1Keep your eye on the donut, not on the holeKeep your eye on the donut, not on the holeIntroduction to Community HealthIntroduction to Community HealthThe Science of Nursing in the CommunityThe Science of Nursing in the CommunityN5290N5290Jill Gallin, CPNPJill Gallin, CPNPAssistant Professor of Clinical NursingAssistant Professor of Clinical NursingColumbia University School of NursingColumbia University School of NursingStudent Experience?Student Experience?McKenzie et al, An Introduction to McKenzie et al, An Introduction to Community Health (2002)Community Health (2002)Brief History of Community HealthBrief History of Community Health500 B.C.500 B.C.--A.D. 500A.D. 500••GreeksGreeks––Exercise in physical games of strengthExercise in physical games of strength••RomansRomans––AqueductsAqueducts––Sewer systemSewer system––Refuse removalRefuse removal––hospitalhospitalA.D. 500A.D. 500--15001500Spiritual era of public healthSpiritual era of public health••Belief of disease from supernatural causesBelief of disease from supernatural causes••Spread of communicable diseasesSpread of communicable diseases––LeprosyLeprosy––Plague (half the population of London, France Plague (half the population of London, France 1 in 10 survived)1 in 10 survived)2CDC.gov (2004)CDC.gov (2004)Leprosy/ Hansen’s DiseaseLeprosy/ Hansen’s Disease••MycobacteriumlepraeMycobacteriumleprae••Skin and nerve damageSkin and nerve damage••Manifestations of diseaseManifestations of disease––Skin lesions, nodules, plaquesSkin lesions, nodules, plaques––Thickened dermisThickened dermis––Involvement of nasal mucosa, Involvement of nasal mucosa, epistaxisepistaxis––Necrosis of body partsNecrosis of body parts––Sensory loss, numbnessSensory loss, numbness––Muscle weaknessMuscle weaknessBBC.orgBBC.orgleprosyleprosyBBC.orgBBC.orgLeprosyLeprosyBBC.orgBBC.orgLeprosyLeprosyCDC.gov (2004)CDC.gov (2004)Bubonic PlagueBubonic Plague••Usually result of a bite from an infected Usually result of a bite from an infected rodent flea, or by handling infected animalsrodent flea, or by handling infected animals••Does NOT usually spread person to personDoes NOT usually spread person to person••SymptomsSymptoms––high feverhigh fever––enlarged, tender lymph nodes, often in the groinenlarged, tender lymph nodes, often in the groin••Incubation period: 2Incubation period: 2--10 days 10 days ••Treatment: antibioticsTreatment: antibioticsCDC.gov (2004)CDC.gov (2004)Pneumonic PlaguePneumonic Plague••Result of sufficient dose of bacterial Result of sufficient dose of bacterial organisms is inhaled; a small percentage organisms is inhaled; a small percentage of bubonic cases develop pneumonic of bubonic cases develop pneumonic plagueplague••Can be spread person to personCan be spread person to person••Incubation period: 2Incubation period: 2--3 days3 days••Bacillus viable one hour after attackBacillus viable one hour after attack3CDC.gov(2004)CDC.gov(2004)PlaguePlague••Signs and SymptomsSigns and Symptoms––Acute fulminate pneumonia with high feverAcute fulminate pneumonia with high fever––dyspneadyspnea––cough w/ blood tinged or purulent sputumcough w/ blood tinged or purulent sputum––cutaneous manifestations: cutaneous manifestations: livid cyanosislivid cyanosisecchymosisecchymosisnecrosis of digits and nosenecrosis of digits and noseRing Around the RosyRing Around the RosyRing around the rosyRing around the rosy(rose(rose--colored purpuric lesions)colored purpuric lesions)Pocket full of posiesPocket full of posies(flowers carried to prevent the disease and cover (flowers carried to prevent the disease and cover the stench)the stench)Ashes, AshesAshes, Ashes(death)(death)We all fall downWe all fall down(we all die)(we all die)PlaguePlagueA.D. 1500A.D. 1500--17001700Renaissance and ExplorationRenaissance and Exploration••Plague killed saints and sinners alikePlague killed saints and sinners alike••Environment played a role in diseaseEnvironment played a role in diseaseEighteenth CenturyEighteenth Century••Overcrowded citiesOvercrowded cities••Poor water supplyPoor water supply••Poor sanitationPoor sanitation••Unsafe workplaceUnsafe workplace4Eighteenth Century Eighteenth Century communicable diseasecommunicable disease••Small poxSmall pox••CholeraCholera••Typhoid feverTyphoid fever••Yellow feverYellow fever••Average age of death: 29 Average age of death: 29 SmallpoxSmallpox••OrthopoxvirusOrthopoxvirusfamily,family,((variolavariolamajor)major)••Can spread from person to person, aerosolizedCan spread from person to person, aerosolized••Signs and symptomsSigns and symptoms––fluflu--like beginning with high feverlike beginning with high fever––maculopapular rash usually starts on face and hands maculopapular rash usually starts on face and hands then forearms and trunk and legsthen forearms and trunk and legs––become vesicular and pustular (embedded in dermis)become vesicular and pustular (embedded in dermis)––all lesions occur at same level of developmentall lesions occur at same level of development––leave pitted scar after separation from skinleave pitted scar after separation from skinCholeraCholera••Infection of small intestine by Infection of small intestine by VibrioVibriocholeraecholerae, , ingesting contaminated food and ingesting contaminated food and waterwater••watery diarrheawatery diarrhea••Severe dehydrationSevere dehydration––Review symptomsReview symptomsTyphoidTyphoid••Infection by salmonella Infection by salmonella typhityphiin in contaminated food, watercontaminated food, water••DiarrheaDiarrhea••Systemic disease, high fever, weakness, Systemic disease, high fever, weakness, fatigue, deliriumfatigue, delirium••Rash “rose spots” abdomen and chestRash “rose spots” abdomen and chestYellow FeverYellow Fever••Virus transmitted by mosquitoesVirus transmitted by mosquitoes••Fever, jaundice, generally illFever, jaundice, generally ill••15% progress to intoxication period15% progress to intoxication period––Kidney failure, hemorrhage, brain dysfunction, Kidney failure, hemorrhage, brain dysfunction, seizures, coma, deathseizures, coma, death5Eighteenth Century AdvancesEighteenth Century Advances••1790 George Washington ordered the first US 1790 George Washington