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Communit y Assessment of Houston, Presented by: Brooke Smith, Click to edit Master subtitle style Ms. Debra McGreger, and Laquania
Williams

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Objectives

Utilize nursing processes and appropriate level of prevention in the community focusing on individuals, families, groups, and community the needs in this community a primary concern in the community and issues that affect this communities health

Assess

Diagnose

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Objectives
Organize

a plan through community assessment to address a primary health issue for this community develop, implement, and evaluate an educational presentation that is appropriate for peers, individuals, and groups in the community

Assess,

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Houston, Ms Physical Environment

Houston

is 7.035 square miles

Much of the land surrounding Houston is pastures, woods, and fields. Large trees and green grassy areas are still very common in this town

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Google Map of Houston

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History of Houston, Ms.

July

8, 1836 Joel Pinson offered land for a county seat with the town being named Houston in honor of a great Texas hero, Major, Gen. Sam Houston, who was a close friend of Pinsons was incorporated may 9, 1837

Town

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Houston

is predominantly white, black, and Mexican/Hispanic with some other ethnic groups mixed in. Both males and females are seen. There is a wide variety of people from children to the elderly.
Population, 2010 3623 : male = 1617 and female = 2006

Population Characteristics

White persons, Black persons, American Indian and Asian persons, percent, 2010 percent, 2010 Alaska Native percent, 2010 (a) 54.0% (a) 42.1% persons, percent, (a) 0.3% 2010 (a) 0.1%

Persons reporting Persons of Hispanic two or more races, or Latino origin, percent, percent, 2010 (b) 1.0% 3.7%

6/7/12 In Houston there are several different ethnicities. Most prominent, other than black and white, are Mexicans. There are two different Mexican restaurants in Houston currently.

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Education

Has its own school system grounds are well kept 1933 students to 138 full time teachers Houston Elementary is ranked 141st out of 235 cities on state standardized tests middle school is ranked 97th and the high school is ranked 15th out of 187 cities Houstons 2009 dropout rate was 29.9%

The

The

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Safety
Houston

does have a fire department

Police

department department in town

Sanitation

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Transportation
Most

people own cars

There

is no public transportation, with the exception of school buses and a bus for people with disabilities. In order to use the disabilities to bus you must be approved by the state Occasionally you will see someone on a bike

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Politics
Popular through their Mayoral elections. (There has been debate over improper voting in the mayoral elections.) During campaign time there are posters everywhere you look. Go door to door campaigning Monthly town meetings open to public

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Government
Our

mayor elected to office along with the city council A person from each district is elected to District supervisor to represent the district get very involved with decision making and their input is acknowledged

people

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Health and Social Services

Trace

Regional Hospital is a rural hospital ( includes an ER, medicalsurgical floor, and Geriatric-Psychiatric floor. The hospital has recently begun to perform small surgeries ) 4 clinics

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Health continued
The Two

Floy Dyer nursing home

sets of assisted living apartments in town North Mississippi Health Services Home Health agency provides care in this area, as well as Gilberts III office provides counseling services

Region WIC

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Health and Social Services continues

Within

an hours drive to Tupelo, Mississippi which offers a large variety of health services and programs and many of the residents of the town do use the facilities in Tupelo such as NMMC for their special needs is often where the residents go for specialty services, such as cardiovascular treatment and surgeries

Tupelo

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Spiritual
Baptist

Churches in Houston
4 2 of God 1 of Christ 1 3 1 4 of the Nazarene 1 1 3
Methodist Church Church

Episcopal Church

Presbyterian Catholic

Nondenominational Pentecostal

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COMMUNICATIO N
Hardees parking The

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lot is a common meeting area for young and old Times Post is the local newspaper Most people that live in Houston have televisions, radios, cable or satellite the Tupelo news on WTVA. station in Houston 940AM WCPC

Watch Radio

Most everyone in this town has a home phone and/or a cell phone

6/7/12 Economic s Major employer in town Franklin Manufactures

Corporation, Inc.

Small

jobs available such as Wal-Mart, McDonalds, Hardees and other fast food restaurants. people travel to Tupelo, Starkville, Columbus, Oxford, or even Grenada for employment grocery stores in town has a Dollar General, Freds, and WalMart.
For general home supplies and food many people shop in Houston. For other needs such as clothing, most people go to Tupelo to shop. EBTs are used and accepted widely by many in this town.

Many

Two Also

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Economics continued
The

unemployment rate for Houston is 12.10% with the national average being 9.10%. Houston is significantly higher. income per capita is $14,453 which includes all adults and children. The median household income is $28,202.

The

Recreation
Houston Soccer,

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has a childrens park in town.

baseball, softball, and basketball are available as city leagues throughout the year. Anyone that lives within the Houston school district between the ages of 3 and 18 may participate in any of these programs has one soccer field and seven baseball/softball fields. Life Center of the First United Methodist Church of Houston has a basketball court have one tennis court.

Houston Family They

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Recreation continued
Country Houston The

club with a golf course and pool for members does not have any public golf courses or swimming pools in town. town has a bi-yearly Flywheel Festival. The Spring Festival is much bigger with arts and crafts along with antique tractors and equipment. The Fall festival is generally just the antiques.

Community Strengths
Hospital

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located within the community is a major strength. People are able to utilize the hospital in case of emergencies, acute care, limited surgeries, and psychiatric treatment for geriatrics. clinic is also a strength concerning health in the community. People are able to go to the After Hours clinic for non-life threatening illnesses without having the major costs of an emergency room visit.

After hours

Strengths
Local

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pharmacies are also a strength for the community. With having family owned pharmacies, clients are sometimes able to contact their local pharmacy to get prescriptions filled after hours and most are able to credit their accounts for the amount of their purchase and pay the pharmacy monthly if they do not have the money on hand for needed prescriptions. Gyms provide strength for the community by giving the people in the community an opportunity to stay healthy and fit by working out and exercising 24 hours a day.

Fitness

Community Weaknesses

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Low

income, and very few, more than

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Weaknesses
Obesity

is also a major weakness of the community; with all the fast food restaurants around now and a majority of the population considered to have low low medium incomes, the dollar menus seem to come in handy. Hypertension is a weakness of the community due to the cost of medications used to treat hypertension, obesity, high sodium intake, and lack of exercise.

Uncontrolled

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Community Priority Nursing Diagnosis

Obesity related to lack of exercise and poor nutrition

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Nursing Goal
Hold

obesity awareness seminar

Strongly

encourage the use of a daily exercise regimen and limit the amounts of fast food intake purchasing and maintain a healthier diet plan

Nursing Plan
Hold obesity awareness seminar Determine main concern of the

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Nursing Interventions

Educate through seminar

Community Presentation

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THE FIGHT AGAINST OBESITY

OBESIT Y
Click to edit Master subtitle Complications and style

Health Risks

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Definition of Obesity
Overweight

and obesity are both labels for ranges of weight that are greater than what is generally considered healthy for a given height. terms also identify ranges of weight that have been shown to increase the likelihood of certain diseases and other health problems.

The

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For adults,

overweight and obesity ranges are determined by using weight and height to calculate a number called the "body mass index" (BMI). BMI is used because, for most people, it correlates with their amount of body fat. An adult who has a BMI between 25 and 29.9 is considered overweight. An adult who has a BMI of 30 or higher is considered obese.

OBESIT Y
Second

leading cause of preventable

death
Third

leading reason for liver transplant

Health risks associated with obesity

Problems

occur at higher rates for obese

patients
Mortality

rate rises as obesity increases

Health risks associated with obesit y (contd)

Obese

patients have a decreased quality

of life
Most

conditions improve with weight loss

Cardiovascular Problems
Obesity Risks

is a significant risk factor for predicting cardiovascular disease Elevated low-density lipoproteins (LDLs) Elevated triglycerides Decrease high-density lipoproteins (HDLs)

Cardiovascular Problems (contd)

Risks

Hypertension
Abnormal Decrease

vasoconstriction cardiac output

Vascular relaxation

Increased

Respirator y Problems
Severe

obesity may be associated with

Sleep apnea Obesity hypoventilation syndrome Decrease chest wall compliance Increase workload on breathing

Diabetes Mellitus
Type

2 Diabetes

80% of people with type 2 diabetes are obese Weight loss and exercise improve glucose control

Musculoskeletal Problems
Osteoarthritis

Trauma to weight bearing joints

Gout

Gastrointestinal and Liver Problems

Gastrointestinal Gallstones Nonalcoholic

Reflux Disease (GERDS)

Steatohepatitis (NASH)

Can eventually lead to cirrhosis Weigh loss can improve NASH

Cancer

Obesity is one of the most important known preventable causes of cancer

Women
Breast,

endometrial, ovarian,and cervical

Men
Prostate

Both Genders: Colon Cancer

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Management/Preventio n &Treatment of Obesit y

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Steps in Determining Treatment Options

Determine Drug

BMI range

treatment is NOT to be used when BMI is under 27

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Steps in Determining Treatment Options

Assess

Complications and Risk Factors BMI-related health risk weight reduction exclusions or lactation

Determine Determine

Temporary Pregnancy Mental

Illness medical conditions

Unstable Some

medications

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Steps in Determining Treatment Options

Possible exclusions
Osteoporosis BMI

in minimal or no-risk category of Mental Illness exclusions illness

History

Medications Permanent Anorexia Terminal

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Steps in Determining Treatment Options

Treatment Options 1. Mild energy-deficit regimen Diet Diet and exercise 2. Aggressive energy-deficit regimen VLCD Extensive exercise program 3. Obesity Drugs
More Extreme Options

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Diet
When someone is a few pounds overweight and is motivated to lose weight, there are safe and effective methods to lose weight and to maintain weight loss.

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Dieting Using Calorie Controlled Portions

Meal Replacement Plan

The rationale behind this plan is the use of a liquid formula or a packaged item with a fixed number of calories to replace a meal. controlling portion sizes, fat and carbohydrates, a person can control calories. replacement items are balanced and contain a mix of protein, carbohydrate and fat as well as other nutrients.

By

The

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Meal Replacement Plan

4 types of meal replacers: Powder mixes Shakes Bars Prepackaged meals The usual plan is to use a meal replacement for one or two meals per day while having sensible meals that combine lean meat, starch, vegetables and fruit for the other meals during the day

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Meal Replacement Plan

An intake of 5 fruits and vegetables is recommended

A meal replacement program is more effective for losing weight than a conventional, structured weight loss diet. Meal replacements offer a convenient, nutritionally balanced weight loss alternative to conventionally structured weight loss diets.

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Example: A Meal Meal Replacement Replacement Plan Breakfast

Lunch Dinner Snacks Sensible meal or meal replacement Sensible meal Fruit, vegetable, fat-free yogurt or cheese, nuts, pretzels, or air-popped popcorn

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Exercise
The American

College of Sport Medicine recommends that adults get 30-45 minutes of exercise three to five days a week, maintaining the intensity for the duration of the exercise. session should contain a 5-10 minute warm up and cool down period. weight loss is a major goal, aerobic activity should last at least 30 minutes a day for five days each week.

Each If

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Exercise
Maintaining, gaining, and losing weight are tied to Energy Balance
Positive energy balance leads to weight gain. Negative energy balance leads to weight loss. Maintaining weight means that an energy balance has been reached.

Physical activity and caloric intake balance each other out when an individual is at weight maintenance.

Exercise: Benefits

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Exercise can build lean body mass, which burns more calories than fat Walking, running and doing physical activity can burn two to three times more calories than a similar amount of time sitting Weight loss similar to diet can be achieved by exercise alone.

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Exercise
For Weight loss

150 to 200 minutes of moderate physical activity each week combined with a diet for weight loss can result in reduced body weight and fat. It is important not to compensate for the exercise calories with food. For Improved Health An exercise program with less than 150 minutes a week and lower intensity can result

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Aerobic Activity
Aerobic exercise is any extended activity that makes the lungs and heart work harder while using the large muscle groups in the arms and legs at a regular, even pace. Aerobic activities help the heart grow stronger and more efficient. Aerobic activities use more calories than other activities.

EXAMPLES : Jogging Racket sports Bicycling Lawn

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ANAEROBIC ACTIVITY
Anaerobic activity is short bursts of very strenuous activity using large muscle groups (Ex: weight lifting, curls, power lifting) Helps build and tone muscles, but it does not benefit the heart or the lungs. During the anaerobic activity, glycogen (carbohydrate stored in the muscle and liver) is used for energy and at the end of anaerobic

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Very low calorie diets (vlcd)

VLCD

are commercially prepared formulas of 800 calories or less that replace all the usual food intake. are not the same as over-the-counter meal replacements, which are meant to be substituted for one or two meals a day. used under proper medical supervision, they effectively produce significant short-term weight loss in moderately to severely obese patients. VLCD are prescribed and supervised by a medical doctor.

They

When

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Vlcd:
Facts
Generally safe when used under proper medical supervision in patients with a BMI greater than 30
Not recommended for pregnant or breastfeeding women. Not of VLCD in patients with a BMI of specialized Use appropriate for children or adolescents, unless in27 to 30 treatment programs. should not recommended forthose in olderhave medical be reserved for usage who individuals because Generally of complications resulting frompreexisting conditions. the potential of side effects caused by their obesity.

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Drugs for treatment of obesity:

indicated when
BMI BMI

is greater than 30

is higher than 27 and there are other cardiovascular complications attempts diet alone is not enough

After several

Cardiovascular complications include: Hypertension, Dyslipidemia, Coronary Heart Disease, Type 2 Diabetes and Sleep Apnea.

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Drug therapy
Commonly

prescribed drugs for the treatment of obesity include:

Phentermine

Sibutramine

Orlistat

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Surgical treatment for obesity

Criteria used for surgical treatment:
BMI

is 40 or higher.

(This is about 100 lbs overweight for men and 80 lbs for women)

BMI

of 35 39.9 and a serious obesity related health problem, such as:

Type 2 Diabetes, Hypertension, Heart Disease or Sleep Apnea

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Surgical treatment of obesity

Gastrointestinal

surgery is an option for people who are severely obese and can not lose weight by traditional means or who suffer from serious obesity-related health problems. operation promotes weight loss by restricting food intake and, in some operations, by interrupting the digestive process.

The

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Types of gi surgeries available

Restrictive

Malabsorptive

Combined

restrictive/malabsorptive

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Restrictive operations
Purely restrictive operations only limit food intake and do not interfere with the normal digestive process. At first the pouch, which the doctors create at the top of the stomach, holds about 1 ounce of food and later may stretch to 2-3 ounces. The lower outlet of the pouch is usually about inch in diameter or smaller. This small outlet delays the emptying of food from the pouch into

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Restrictive operations: example

1.

Adjustable gastric banding:

The band can be tightened or loosened over time to change the size of the passage by increasing or decreasing the amount of salt solution which inflates the band.
2.

Vertical banded gastroplasty:

Uses the band and staples to create a small pouch. Not commonly used today.

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Restrictive operation: advantages

1.

Generally safer than malabsorptive procedures. Adjustable gastric banding is generally done via laparoscopy allowing for smaller incisions, less tissue damage, shorter operation time and hospital stay. Surgeries can be reversed if necessary.

1.

1.

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1.

Patients generally lose less weight than patients undergoing malabsorptive procedures.

Restrictive operations: disadvantages

1.

Some patients regain weight by eating high calorie soft foods that easily pass through the opening to the stomach.

1.

Others are unable to change their eating habits and do not lose much weight.

1.

Successful results depend on the patients willingness to adopt a long-term plan of healthy eating and regular physical activity.

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Restrictive operations: risks

1.

Vomiting, which occurs when the patient eats too much or when the narrow passage into the larger part of the stomach is blocked. Common risk of adjustable gastric banding is breaks in the tubing between the band and the access port, requiring another operation to repair. Between 15%-20% of vertical banded gastroplasty patients may have to undergo a

1.

1.

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Combined restrictive/malabsorptive operations amount of Restrict both food intake and the
calories and nutrients the body absorbs
1.

Roux-en Y gastric bypass (RGB):

A small pouch is created to restrict food intake. A section of the small intestine is then attached to the pouch allowing for food to bypass both the large portion of the stomach, the duodenum, and the first part of the jejunum.

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2.

Combined restrictive/malabsorptive operations Biliopancreatic diversion (BPD):

The lower portion of the stomach is removed and the small pouch that remains is connected directly to the final segment of the small intestine completely bypassing the duodenum and the jejunum. Although this procedure leads to weight loss, it is used less often than other types of operations because of the high risk of nutritional deficiencies.

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Combined operations: advantages

1.

Rapid weight loss continues 18-24 months after procedure. With Roux-en-Y procedure, many patients maintain a weight loss of 6070% of their excess weight for 10 years or more.

1.

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Combined operations: disadvantages

1.

More difficult to perform than restrictive surgeries. More likely to result in long-term nutritional deficiencies. Decreased absorption of iron and calcium since the duodenum and jejunum are bypassed from the surgery. Patients undergoing BPD operation require fat soluble vitamin supplementation and life-long use of special foods and medications. Dumping syndrome is likely to occur with these

2.

3.

4.

5.

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Combined operations: risks

1.

More likely to lead to complications than the restrictive surgeries. Greater risk than restrictive operations for abdominal hernias (up to 28%), which require follow up to correct. The risk of death associated with these procedures is less than 1% for gastric bypass and around 2.5-5% in biliopancreatic diversion with duodenal switch operation.

1.

1.

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GI or bariatric surgeries: Facts

Procedures cost from $25,000 to $35,000. Medical insurance coverage varies by state.

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conclusions
When

there are no complications or co-morbidities associated with obesity, dietary, and exercise are the best approaches. successful weight loss to become permanent, an individual has to adopt new behaviors to maintain weight loss.

For

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conclusions
It

is very important for individuals considering initiation of weight loss drug therapy or surgeries to be well aware of the risks associated with the treatments. all risks are understood, then ultimately it is the individuals decision to go along with the treatment or not.

Once

Planning
Modify

eating habits in a regular physical activity

Participate

program

Achieve

weight loss to a specified level

Nursing Implementation
All

opportunities for patient education should stress healthy eating and exercise

Suppor t Groups
Encouragement Many

can be offered to join a group of other obese people self help groups are available
Weight Watchers Take Off Pounds Sensibly (TOPS)

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Presentation Goals
Attendance Increased

of at least 5 people

awareness of obesity risks and treatments of importance of healthy eating habits and exercise to promote health weight

Verbalization

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Evaluation of Presentation
All

guest will fill out evaluation/feedback forms

Guest Guest

will be able to verbalize at least 2 ways to prevent obesity will verbalize importance of healthy life choices such as diet and exercise

References

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Lewis, Sharon. Medical Surgical Nursing, Assessment and Management of Clinical Problems. (7th ed.) Mosby, Inc.

http://www. Mayoclinic.com/health/obesity/DS00314/DSECTION=treat ments-and-drugs .Retrieved Feb.16, 2012 http://www.cdc.gov National Heart, Lungs, and Blood Institute, Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, 1998 http://win.niddk.nih.gov/publications/gastric.htm. Retrieved Feb.16, 2012

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REFERENCES
McArdle WD, Katch FL, and Katch VL. Exercise Physiology: Energy, Nutrition and Human Performance. 5thed. Lippincott Williams and Wilkins 2004 http://www.webmd.com/diet/features/mealreplacements-choose-those -bars-and-drinkscarefully . Retrieved Feb. 17, 2012

http://www.nhbli.nih.gov/health/public/heart/obesity/wecan/ http://www.cpaa.sa.gov.au/benefit_exer.html

www.cdc.gov/physicalactivity/everyone/guidelines/adults.htm http://win.niddk.nih.gov/publications/low_calorie.htm http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2999518/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1395777/

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References continued
Chickasaw Development Foundation. Retrieved from http://www.houstonms.org/, retrieved February 1, 2012 City-Data.com. (Data file). Retrieved from http://www.city-data.com/city/Houston-Mississippi.html , retrieved February 1, 2012 Elliott, D. (2012). Mississippi Losing War with Obesity. Retrieved from http://www.npr.org/2011/05/19/136018514/mississippi-losing , retrieved February 5, 2012 Google Maps. (2012). Retrieved from http://maps.google.com/, retrieved February 6, 2012 Kids Count Data Center. (2009). (Data file). Retrieved from

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References continued

http://datacenter. , retrieved February 6, 2012 Mississippi