Non Communicable Diseases

1. Non Communicable Diseases Abeer Fayez Qato

2. 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.

3. Objective By the end of this Seminar, the students will be able to : • - Identify the definition of Non communicable • Diseases (NCDs). • IdentifyTypes of Non-Communicable diseases. • Identify the role of community nurse in primary, • secondary and tertiary prevention.

4. 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.

5. 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.

6. 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.

7. 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) .

8. Types of Non-Communicable diseases Main types of (NCDs) are: 5.diabetes 6. Hyper lipid 7. Obesity 8. Smoking

9. Cardiovascular Disease - Stroke - Heart failure

10. Stroke

11. 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

12. 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.

13. 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.

14. 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.

15. 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

16. Diagnosis - Imaging - Echocardiography is commonly used to support a clinical diagnosis of heart failure. - Chest X-rays - Electrophysiology - An electrocardiogram (ECG/EKG) - Blood tests

17. 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.

18. 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

19. 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.

20. 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

21. 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.

22. 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.

23. Patient Education *Hypertension is a lifelong disorder. For optimal control, a long-term commitment to lifestyle modifications and pharmacologic therapy is required. Therefore, repeated in-depth patient education and counseling not only improve compliance with medical therapy but also reduce cardiovascular risk factors. *Various strategies to decrease cardiovascular disease risk include the following:

24. 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.

25. 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

26. Patient Education *Avoidance of cigarette smoking *Avoidance of the use of illicit drugs, such as cocaine

27. CANCER

28. 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.

29. Cancer Epidemiology • Cancer Epidemiology • although cancer affect people of all ages, most cancer occur in people older than 65 years of age. • overall, the incidence of cancer is higher in men than in women. • Higher in industrial nations.

30. Cancer Epidemiology In Female In male WHO

31. 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

32. Cancer Epidemiology

33. 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.

34. Risk Factors • Non modifiable • Aging “The most significant risk factor is age” • Genetics

35. 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.

36. Detection In many cases, the sooner cancer is diagnosed and treated, the better a person's chance for a full recovery. Often a doctor can find early cancer during a physical exam or with routine tests Imaginig ( X-Ray, CT scan, MRI, Ultrasound ) Endoscopy Tissue samples The only absolutely certain way to diagnose cancer is to take a cell sample (a process called a Biopsy ) Tests on blood and other samples

37. 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.

38. 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.

39. The Role of nurse in Cancer treatment • direct patient care; • documentation in the medical record; • participation in therapy; • symptom management; • organization of referrals to other healthcare providers; • both patient and family education;

40. The Role of nurse in Cancer treatment • as well as counseling throughout diagnosis, therapy, and follow up. • The nurse should serve as the patient's first line of communication. • Ideally, the patient and family should feel free to contact the oncology nurse by phone during the entire treatment program. • Many patients travel long distances, so the importance of communication by telephone must be emphasized. It allows continuous patient communication, early recognition of emergencies, and regular emotional support.

41. Chronic Respiratory Diseases-Chronic Obstructed Pulmonary Disease (COPD) -Asthma

42. (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.

43. (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.

44. (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.

45. (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.

46. (COPD)Prevention • 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.

47. (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.

48. (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.

49. (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.

50. (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.