Transcript Non Communicable Diseases

Non Communicable
Diseases
Abeer Fayez Qato
Outline:
• Seminar Objectives
Non communicable Diseases (NCDs)
-
Introduction
Definition
Types of (NCDs)
How to Prevent
1- Primary
2- Secondary
3- Tertiary
Summary
- conclusion
-
The Role of community Health nurse in
Prevention and treatment
Evidence Based Article.
Objective
By the end of this Seminar, the students will be able to :
- Identify the definition of Non communicable
Diseases (NCDs).
-
Identify Types of Non-Communicable diseases.
-
Identify the role of community nurse in primary,
secondary and tertiary prevention.
Non communicable
Diseases (NCDs)
 Also
known as chronic diseases, are not passed from
person to person. They are of long duration and
generally slow progression. They are non-contagious
diseases usually associated with lifestyle. They are,
therefore, largely preventable.
Who is at risk to such
disease:
 NCDs
are often associated with older age
groups
90% occurred in low- and middle-income
countries.
Children, adults and the elderly are all vulnerable
to the risk factors that contribute to non
communicable diseases, whether from unhealthy
diets, physical inactivity, exposure to tobacco
smoke or the effects of the harmful use of
alcohol.
Statistics
around the world
• Tobacco accounts for almost 6 million
deaths every year (including over 600 000
deaths from exposure to second-hand
smoke).
• About 3.2 million deaths annually can be
attributed to insufficient physical activity.
• Approximately 1.7 million deaths are
attributable to low fruit and vegetable
consumption.
• Half of the 2.3 million annual deaths from
harmful drinking are from NCDs.
Types of Non-Communicable
diseases
Main types of (NCDs) are:
1.cardiovascular diseases (like heart attacks
and stroke)
2. Hypertension
3.cancers
4.chronic respiratory diseases (such as
chronic obstructed pulmonary disease and
asthma)
.
Types of Non-Communicable diseases
Main types of (NCDs) are:
5.diabetes
6. Hyper lipid
7. Obesity
8. Smoking
Cardiovascular Disease
- Stroke
- Heart failure
Stroke
Stroke
Definition:
sometimes referred to as a cerebrovascular accident (CVA), is the
rapid loss of brain function due to disturbance in the blood supply
to the brain. This can be due to ischemia (lack of blood flow)
caused by blockage (thrombosis, arterial embolism), or a
hemorrhage.[1] As a result, the affected area of the brain cannot
function, which might result in an inability to move one or more
limbs on one side of the body, inability to understand or
formulate speech, or an inability to see one side of the visual field
Prevention
Because stroke may indicate underlying atherosclerosis, it is
important to determine the patient's risk for other
cardiovascular diseases such as coronary heart disease. Conversely,
aspirin confers some protection against first stroke in people who
have had a myocardial infarction or those with a high
cardiovascular risk In those who have previously had a stroke,
treatment with medications such as aspirin, clopidogrel and
dipyridamole may be given to prevent platelets from aggregating.
Risk Factors
- The most important modifiable risk factors for stroke are high
blood pressure and atrial fibrillation. Other modifiable risk factors
include high blood cholesterol levels, diabetes, cigarette smoking
(active and passive), heavy alcohol consumption and drug use, lack
of physical activity, obesity, processed red meat consumption and
unhealthy diet.
Heart Failure
Often called congestive heart failure (CHF) or congestive cardiac
failure (CCF), occurs when the heart is unable to provide sufficient
pump action to maintain blood flow to meet the needs of the
body. Heart failure can cause a number of symptoms including
shortness of breath, leg swelling, and exercise intolerance. The
condition is diagnosed by patient physical examination and
confirmed with echocardiography. Blood tests help to determine
the cause.
Causes
1.Ischaemic heart disease 62%
2.Cigarette smoking 16%
3.Hypertension (high blood pressure) 10%
4.Obesity 8%
5.Diabetes 3%
6.Valvular heart disease
Diagnosis
- Imaging
- Echocardiography is commonly used to support a clinical diagnosis
of heart failure.
- Chest X-rays
- Electrophysiology
- An electrocardiogram (ECG/EKG)
- Blood tests
Risk factors
- High blood pressure. Your heart works harder than it has to if
your blood pressure is high.
- Coronary artery disease. Narrowed arteries may limit your heart's
supply of oxygen-rich blood, resulting in weakened heart muscle.
- Heart attack. Damage to your heart muscle from a heart attack
may mean your heart can no longer pump as well as it should.
- Diabetes. Having diabetes increases your risk of high blood
pressure and coronary artery disease.
Prevention
Lower risk of getting heart disease by
making lifestyle changes.
 Control certain health problems, such
as high blood pressure and diabetes.
 Recommended Related to Heart
Failure
 Edema Overview

Prevention
Don't smoke. If you smoke, quit.
Smoking greatly increases your risk
for heart disease. Avoid secondhand
smoke too.
 Lower cholesterol. If you have high
cholesterol, follow doctor's advice for
lowering it. Eating a heart-healthy
diet-such as exercising, and quitting
smoking will help keep cholesterol
low.

Hypertension
Hypertension is defined as a systolic blood pressure greater than
140 mm Hg and a diastolic pressure greater than 90 mmHg based
on the average of two or more accurate blood pressure
measurements taken during two or more contacts with a health
care provider
Hypertension
Hypertension may be primary, which may develop as a result of
environmental or genetic causes, or secondary, which has multiple
etiologies, including renal, vascular, and endocrine causes. Primary
or essential hypertension accounts for 90-95% of adult cases, and
a small percentage of patients (2-10%) have a secondary cause.
Hypertensive emergencies are most often precipitated by
inadequate medication or poor compliance.
Hypertension
Most individuals diagnosed with hypertension will have increasing
blood pressure (BP) as they age. Untreated hypertension is
notorious for increasing the risk of mortality and is often described
as a silent killer. Mild to moderate hypertension, if left untreated,
may be associated with a risk of atherosclerotic disease in 30% of
people and organ damage in 50% of people within 8-10 years after
onset.
Death from ischemic heart disease or stroke increases
progressively as BP increases. For every 20 mm Hg systolic or 10
mm Hg diastolic increase in BP above 115/75 mm Hg, the
mortality rate for both ischemic heart disease and stroke doubles.
Patient Education
*Hypertension is a lifelong disorder. For optimal control, a longterm commitment to lifestyle modifications and pharmacologic
therapy is required. Therefore, repeated in-depth patient
education and counseling not only improve compliance with medical
therapy but also reduce cardiovascular risk factors.
*Various strategies to decrease cardiovascular disease risk include
the following:
Patient Education
*Prevention and treatment of obesity: an increase in body mass
index (BMI) and waist circumference is associated with an increased
risk of developing conditions with high cardiovascular risk, such as
hypertension, diabetes mellitus, impaired fasting glucose, and left
ventricular hypertrophy.
Patient Education
*Appropriate amounts of aerobic physical activity
*Diets low in salt, total fat, and cholesterol
*Adequate dietary intake of potassium, calcium, and magnesium
*Limited alcohol consumption
Patient Education
*Avoidance of cigarette smoking
*Avoidance of the use of illicit drugs, such as cocaine
CANCER
What Is Cancer?
Cancer is a class of diseases characterized by out-of-control cell
growth. There are over 100 different types of cancer, and each is
classified by the type of cell that is initially affected.
Cancer harms the body when damaged cells divide
uncontrollably to form lumps or masses of tissue called tumors
(except in the case of leukemia where cancer prohibits normal
blood function by abnormal cell division in the blood stream).
Tumors can grow and interfere with the digestive, nervous, and
circulatory systems, and they can release hormones that alter body
function. Tumors that stay in one spot and demonstrate limited
growth are generally considered to be benign.
Cancer Epidemiology

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

Cancer Epidemiology
although cancer affect people of all ages,
most cancer occur in people older than 65
years of age.
overall, the incidence of cancer is higher in
men than in women.
Higher in industrial nations.
Cancer Epidemiology
In Female
In male
WHO
Cancer Epidemiology

Jordanians:

Age group and Gender:
A total of (4798) new cases of cancer were recorded among
Jordanian in the year 2009, of these, 2280 cases (47.5 %)
were males and (2518) cases (52.5 %) were females .
The male to female ratio for cancer cases in Jordan was
0.90: 1; it’s slightly less than the ratio in 2008 (0.97:1).
Distribution of cancer cases by age group shows that about
42.6 % of the cases occurred in the age 60 years and
above. In this age group cancer is more in males (55%) than
females (45%). on the other hand cancer in females
predominate (61%) in the age group 30-59 years compared
with cancer in males (39%) and this is mostly due to high
incidence of breast cancer in this age group, while in the
age group 0-29 years males (52%) were slightly more than
female



Cancer Epidemiology
What causes cancer?
Cancer is ultimately the result of cells that
uncontrollably grow and do not die. Normal
cells in the body follow an orderly path of
growth, division, and death. Programmed
cell death is called apoptosis, and when this
process breaks down, cancer begins to
form. Unlike regular cells, cancer cells do
not experience programmatic death and
instead continue to grow and divide. This
leads to a mass of abnormal cells that
grows out of control.
Risk Factors

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
Non modifiable
Aging “The most significant risk factor
is age”
Genetics
Risk Factors
Modifiable
 Tobacco smoking, which is strongly associated with lung cancer,
mouth, and throat cancer

Drinking alcohol, which is associated with a small increase in oral,
esophageal, breast, liver and other cancers

a diet low in fruit and vegetables,

physical inactivity, which is associated with increased risk of colon,
breast, and possibly other cancers

obesity , which is associated with colon, breast, endometrial, and
possibly other cancers
 sexual transmission of human papillomavirus , which causes
cervical cancer and some forms of anal cancer.
Other lifestyle and environmental factors known to affect cancer risk
(either beneficially or detrimentally) include the use of exogenous
hormones (e.g., hormone replacement therapy causes breast
cancer), exposure to ionizing radiation and ultraviolet radiation, and
certain occupational and chemical exposures.

Detection

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

In many cases, the sooner cancer is
diagnosed and treated, the better a person's
chance for a full recovery.
Often a doctor can find early cancer during a
physical exam or with routine tests
Imaginig ( X-Ray, CT scan, MRI, Ultrasound )
Endoscopy
Tissue samples
The only absolutely certain way to diagnose
cancer is to take a cell sample (a process called
a Biopsy )
Tests on blood and other samples
Prevention of Cancer
Primary Prevention
Is concerned with reducing the risk of disease through
health promotion strategies.
1/3 Cancer cases can be prevented through health
promotion program.
The role of community health nursing is essential to
reduce cancer prevalence; through:
1- Help patient avoid known carcinogens.
2- encourage client to make dietary and lifestyle
changes ( smoking cessation, decrease calories
intake, increase physical activity)
3- Nurses use their teaching and counseling skills to
provide patient education and support public
education.

Prevention of Cancer




Secondary prevention
Secondary prevention program
promote screening and early detection
activities such as breast and testicular
self examination.
Cancer test such as mammogram,
digital rectal examination.
In-depth screening and follow up for
people who are at high risk.
The Role of nurse in Cancer
treatment




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direct patient care;
documentation in the medical record;
participation in therapy;
symptom management;
organization of referrals to other
healthcare providers;
both patient and family education;
The Role of nurse in Cancer
treatment
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as well as counseling throughout diagnosis, therapy,
and follow up.
The nurse should serve as the patient's first line of
communication.
Ideally, the patient and family should feel free to
contact the oncology nurse by phone during the entire
treatment program.
Many patients travel long distances, so the importance
of communication by telephone must be emphasized.
It allows continuous patient communication, early
recognition of emergencies, and regular emotional
support.
Chronic Respiratory Diseases
-Chronic Obstructed Pulmonary Disease (COPD)
-Asthma
(COPD)
Definition
Is a progressive disease that makes it hard
to breathe. "Progressive" means the disease
gets worse over time.
COPD can cause coughing that produces
large amounts of mucus (a slimy substance),
wheezing, shortness of breath, chest
tightness, and other symptoms.
(COPD)
Risk factors
1- Cigarette smoking is the leading cause of
COPD. Most people who have COPD smoke
or used to smoke.
2- Long-term exposure to other lung
irritants—such as air pollution, chemical
fumes, or dust—also may contribute to
COPD.
(COPD)
Risk factors
3- Rarely, a genetic condition called alpha-1
antitrypsin deficiency may play a role in
causing COPD.
4- Some people who have asthma can
develop COPD.
(COPD)
Risk factors
5- Most people who have COPD are at
least 40 years old when symptoms begin.
Although uncommon, people younger than
40 can have COPD. For example, this may
happen if a person has alpha-1 antitrypsin
deficiency, a genetic condition.
(COPD)
Prevention

1.
Prevent COPD Before It Starts
The best way to prevent COPD is to not
start smoking or to quit smoking. Smoking
is the leading cause of COPD. If you smoke,
talk with your doctor about programs and
products that can help you quit.
(COPD)
Prevention

Prevent COPD Before It Starts
2. If you have trouble quitting smoking on
your own, consider joining a support group.
to help people quit smoking. Ask for
support.
3.Also, try to avoid lung irritants that can
contribute to COPD.
(COPD)
Prevention

Prevent Complications and Slow the
Progress of COPD
The most important step you can take is
to quit smoking. Quitting can help prevent
complications and slow the progress of the
disease. You also should avoid exposure to
the lung irritants.
(COPD)
Prevention

Prevent Complications and Slow the
Progress of COPD
Follow your treatments for COPD exactly
as your doctor prescribes. They can help you
breathe easier, stay more active, and avoid
or manage severe symptoms.
(COPD)
Prevention

Prevent Complications and Slow the
Progress of COPD
Talk with your doctor about whether and
when you should get flu (influenza) and
pneumonia vaccines. These vaccines can lower
your chances of getting these illnesses,
which are major health risks for people who
have COPD.
(COPD)
Prevention
Living With COPD
COPD has no cure yet. However, you can
take steps to manage your symptoms and
slow the progress of the disease. You can:
1. Avoid lung irritants
2. Get ongoing care
3. Manage the disease and its symptoms
4. Prepare for emergencies

(COPD)
Prevention
Living With COPD
Manage the disease and its symptoms
1- Do activities slowly.
2- Put items that you need often in one
place that's easy to reach.
3- Find very simple ways to cook, clean, and
do other chores. For example, you might
want to use a small table or cart with
wheels to move things around and a pole or
tongs with long handles to reach things.

(COPD)
Prevention
Living With COPD
Manage the disease and its symptoms
4- Ask for help moving things around in your
house so that you won't need to climb
stairs as often.
5- Keep your clothes loose, and wear clothes
and shoes that are easy to put on and take
off.

2. Asthma
What Is Asthma?
Is a chronic (long-term) lung disease that
inflames and narrows the airways. Asthma
causes recurring periods of wheezing (a
whistling sound when you breathe), chest
tightness, shortness of breath, and
coughing. The coughing often occurs at night
or early in the morning.
Who Is at Risk for Asthma?
1- Asthma affects people of all ages, but it
most often starts during childhood. In the
United States, more than 25 million people
are known to have asthma. About 7 million
of these people are children.
Who Is at Risk for Asthma?
2- Young children who often wheeze and
have respiratory infections—as well as
certain other risk factors—are at highest
risk of developing asthma that continues
beyond 6 years of age. The other risk
factors include having allergies, eczema (an
allergic skin condition), or parents who have
asthma.
Who Is at Risk for Asthma?
3- Among children, more boys have asthma
than girls. But among adults, the disease
affects men and women equally. It's not
clear whether or how sex and sex hormones
play a role in causing asthma.
Who Is at Risk for Asthma?
4- Most, but not all, people who have
asthma have allergies.
5-Some people develop asthma because of
contact with certain chemical irritants or
industrial dusts in the workplace. This type
of asthma is called occupational asthma.
How Can Asthma Be
Prevented?
You can’t prevent asthma. However, you
can take steps to control the disease and
prevent its symptoms.
For example:
1-Learn about your asthma and ways to
control it.
2-Follow your written asthma action plan.
Get regular checkups for your asthma.
How Can Asthma Be
Prevented?
3-Use medicines as your doctor prescribes.
4-Identify and try to avoid things that make
your asthma worse (asthma triggers).
However, one trigger you should not avoid is
physical activity. Physical activity is an
important part of a healthy lifestyle. Talk
with your doctor about medicines that can
help you stay active.
Diabetes Mellitus
Diabetes Mellitus
•
Occurs when the pancreas does not produce
enough insulin, or when the body cannot
effectively use the insulin it produces. This
leads to an increased concentration of
glucose in the blood (hyperglycemia).
Diabetes Mellitus
•
•
Type 1:(previously known as insulindependent or childhood-onset diabetes) is
characterized by a lack of insulin production.
Type 2:(formerly called non-insulindependent or adult-onset diabetes) is
caused by the body’s ineffective use of
insulin. It often results from excess body
weight and physical inactivity.
Diabetes Mellitus
Risk factors
1-People of South Asian, African, AfricanCaribbean, Polynesian, Middle-Eastern and
American-Indian descent are at greater risk
of type 2 diabetes, compared with the
white population.
2-People who are obese, are inactive or have
a family history are also at increased risk of
type 2 diabetes.
Diabetes Mellitus
Risk factors
*Weight
The more fatty tissue you have, the
more resistant your cells become to insulin.
*Inactivity
The less active you are, the greater your
risk. Physical activity helps you control your
weight and good health
Decreasing the risk of diabetic
Helps you to deal with stress and improve
mood .
Diabetes Mellitus
Risk factors
2-dietary factors
3- Family history. Your risk increases if a
parent or sibling has type 2 diabetes.
Diabetes Mellitus
managment
4-*foot care:
1. Is very important to check your leg daily
2. Keep clean and soft
3. Breathable shoes
4. Report any change
Checking your blood sugar:
 Frequency and time of day
 Hyper( polyuria ( frequency urination)
, polydipsia( increase thirst )
Polyphagia ( increase hungry).
 Hypo ( lightheadness ,confusion
,sweating , pounding in HR)

Prevention
•
Healthy lifestyle choices can help you
prevent type 2 diabetes. Even if you have
diabetes in your family, diet and exercise
can help you prevent the disease. If you've
already been diagnosed with diabetes, the
same healthy lifestyle choices can help you
prevent potentially serious complications.
Prevention
•
•
•
Eat healthy foods. Choose foods low in fat
and calories. Focus on fruits, vegetables and
whole grains.
Get physical. Aim for 30 minutes of
moderate physical activity a day. Take a
brisk daily walk.
Lose excess pounds.
hyperlipidemia

abnormally elevated levels of any or
all lipids and/or lipoproteins in the
blood.[1] It is the most common form of
dyslipidemia (which includes any
abnormal lipid levels).
Obesity
*Obesity: 
is a medical condition in which excess body
fat has accumulated to the extent that it may
have an adverse effect on health, leading to
reduced life expectancy and/or increased
health problems

. People are considered obese when their body
mass index (BMI), a measurement obtained
by dividing a person's weight in kilograms by
the square of the person's height in metres,
exceeds 30 kg/m2
Risk factors
1.
2.
3.
4.
5.
6.
Obesity increases the likelihood of various diseases
heart disease
type 2 diabetes
obstructive sleep apnea
certain types of cancer
osteoarthritis.
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excessive food energy intake
lack of physical activity
genetic susceptibility
endocrine disorders
medications
psychiatric illness.
Role of nursing
health education
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Dieting and physical exercise are the
mainstays of treatment for obesity.
Diet quality can be improved by
reducing the consumption of energydense foods such as those high in fat
and sugars, and by increasing the
intake of dietary fiber.

Anti-obesity drugs may be taken to
reduce appetite or inhibit fat
absorption together with a suitable
diet.
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gastric balloon may assist with weight
loss, or surgery may be performed to
reduce stomach volume and/or bowel
length.
Smoking
Risks to your health
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Smoking causes about 90% of lung
cancers.
It also causes cancer in many other
parts of the body, such as the:
throat
voice box (larynx)
esophagus (the tube between your
mouth and stomach)
bladder
Kidney , liver , stomach
pancreas
Risks to your health

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Smoking damages your heart and your
blood circulation, increasing the risk of
conditions such as:
coronary heart disease
heart attack
stroke
Summary :
Nurses Play a central role in health
service delivery, promotion, prevention,
treatment and rehabilitation in areas of
great health need, where they may be
the only frontline providers of health,
especially in remote areas Since in most
countries nurses and midwives form the
bulk of the clinical health workforce,
developing and strengthening human
resources for health means recognizing
that nursing services play a vital role in
improving health service delivery
References
- Medical Surgical book
- Medscape
- Wiki
(http://www.nhs.uk/chq/Pages/2344.aspx?Cat
egoryID=53)
_ who
-CDC
Article
Prevalence of Selected Chronic, Noncommunicable
Disease Risk Factors in Jordan: Results of the 2007
Jordan Behavioral Risk Factor Surveillance Survey.
Abstract
Introduction
Non-communicable diseases (NCDs) are the leading cause of
illness and death in Jordan. Since 2002, the Jordan
Ministry of Health, in cooperation with the World Health
Organization and the Centers for Disease Control and
Prevention, established the Jordan Behavioral Risk Factor
Surveillance Survey to collect information on many of the
behaviors and conditions related to NCDs. The objectives of
this study were to describe the prevalence of selected NCD
risk factors and the relationship between body mass index and
selected health conditions among a nationally
representative sample of Jordanian adults aged 18 years or
older.
Methods
We used a multistage sampling design to select 3,688 households,
from which we randomly selected and interviewed 1
adult aged 18 years or older. A total of 3,654 adults completed the
survey. We randomly selected a subsample of 889
interviewed adults and invited them to visit local health clinics for a
medical evaluation; we obtained measurements,
including fasting blood glucose and blood lipids, from 765 adults.
Data were collected between June 1, 2007, and
August 23, 2007.
Results:
Nearly one-third of participants smoked cigarettes, 18% reported
having been diagnosed with high blood pressure, and
10% reported frequent mental distress. Compared with survey
participants who did not participate in the medical
evaluation, those who participated were more likely to self-report high
blood pressure, high blood cholesterol, and
diabetes and report lower levels of health-related quality of life. Among
participants of the medical evaluation, an
estimated 11% reported they had been diagnosed with diabetes by a
health professional, and 19% were diagnosed with
diabetes according to laboratory testing. Approximately one-third of
participants of the medical evaluation were either
overweight (30%) or obese (36%). In the fully adjusted model, obese
participants of the medical evaluation were nearly
3 times as likely to have high blood pressure and more than 2 times as
likely to have high blood cholesterol as normal weight
participants.
Conclusion
Diabetes, high blood pressure, high cholesterol,
and obesity are a public health concern in
Jordan. Adequate and
continuous monitoring of NCD risk factors in
Jordan is needed, and the surveillance findings
should be used in health
promotion and disease prevention activities.
Mohannad Al-Nsour, MD, MSc; Meyasser
Zindah, MD; Adel Belbeisi, MD; Raja
Hadaddin, MD;
David W. Brown, DSc, MScPH, MSc; Henry
Walke, MD, MPH.