Transcript Sawyer-Banda Travel Clinic Nursing - Bonnie Sawyer

Travel Clinic Nursing
An educational program for nurses that wish to provide
Pre-Travel Assessments and Consultations
Bonnie Sawyer-Banda
University of Central Florida
Fall 2012
NGR 6776L
Steps to a Healthy Journey
 Part I – Define Travel Health Nursing
 Part II - Assessment
 Part III - Trip research and risk identification
 Part IV - Pharmacological Interventions
 Part IV – Non-Pharmacological Interventions
Part I - What is Travel Medicine?
 “The highly specialized area of medicine
devoted to the maintenance of the health of
international travelers through health
promotion and disease prevention.”
(Kozarsky and Keystone, 2008, p.1)
Why study Travel Medicine?
 According to the World Tourism Organization there
were 980 million international travelers in 2011. This
number is expected to reach 1.6 billion by the year
2012 (UNWTO, 2012).
 One study showed that 76.5% of international
travelers think that seeking medical advice before
traveling is important. However, only 58.9% actually
got information before traveling. This study
demonstrated a lack of traveler’s knowledge about
safety measures and health information regarding
disease prevention (El Sherbiny and Wafik, 2011).
What is travel health nursing?
 Travel health nursing is an emerging
specialty focusing on the health needs of the
traveler. It is an interdisciplinary specialty that
uses the knowledge of epidemiology, public
health, curative medicine and health
education (Rosselot, 2004).
Why have a Travel Medicine Clinic?
 Provide a needed service to our local
population
 Maintain a healthy Central Florida / Seminole
County – prevent diseases from coming here
to infect us and our families
 Provide International Travelers with
information that will enable them to have a
healthy journey
Part IISteps to a Healthy Journey
 Assess client’s health
 Analyze their itineraries
 Select appropriate
vaccines
 Provide education
about prevention and
self treatment of travel
related diseases
(Shaw, 2006; Spira,
2003)
Pre-travel visit
 Focus on disease prevention and health
promotion
 Pre-trip preparation should be 4-6 weeks
prior to departure and 3-6 months ahead for
more complex travel such as extended stays
or remote adventure trips.
Assessment
 Pre-travel Assessment:
This form will be posted
on the Travel Clinic
internet site for clients
to access, retrieve and
complete prior to visit.
 When the traveler calls
to make an
appointment, they
should be directed to
the web site to retrieve,
print the form and fill out
prior to visit.
A focused health history is
comprised of 6 areas
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Demographics – age, gender, country of birth
Medical History – acute and chronic health problems,
pregnancy, hospitalizations, and surgeries, psychological or
psychiatric problems. State of current health.
Allergies – vaccines, foods, medications, environmental
triggers, anaphylaxis history
Medications – all, including prescription drugs, OTC. Herbal
remedies and drugs acquired abroad.
Immunizations- documentation, vaccination dates and any
adverse reactions
Travel illness – history of trip illness or injury, experience with
health care abroad, knowledge of first aid and use of travel
medications (anti-diarrheal), travel insurance (Rosselot, 2004).
Specific information about the trip
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All destinations, in order of travel, including layovers.
Duration of travel with dates of departure and length of stay in
each location
Type of travel (urban vs. rural, business, backpacking, group,
solo, family vacation)
Means of transportation and type of accommodation (luxury or
budget hotels, camping, homes, hostels, cruise ship)
For example, travelers staying in budget hotels in malaria
endemic locations are more likely to contract malaria than
those who stay in air conditioned luxury hotels (Spira, 2003).
Activities planned during the trip: purpose of trip, work and
pleasure plans, water activities, contacts with locals and
sexual activity (Rosselot, 2004).
Part III
Trip research
and risk
identification
Part III: Trip research and risk
identification
 Using professional
knowledge, experience
and updated resources
the travel nurse
identifies important
health and safety risks
for this particular
traveler on this
particular trip.
Factor contributing to risk include:
 Unstable medical conditions (cardiovascular, pulmonary,
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musculoskeletal, neuropsychiatric issues)
Traveler age – young and older travelers are at increased risk
Pregnancy, especially in the 1st and 3rd trimester
Medication and drug use (diuretics, alcohol and illicit drug use
raises the risk for many health and safety problems)
Destination – travel to remote, rural and underdeveloped
destinations. Travel to areas with inadequate health and safety
services; and travel to areas of unrest add to risk.
Season of travel – risk of infectious disease and climate related
illness can vary with season of travel (rainy season, dry season)
Overseas work assignment can pose special occupational risks
Contact with local individuals, especially children, refugees and
ill individuals increases risk of infectious disease. (Rosselot,
2004).
It is important to research all trip
destinations for
 Vaccine preventable
diseases
 Safety issues
 Food and water borne
illness
 Vector borne diseases
such as malaria and
dengue.
Updated risk information is
available from
 Center for Disease Control and prevention (CDC)
http://www.cdc.gov/travel
 U.S. State Department - http://travel.state.gov/travel
 World Health Organization (WHO)
http://www.who.int/ith
 Travel Health Online – http://www.tripprep.com
(Good source for clients, can not be used by health
care providers) (Leggat, 2004).
 (Put these links in your favorites for easy
retrieval)
Smart Traveler Enrollment Program
(STEP)
A free program where
US citizens can register
with the US State
Department for updates
on the latest security
and safety
announcements.
Enrollment also helps
the embassy locate
your family if there is an
emergency.
http://www.state.gov/
Part IV
 Pharmacological Interventions
Part IV: Pharmacological
Interventions
 Offer vaccines and travel medications
 Travelers should be up to date on all routine
immunizations and offered additional vaccines
depending on risks identified.
 When making vaccine recommendations, the nurse
must consider:
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Prior immunization history
Client age
Pregnancy
Allergies and medical history
Date of departure and
Trip duration
Individual assessment
 The nurse must evaluate every individual for
contraindications, precautions and determine
a suitable schedule for vaccines with multiple
dose requirements (Rosselot, 2004)..
Vaccine administration – Critical
Skill
 Preserve vaccine potency – Cold chain
 Delivery of immunizations in accordance with
latest care standards
 Federal law – risk communication dialogues
 Specialized chart documentation
 Travelers must be monitored for adverse
reactions
Vaccines are categorized as
Routine
Recommended
 Required
Routine
 These are vaccines that are included in the
standard United States childhood and adult
schedules. The pre-travel visit is a good
opportunity to update these vaccines as
needed.
Routine
 Hepatitis B – 3 dose primary series indicated for
long stay travel and certain at risk groups.
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One study found that 45% of travelers reported either
domestic or travel related hepatitis B risk factors
(Conner, Jacobs and Meyerhoff, 2006).
Accessing medical or dental interventions in
developing countries is a risk factor for acquiring
Hepatitis B (Lau, 2007). Also, tattooing.
Those at highest risk are single males traveling alone.
An accelerated schedule for Twinrix can be
administered on days 0,7 and 21-30 days followed by a
booster at one year (CDC, 2012b). The traveler must
receive 2 doses of Twinrix before departure to be
protected against Hepatitis A!
Hepatitis B Prevalence
Routine
 Inactivated Polio – One time adult booster; needed for certain
destinations only.
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Adult travelers to endemic countries (Parts of Africa and India) should
have a booster of IPV which will give life-time immunity if they were
fully vaccinated in childhood (Lau, 2007).
 Influenza: Is the commonest vaccine preventable disease
encountered by travelers.
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Influenza virus circulates all year in tropical zones. Airports, lounges
and waiting areas are common sites of infection (Lau, 2007).
 Measles, mumps, rubella: For non-immune travelers, 2 dose series.
 Pneumoccocal – single dose indicated for adults 65 and older and
certain at risk groups
 Tetanus and Diphtheria - booster every 10 years –(tdap one time in
lifetime)
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5 year booster is recommended for travelers going for prolonged or
remote travel (Lau, 2007)
 Varicella – 2 dose series indicated for travelers without prior immunity.
Recommended
 vaccines that protect
the traveler against
diseases not usually
seen in the U.S.
Recommended
 Hepatitis A – 2 dose series to prevent food and waterborne
illness.
 Hepatitis A is the most common vaccine preventable illness.
The risk to a standard tourist is 3 per 1000 per month. The
risk increases with adventurous and non traditional
itineraries. 94% of tourists develop protective antibodies with
2 weeks of injection. (Spira, 2003)
 A single dose of Hepatitis A vaccine offers immediate
protection and can be given up to the date of departure. One
dose of Twinrix (Hep. A+B) is not adequate to provide
Hepatitis A protection. 2 doses, 4 weeks apart must be
given. In cases of time constraint, a single dose of Hepatitis
A vaccine should be given instead of Twinrix (Lau, 2007).
 An accelerated schedule for Twinrix can be administered on
days 0,7 and 21-30 days followed by a booster at one year
(CDC, 2012b).
Hepatitis A Prevalence
Recommended
 Meningococcal – one
dose for travelers with
current outbreaks (also
for travel to the Hajj)
Typhoid
 CDC recommends typhoid
vaccine for travelers to areas
where there is an increased
risk of exposure to S.Typhi.
The typhoid vaccines do not
protect against S. Paratyphi
infection. Both typhoid
vaccines protect 50%–80%
of recipients; travelers
should be reminded that
typhoid immunization is not
100% effective, and typhoid
fever could still occur. Two
typhoid vaccines are
available in the United
States:
Typhoid vaccines
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Oral live, attenuated vaccine (Vivotif
vaccine, manufactured from the
Ty21a strain of S. Typhi by
Crucell/Berna)
Primary vaccination with oral Ty21a
vaccine consists of 4 capsules, 1
taken every other day. The capsules
should be kept refrigerated (not
frozen), and all 4 doses must be
taken to achieve maximum efficacy.
Each capsule should be taken with
cool liquid no warmer than 98.6°F
(37°C), approximately 1 hour before
a meal. This regimen should be
completed 1 week before potential
exposure. The vaccine
manufacturer recommends that
Ty21a not be administered to infants
or children aged <6 years.
 Vi capsular polysaccharide vaccine
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(ViCPS) (Typhim Vi, manufactured
by Sanofi Pasteur) for intramuscular
use
Primary vaccination with ViCPS
consists of one 0.5-mL (25-mg)
dose administered intramuscularly.
One dose of this vaccine should be
given ≥2 weeks before expected
exposure. The manufacturer does
not recommend the vaccine for
infants and children aged <2 years.
Oral Typhoid – Price check
 Price check (as of
10/06/2012) for Vivotif
 Wal-mart - $55.84
 CVS - $66
 Costco - $40.32 (do not
have to be a member,
but must pay with cash,
debit or Am Ex)
Rabies
 Found in many parts of Asia, Africa, Central and South America
 Bites or scratches from dogs or bats and also from cats,
monkeys, foxes, jackals, camels and other animals can cause
rabies. The disease is fatal if not treated.
 Animal avoidance is key to prevention.
 Do not pet, feed or approach wild or domestic animals.
 In the event of exposure – wash wound with soap and water and
seek medical care immediately for post exposure treatment
(Rosselot, 2004). 8 human rabies cases associated with dog
bites have been reported in the U.S since 2000. All cases were
acquired abroad. In countries where canine rabies is endemic,
all dog bites should be managed as rabies exposure until the
dog’s disease free status can be confirmed (CDC, 2012a)
Rabies
 3 dose pre-vaccination series
indicated for long stay travelers
 Is transmitted through a bite or
a scratch of an infected animal.
All travelers to endemic areas
should be counseled about
prevention. Vaccine should be
considered for long term
travelers and expatriates.
Children are at high risk (Lau,
2007).
 Even if travelers receive the
vaccine and are subsequently
bitten, they still need to
thoroughly clean the wound and
seek post exposure vaccination
(Spira, 2003).
 Rabies is invariably fatal.
Japanese Encephalitis
Japanese Encephalitis
 Japanese Encephalitis
– Culex mosquitoes
 Risk to most travelers is
low except for certain
long stay travelers
visiting rural,
agricultural areas during
the transmission
season.
Japanese Encephalitis
 3 dose series indicated only for at risk
travelers to certain destinations.
 JE is relatively rare and is indicated for
people living in endemic areas or travelers
spending more than one month in rural areas.
The vaccine is has a high rate of adverse
reactions (Lau, 2007).
Required- Yellow fever
Required – Yellow Fever
 Yellow fever – one dose given at least 10 days
before crossing borders. Yellow fever is the only
vaccine mandated by WHO’s International Health
Regulations (Spira, 2003)
 Vaccine is contraindicated or problematic in the
following individuals:
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Elderly patients over the age of 65
Infants less than 1 year old
Individuals with impaired immune status
Individual with anaphylactic hypersensitivity to eggs or
previous yellow fever vaccination
Those with past history of thymus gland problems
(Lau, 2007)
Yellow fever - caution in older adults
 Older adults are six
times more likely than
younger adults to
experience serious
adverse side effects
(Spain and Edlund,
2010).
Yellow Fever
 found only in Sub Saharan
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Africa and tropical South
America (Yellow fever belt) –
Aedes mosquito - a daytime
biter
Is rare but potentially fatal
Vaccine
Personal protection
measures
Filling out the yellow
certificate correctly –
effective date is 10 days
after the injection. Dates
should be written day-monthyear i.e. 02 Jan 2012.
Required
 Meningitis vaccination is
mandatory only in Saudi Arabia
for pilgrims undertaking the Hajj
pilgrimage. Good for 3 years.
Must be given 10 days prior to
arrival (Spira, 2003). Must be
documented in the yellow
certificate.
 Risk of infection is low, but
fatality rate is 50% despite
treatment. Risk is greatest in
winter and dry season. (Spira,
2003).
Malaria
 Malaria – a life threatening illness. There is no
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vaccine!. Must take anti-malarial chemoprophylaxis
– female anopheles mosquito – bites dusk to dawn
A hazard in more than 100 countries
Responsible for 300-500 million infections yearly
Can be fatal if not treated early
Risk can vary greatly depending on destination,
season of travel and altitude.
All travelers to areas endemic for malaria
need to take the risk seriously!
 They need to use anti-malarial medications and personal
protective measures
 No anti-malarial medication is 100% effective
 Malaria deaths in travelers are usually due to inappropriate
chemoprophylaxis or non-compliance. Medications suppress
malaria by killing the asexual blood stages of the parasite before
they cause disease. Protective levels of the medication must be
in the blood before the parasite emerges from the liver.
Therefore, the prophylaxis should be started before the first
possible exposure and continue for a set period after the last
possible bite (Spira, 2003).
Choice of agent depends on:
 Destination
 Trip duration
 Drug resistance
 Adverse effects
 Cost (Rosselot, 2004).
Atovaquone/proguanil (Malarone)
 Reasonably effective and has fewer side
effects than mefloquine. Has the benefit of
activity against liver stage parasite which
means it can be stopped after one week
which increases compliance.
 Side effects: headache, vomiting, abdominal
pain and dyspepsia with a frequency similar
to placebo (Spira, 2003).
 Instructions: Take one table daily. Begin 1-2
days pre-travel, daily during stay and 1 week
post travel.
Doxycycline
 Side effects: May cause phototoxicity, vaginal
candidiasis, bone and dental damage in
fetuses and children younger than 8 years old
(Spira, 2003)
Chloroquine phosphate
 Inexpensive
 Instructions: Take one tablet daily. Start 1-2
days pre-travel, daily during stay and 4 weeks
post travel.
Chloroquine phosphate
 Is seldom used because it is no longer useful
for protecting most travelers (Spira, 2003).
Malaria
 Teach the traveler the symptoms of malaria
so they may seek prompt medical treatment
for flu like symptoms. Be sure and tell their
health care provider where they have traveled
(Rosselot, 2004).
Part V:
Non-pharmacological interventions - Customized health
counseling
 Most health and safety
risks are not vaccine
preventable
 Top 2 causes of death
in international
travelers:
 Cardiovascular disease
 Motor vehicle accidents
Vehicular Safety:
 Foreign country roads
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are poorly maintained
Traffic is complex with
vehicles, pedestrians
and animals
Signs are poor and in a
foreign language
Traffic laws are not
enforced
Travelers need to wear
seat belts
Air travel hazards
 Jet lag
 The travel nurse can
recommend:
 adequate sleep before
departure
 maximum sleep during
flight
 adjust activities and
mealtimes to
destination time zone
Travel thrombosis
 Travel thrombosis can lead to fatal pulmonary
embolism:
 Travelers at risk include
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older age
pregnancy
cancer
obesity
flights > 5 or 6 hours
History of blood clots, stroke or recent surgery
Travel Thrombosis
 Prevention measures
for travel thrombosis:
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Periodic walks
Isometric exercises
Drinking water
Wearing support hose
 Warning signs include:
 DVT -Pain, redness
and swelling behind
the knee or swelling of
one leg
 PE – SOB, CP,
coughing or fainting
 SEEK IMMEDIATE
MEDICAL
ATTENTION!
(Rosselot, 2004).
Aerotitis
 Caused by a change in
cabin pressure. Results
in ear pain, dizziness,
decreased hearing or
perforation of the ear
drum
 Can prevent by
performing Valsalva’s
maneuver during takeoff and landing and/or
decongestants.
(Rosselot, 2004).
Disinsection
 Some countries require that
airlines spray insecticides
inside the cabin prior to
landing. (to prevent
transmission of vector borne
illnesses – yellow fever,
dengue, malaria) This can
cause allergic reactions, hay
fever or asthma attacks.
Traveler needs to question
the airline about this practice
and take carry on medication
as a precaution. They might
opt to take a mask for use in
the cabin (Murawski, 2002).
Airborne illness
 Tuberculosis, influenza,
upper respiratory illness. Any
disease spread with
infectious droplets
 Actions – avoidance
measures:
 Ask to be moved away
from coughing
passengers
 Frequent hand washing
 Flu and pneumonia
immunizations
 Masks (Rosselot, 2004).
Catering policies of airlines
 Travelers may find
themselves hungry on
long flights.
Recommend that carry
nutritious foods with
them. Children, older
adults and travelers
with chronic health
problems are at greater
risk.
Insects and other animal vectors
 Avoiding vectors is the key to preventing
serious diseases
 The travel nurse needs to educate the
traveler about specific insects or animal
hazards for the trip as well as ways to avoid
them.
Mosquitoes
 “the most lethal animals on the
planet”
Mosquitoes
 Responsible for the spread of Yellow fever,
Dengue fever, Japanese Encephalitis,
malaria and many other diseases!
 Insect are attracted to people by carbon
dioxide, lactic acid and body odor. Travelers
should wear protective clothing (light colored)
that are loose fitting and cover the arms and
legs.
Dengue Fever
 Dengue Fever – The
geographical continues
to increase – Aedes
mosquito – a daytime
biter found in urban
areas (Cases have
been recognized in
Florida!) Bite avoidance
is important! Dengue
hemorrhagic fever is
more serious and
sometimes fatal.
Dengue has been diagnosed in FL
Mosquito repellant
 DEET – 20-50% should
be applied to exposed
skin.
 Permethrin can be
sprayed on mosquito
nets or clothing and will
protect against
mosquitoes and ticks
for weeks or months
(Spira, 2003).
Other insect vectors are:
 Chagas disease is caused by Trypanosoma
cruzi, a parasite related to the African
trypanosome that causes sleeping sickness.
It is spread by reduvid bugs and is one of the
major health problems in South America
(PubMed, 2010).
 Sleeping sickness (tsetse fly)
 Leishmaniasis (female sand fly)
Food and Waterborne Illness
 Traveler’s Diarrhea –
(TD) La turista, Dehli
belly, Montezuma’s
revenge, funny tummy,
tourist trot.
 Is the MOST COMMON
TRAVEL ILLNESS!! 3060% of travelers to
developing countries
are affected. It is the #1
health problem in
international travel!
(Cohen, 2007).
Traveler’s Diarrhea (TD)
 What is Traveler’s
Diarrhea?
 4-5 watery stools per day
that may be accompanied by
cramps, nausea, vomiting,
bloating and fatigue.
 Concerns about drug
resistance prevent
consensus guidelines
recommending the
prophylactic use of
antibiotics (Cohen, 2007).
TD – Continued…
 Most common source of
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infection is contaminated
food or water
Possible infectious agents:
Escherichia coli
Salmonella
Campylobacter jejuni
Shigella
Norwalk virus
Rotavirus
Hepatitis A
Parasites (giardia)
TD - Continued
 Pre-travel visit, the
nurse needs to teach
prevention measures
and stress the
importance of hand
washing. Hand
washing. Hand
washing!!
Safe Food Identification
 How to identify safe food and water sources
at their destinations
 “Hot food served hot”
 “boil it, cook it, peel it or forget it”
Water
 Boiled or
bottled (be
sure the seal
is intact)
 NO ICE
FOOD
 Well cooked – nothing rare!
 Hot food – avoid buffets and salads
 Avoid thin skinned fruits such as raspberries or
strawberries
 Fresh fruits and vegetables that can be peeled by the
traveler are safe
 AVOID SALADS - SHELLFISH –UNPASTEURIZED
DAIRY-UNPASTEURIZED FRUIT JUICE
 Recommend Hepatitis A and Typhoid vaccines
Self treatment of diarrhea consists
of:
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Fluid replacement
Oral rehydration salts
OTC drugs
Bismuth subsalicylate (Pepto bismol) 2 tablets at meals at
bedtime (8 pills per day)
Loperamide (Imodium)
Fiber – Metamucil
Probiotics are safe and effective for the prevention of traveler’s
diarrhea. A meta-analysis found that 85% of traveler’s diarrhea
cases were prevented by probiotics (McFarland, 2007).
Antibiotics if symptoms are severe. Fluoroquinolones
(ciprofloxacin [Cipro] norflaxacin[Noroxin], levofloxacin
[Levaquin]), Azithromycin [Zithromax]or Furazolidone [Furoxone]
(Spira, 2003).
Respiratory Illness
 Air pollution is a problem in
many developing countries –
remind high risk travelers
with asthma, allergies and
underlying respiratory
problems to need bring
medication for self treatment
(Bronchodilators,
decongestants, antibiotics,
etc)
 If traveler is going for
extended stay, a baseline TB
skin test might be a
recommendation
Occupational and Recreational
Hazards
 What the traveler will be doing is as important is
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where they will be doing it.
Leisure activities: Swimming or water sports
Drowning Swimming in fresh water ponds. rivers and lakes
Schistosomiasis – (bilharzia or snail fever) parasitic
worms enter through the skin.
Leptopirosis – infective spirochete that causes renal,
hepatic and pulmonary damage.
Amoebae – can cause amoebic meningitis or
Traveler’s Diarrhea.
Swimming in pools not properly
chlorinated
 Giardia
 Cryptosporidium
 Hepatitis A
 Norwalk virus
Walking barefoot
 Cutaneous
larva
Migrans
 Hookworm
Scuba Diving
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The bends
(decompression
sickness)
Air embolism
(pulmonary
barotrauma)
Marine hazards
(venomous injuries,
infected cuts and
abrasions)
Activities in rural or remote areas (biking, mountain
climbing, trekking, camping)
 Increased
risk for
inadequate
or delayed
medial
treatment
New activities or Extreme Sports
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parasailing, bungee
jumping, rock
climbing,
rollerblading, snow
skiing/boarding
The travel nurse
needs to alert
travelers to activity
hazards and
encourage the use of
safety equipment to
reduce risk.
Problems of Climate and Altitude
Heat related illness:
 Heat stroke and heat exhaustion can occur in
tropical locations with high temperatures and
high humidity
 Dehydration can occur in hot or dry
destinations
 Travelers need to know how to recognize,
prevent and self treat. The best gauge of
hydration is not thirst (a late gauge) but
urination. Urination should occur every 4
hours and the urine should look clear.
Hypothermia
 Very young and elderly
are at increased risk
 Limit exposure, wear
layers, adequate
hydration
Ultraviolet sun hazards
 Sunscreen – take with and
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use correctly (SPF >15)
Wear clothing that covers
arms and legs
Wear wide brimmed hat and
sun glasses
Avoid mid day sun
Check medications do not
increase sensitivity
Sunscreen effectiveness is
reduced by wind, heat,
humidity, sweat and altitude.
When applying sunscreen
and insect repellant...apply
the sunscreen first to allow
skin absorption, then
repellant (Spira, 2003).
Altitude sickness
 Travelers at risk who travel higher than 6,000 to
9,000 feet.
 Acute Mountain Sickness (AMS) usually occurs with
ascents > 9,000 ft.

Headache, fatigue, insomnia,, anorexia, nausea or
vomiting
 If ascent continues, cerebral edema and pulmonary
edema can occur

confusion, ataxia, LOC
 Avoid direct travel to high altitudes; avoid alcohol and
overexertion, “Never take a headache to a higher
level” Descend if symptoms persist.
Motion Sickness
 Prevention begins with
sitting in the most stable
part of the vehicle
 Plane – forward section
of the wings
 Boat – center of the
boat at the waterline
looking at he horizon
 Car or bus – next to the
window and open the
window for fresh air,
Sexually Transmitted Diseases (STDs)
and Bloodborne Pathogens
 5-67% of travelers have sex with people that
are not their usual partners
 Travelers are at risk for HIV or other STDs if
they have unprotected sex
 Travel nurse needs to counsel about the risks
of casual sex
 Abstinence
 condoms
 effect that alcohol and drugs can have on
judgment
References:
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CDC (2010) 10 Essental public health services. Retrieved 03/25/2012 from http://www.cdc.gov/nphpsp/essentialservices.html
CDC. (2012a). Imported human rabies – New Jersey, MMWR 2012. 60 (51&52). 1734-1736.
CDC. (2012b). Recommended adult immunization schedule-United States, 2012. MMWR. 61(4). 1-5.
Cohen, M. (2007). Traveller’s ‘funny tummy’: Reviewing the evidence for complementary medicine. Australian Family Physician.
36(5).335-336.
El Sherbiny, N., and Wafik, G. (2011). A study of travel medicine among national and international travelers in Egypt. Journal of
Public Health and Epidemiology. 3(7). 324-328.
Hill, D., Ericsson, C., Pearson, R., Keystone, J., Freedman, D., Kozarsky, P., DuPont, H., Bia, F., Fischer, P., and Ryan, E. (2006)
The practice of travel medicine: Guidelines by the infectious disease society of America. Clinical Infectious Diseases. 43. 14991539.
Kozarsky, P. (2006). The body of knowledge for the practice of travel medicine – 2006. Journal of Travel Medicine. 13(5). 251254.
Kozarsky, P. & Keystone, J. (2008). Introduction to travel medicine. Travel Medicine, second edition. Mosby Elsevier
Lau, S. (2007). Travel vaccination. Australian Family Physician. 35(5). 304-310.
Leggat, P. (2004). Travel medicine online: International sources of travel information on the internet for travellers. Travel Medicine
and Infectious Diseases. 2. 93-98.
McFarland, L. (2007). Meta-analysis of probiotics for the prevention of traveler’s diarrhea. Travel Medicine and Infectious
Disease. 5. 97-105.
Murawski, J. (2002). “Ladies and gentlemen, you are about to be sprayed” aircraft disinsection-what has been, what is, and where
to go from here. Presented at AFL-CIO 19th Annual SCSI International Aircraft Cabin Safety Symposium. Retrieved 01/26/2012
from http://ashsd.afacwa.org/docs/scsi2_papermar02.doc
PubMed Health (2010) Chagas Disease. retrieved 02/26/2012 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002348/
Rosselot, G. (2004). Travel health nursing: Expanding horizons for occupational health nurses. American Association of
Occupational Health Nurses Journal. 52(1). 28-41.
Shaw, M. (2006) Running a travel clinic. Travel Medicine and Infectious Disease. 4. 109-126.
Spain, M and Edlund, B. (2010). Travel immunization update for older adults. Journal of Gerontological Nursing. 36(4). 9-12.
(UNWTO) World Tourism Barometer (2012). First Printing - Vol. 10 – January 2012Retrieved 02/23/2012 from
http://dtxtq4w60xqpw.cloudfront.net/sites/all/files/pdf/unwto_barom12_01_january_en_excerpt.pdf
The End