arthritis. The most prevalent cases of arthritis are osteoarthritis and rheumatoid arthritis (CDC: Arthritis basics, 2018). Other commonly diagnosed forms of arthritis include juvenile rheumatoid arthritis, knee osteoarthritis, degenerative joint disease, fibromyalgia, and gout (CDC: Arthritis basics, 2018). OA occurs in the joints when cartilage begins to break down; this may be the result of injury, aging, or overuse of the joints (CDC: Arthritis basics, 2018). Osteoarthritis is the most common type of arthritis and affects 30 million people or 60 percent of all diagnosed cases within the U.S. (CDC: Arthritis basics, 2018) and for 70.9 percent of all cases in Georgia (Martyn, Bayakly, & Bagchi, 2013). Furthermore, OA is the reason for 79 percent of hospitalizations among Georgia patients 65 years and older (Martyn, Bayakly, & Bagchi, 2013). OA targets the neck, lower back, hands, hips, and knees and worsens over time, resulting in permanent disability (PubMed Health, 2018). 

Rheumatoid arthritis is an autoimmune disorder that occurs when the immune system attacks the healthy cells in the connective tissue lining of the joints, causing damage and inflammation to joints throughout the body (CDC: Arthritis basics, 2018). Rheumatoid arthritis mainly attacks the synovial membrane soft tissue that lines the joints and leads to bone damage (CDC: Arthritis basics, 2018). RA causes chronic pain in the joint tissues of the hands, wrists, and knees; as a result, the person may develop a lack of balance or a deformity of the hands. Advanced RA may affect other tissues and cause health issues in organs such as the lungs and heart (CDC: Arthritis basics, 2018). RA is the most diagnosed autoimmune inflammatory arthritis in adults, affecting about 1 percent of U.S. general population and accounting for 0.7 percent of hospitalizations among Georgia patients ages 35 – 65 and over (Martyn, Bayakly, & Bagchi, 2013). RA is often misdiagnosed or mistaken for other disorders (Martyn, Bayakly, & Bagchi, 2013). The burden that OA, RA and other forms of arthritis places on arthritis sufferers is significant as it leads to a lower quality of life. Due to physical limitations and difficulty of staying healthy, arthritis sufferers find it increasingly difficult to work or participate in social or familial activities.   

Signs and symptoms 

The overall symptoms of OA are aching pain, stiffness in affected areas, decreased range of motion, and joint swelling. The general symptoms of RA include pain, stiffness, weakness, tenderness, and swelling of the joints. Accompanying systemic symptoms for RA are weight loss, fever, fatigue, eye inflammation, anemia, pleurisy, and subcutaneous nodules (PubMed Health, 2018). When RA symptoms worsen, they are called flare-ups; when symptoms do not appear, they are said to be in remission (CDC: Arthritis basics, 2018). Risk factors associated with osteoarthritis and rheumatoid arthritis are multifactorial and include familial, individual, or behavioral causes (Martyn, Bayakly, & Bagchi, 2013). Hereditary risk factors are genetic mutations that increase the risk of RA or OA; individual risk factors include aging, being female, and being White; behavioral risk factors are joint injuries sustained during an activity, repetitive motion characteristic of certain jobs, long-term infections, and obesity (Martyn, Bayakly, & Bagchi, 2013). In terms of the effect of RA and OA on patients in long-term care, the ability of these arthritic conditions to debilitate the body has adverse mental effects. Affected residents often experience feelings of fear, helplessness and anxiety, which lead to depression and increased stress levels. Many patients with RA suffer from comorbidity 

Incidence/Prevalence statistics  

Of the 1.7 million adult Georgians who report having been diagnosed with arthritis, 76,000 report they are disabled (Martyn, Bayakly, & Bagchi, 2013). Among racial and ethnic groups diagnosed with arthritis, the most affected group is White non-Hispanic at 69 percent (Ibid.). RA and OA are most prevalent among women at 59 percent (Ibid.). Women are 30 percent more likely to report symptoms of arthritis than men at 22 percent (Ibid.). Among racial and ethnic groups, White non-Hispanic females are most likely to report arthritis symptoms at 32 percent, followed by White non-Hispanic males at 25 percent, Black non-Hispanic females at a 26 percent, and Black non-Hispanic males at 20 percent (Ibid.). Georgians 65 years and older report arthritis symptoms at 57 percent while Georgians ages 18 to 24 years old only report at 4 percent (Ibid.). Among Georgia adults diagnosed with arthritis, 58 percent were still employed, 10 percent had retired, and 18 percent were totally disabled and unable to work (Ibid.).   

On average, 24,360 Georgia residents are hospitalized every year due to arthritis complications (Martyn, Bayakly, & Bagchi, 2013). Of the Georgia adults who have health insurance, 28 seek medical attention for arthritis; 18 percent of Georgia adults without health insurance seek medical attention for arthritis symptoms (Martyn, Bayakly, & Bagchi, 2013).  The rate of hospitalizations was highest among women at 58 percent , Whites  at 77 percent, and patients 55 years and older at 77 percent (Ibid.). Per year, an average of 2,084 Georgians dies from arthritis or health issues linked to arthritis (Ibid.). Of these deaths, 66 percent occurred among females, 66 percent occurred among Whites, and 61 percent among people age 65 years or older (Ibid.).  The prevalence of arthritis is drastically lower in metro-Atlanta county health districts: the lowest numbers reveal Clayton County at 16.7 percent, DeKalb County at 17.6 percent, and Fulton County at 20 percent (Ibid.). The prevalence of arthritis is higher outside of metro-Atlanta counties: the cities with the highest incidences are Dublin at 32.8 percent, Albany at 31.2 percent, Augusta at 31.2 percent, Waycross at 31.1 percent, and North Georgia health districts at 31.1 percent (Ibid.).   

               Figure 2: Georgia public health district arthritis comparison. 

On a national scale 22.7 percent (54.4 million people) of the population has been diagnosed with arthritis, and 21 million of these sufferers complain they are disabled due to their arthritis (CDC: Arthritis related statistics, 2018). 7.1 percent of people between the ages of 18 to 44 report they have been diagnosed with arthritis; 29.3 percent of people between the ages of 45 to 64 report arthritis; 49.6 percent of people age 65 and older have reported doctor-diagnosed arthritis (Ibid.). 26 percent of the women and 19.1 percent of men in the U.S. report doctor-diagnosed arthritis (Ibid.). Out of the 54.4 million people to be diagnosed with arthritis, 4.4 million are Hispanics, 41.3 million are non-Hispanic Whites, 6.1 are non-Hispanic Blacks, and 1.5 are non-Hispanic Asians (Ibid.). By 2040, 78 million or 26 percent of the adult U.S. population is projected to be diagnosed with some form of arthritis (Ibid.).   

Current surveillance methods 

The CDC (2018) suggests the Behavioral Risk Factor Surveillance System (BRFSS) is the most reliable resource for accessing state-specific arthritis prevalence statistics. The BRFSS survey system is based in every state, the District of Columbia, and three U.S. territories (CDC: State statistics, 2018). The system randomly dials individuals aged 18 years or older who have a registered phone number (CDC: State statistics, 2018).  The BRFSS system has been collecting arthritis data from since 1996 (Ibid). The Morbidity and Mortality Weekly Report (MMWR) provides an arthritis surveillance summary that explains the differences between each type of arthritis and the impact arthritis has at the state and local levels (Ibid.). The CDC (2018) also recommends self-reporting methods to estimate the prevalence of doctor-diagnosed arthritis. Researchers should consider individuals to have self-reported, if they ever responded “yes” to the following question found in the National Health Interview Survey (NHIS) and the state-based Behavioral Risk Factor Surveillance System (BRFSS): “Have you been informed by a physician or other healthcare professional that you have some form of arthritis?” (Ibid.). For public health surveillance, the CDC has coordinated with the National Arthritis Data Workgroup to administer the National Health Interview Survey (NHIS) to identify people in every U.S. state and territory with at least one of the 100 diseases that fall under arthritis conditions (Ibid.). The Georgia Department of Public Health relies on the information collected by the CDC, BRFSS, and minimum data set (MDS) nurses in public and private healthcare facilities to compile its state numbers on arthritis (Martyn, Bayakly, & Bagchi, 2013).  

Epidemiology analysis 

Nationwide, approximately 54 million people report having been diagnosed with arthritis.. Risk factors are multifactorial, with old age, being White and female as the main factors. OA affects over 30 million adults; research suggests wear and tear plays a large role in its diagnosis. RA affects a little over one percent of the national population; research suggests that behavioral and genetic factors play a role in its diagnosis. Women develop arthritis more than men, especially after age 50 with a significantly higher age-adjusted prevalence in women at 23.5 percent than in men at 18.1 percent. Inactive adults have a higher prevalence of arthritis conditions at 23.6 percent than adults who report they are active at 18.1 percent.  In Georgia, 26 percent of the population suffers from some form of arthritis. White non-Hispanics report doctor-diagnosed arthritis at 29 percent, which is more than any other racial/ethnic group in the state. Georgians 65 years are more prone to doctor-diagnosed arthritis. Cobb-Douglas County has reported to date the lowest prevalence of arthritis at 18.4 percent. The population most affected is White women over the age of 65.  

Incidence of RA in women is lower among women who take oral contraceptives compared with women who have never taken oral contraceptives or those who have stopped taking oral contraceptives (Tavakoli, Akwara, & Kish, 2018). Research shows that female subfertility increases RA in women (Tavakoli, Akwara, & Kish, 2018). Women who breastfeed and women who go through a postpartum period after a first pregnancy are at greater risk of RA (Ibid.). Environmental factors such as viral and bacterial infections increase the chance of RA in men and women (Ibid.). Men and women who smoke cigarettes increase their risk of RA (Ibid.). Over 15 percent of female in-home nursing assistance insurance claims are due to arthritis (Ibid.). The numbers show that 10 percent of nursing home residents receiving benefits for arthritis or arthritis related conditions are women over age 50 diagnosed with arthritis (Ibid.). 

In 2013, the national arthritis medical care costs and earnings losses totaled $303.5 billion; attributable lost wages amounted to $164 billion (CDC: Cost statistics, 2018). The direct total cost per adult in national arthritis medical amounted to $2,117 (CDC: Cost statistics, 2018). OA is the second most costly hospitalized health conditions among U.S. residents, accounting for $16.5 billion of the combined costs for hospitalizations and $6.2 billion in hospital costs for privately insured patients (CDC: Cost statistics, 2018). Adults with arthritis bring home $4,040 less pay compared to adults without arthritis due to taking days off to recuperate from symptoms (CDC: Cost statistics, 2018).  The State of Georgia estimates it loses over $2.4 billion in direct costs and $1.5 billion in indirect costs treating patients with arthritis conditions (Martyn, Bayakly, & Bagchi, 2013).  

Diagnosis and Screening and Prevention 

To diagnose arthritis, a doctor will ask about symptoms then perform a physical examination to detect swollen joints or loss of range of motion (Martyn, Bayakly, & Bagchi, 2013). To distinguish the type of arthritis the doctor will order blood tests and X-rays (Ibid.). Doctors’ evaluations may include questions about symptoms, current and past health issues, health habits, and family medical history (Martyn, Bayakly, & Bagchi, 2013). Doctors will conduct a hands-on joint evaluation; depending on the findings, the doctor may order lab or imaging tests (CDC: Arthritis basics, 2018). The primary care doctor may refer the patient to a rheumatologist for a more comprehensive assessment (CDC: Arthritis basics, 2018). If necessary, the rheumatologist may make a referral for an orthopaedist who will determine if surgery is needed (CDC: Arthritis basics, 2018). To date there are no specific screening tests for arthritis (Ibid.). Early diagnosis has been determined to be the best screening method to detect arthritis (Ibid.).  The National Arthritis Action Plan is a public health strategy headed by the CDC and the Arthritis Foundation to combine efforts with other health organization to educate the public about arthritis and self-management goals (Ibid.). 

Since there is a lack of data about the sensitivity, specificity, and costs factor of tests used to diagnose arthritis, more specifically rheumatoid arthritis, a five-year study was conducted to compare the following tests: B-cell gene expression, MRI, IL-6 serum level, and genetic assay (Busiman et al., 2016). The results of the study revealed, the B-cell exam was the overall best test when doctors used it as an additional test to confirm early diagnosis and as an overall diagnostic replacement in at-risk patients (Busiman et al., 2016). The following numbers show the B-cell test has better health outcomes, one of the lowest cost values, and high prevention value: B-cell gene expression test sensitivity reads 0.60, specificity reads 0.90, costs on average is $170—which means the test is not that sensitive to false positive results, it’s about 90 percent accurate, and is affordable without insurance (Busiman et al., 2016).    

Nurse practitioner implementation plan and conclusion 

Arthritis is the leading cause of disability in the U.S. and Georgia. There are 100 different types of arthritis that affect people of all ages and backgrounds. OA and RA are the most common types of arthritis, and women are affected more than men. After I graduate, I will use my knowledge of arthritis and its management to develop a fall prevention strategy for LTC patients. My program will involve a risk assessment for patients who walk with gaits or who have been noted to have balance difficulties or a history of falling. The assessment will involve muscle evaluation for weakness, an orthostatic hypotension check, a full examination of the feet, and a replacement of inefficient and unsafe footwear. The assessment will evaluate the patient’s ADL capabilities and use of mobility aids. I will also give patients a questionnaire about fears, falling, exercise, medication, and health goals. This information will make a difference in how interventions and treatment plans are executed.  

Since arthritis is characterized by pain, stiffness and inflammation in affected joints, nurse practitioners play a pivotal role in both the early detection of arthritis symptoms in at risk patients and the pain management of patients with chronic arthritis. The first action I will take is getting involved in arthritis community programs that educate the general public about non-pharmaceutical pain management methods. Addiction to pain medication has become a national concern, and arthritis patients who become addicted to pain medications will only make their health conditions worse. Next, I will address the physical, psychological and social needs of the patient by asking questions during patient check-ups about each of these areas then by providing resources to help resolve any concerns.  My goal is to improve the patient’s quality of life, so I will focus on a holistic approach to alleviating arthritis symptoms that involves a manageable diet and exercise regimen, participation in a social or spiritual activity, and shared decision making about treatment options.  

References 

Bayakly, A. R. (2015). Burden of Chronic Disease in Georgia. Retrieved from Georgia Department of Public Health website: https://dph.georgia.gov/sites/dph.georgia.gov/files/Chronic%20Disease%20Burden_Rana_8.13.15.pdf 

Buisman, L. R., Luime, J. J., Oppe, M., Hazes, J. M. W., & Rutten-van Mölken, M. P. M. H.  

(2016). A five-year model to assess the early cost-effectiveness of new diagnostic tests in the early diagnosis of rheumatoid arthritis. Arthritis Research & Therapy, 18, 135. http://doi.org/10.1186/s13075-016-1020-3 

Centers for Disease Control and Prevention (CDC). (2018, February 21). Arthritis basics. Retrieved from https://www.cdc.gov/arthritis/basics/index.html 

Centers for Disease Control and Prevention (CDC). (2018, August 1). Arthritis-related statistics. Retrieved from https://www.cdc.gov/arthritis/data_statistics/arthritis-related-stats.htm 

Centers for Disease Control and Prevention (CDC). (2018, July 18). Arthritis: State statistics. Retrieved from https://www.cdc.gov/arthritis/data_statistics/state-data-current.htm