Assessment and Diagnosis July 24, 2011 Chamberlain College of Nursing NR443: Community Health Nursing S. Cleveland Summer 2011 Session A Community The city of Cheyenne is the capital and the largest city in the state of Wyoming. Located in the southeastern most part of the state and considered the northern terminus of the extensive and fast-growing Front Range Corridor. According to the 2010 U. S. Census Bureau Cheyenne had a population of 59,466 with a growth rate of 12. 2% since the 2000 census. The community that was observed is that of South Cheyenne.
This area has the most diversity within the city limits. South Cheyenne has an unfounded image of being the slums, poverty side of town, Northside/Southside division, reputation. South Greeley Highway does not present a positive image for the community. The amount of junkyards, garbage, and abandon buildings create an “eye sore” presenting an uninviting appearance. This area has multiple trailer parks that are rundown and there is a sense of some lack of pride in ownership for both homes and businesses.
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There is one grocery store, a half dozen of food establishments, ranging from fast food to dining in.
A few liquor stores, several bars, an elementary and high school. There appears to be minimal recreational opportunities for the community. There is Romero Park with the youth activity center, and the Boys and Girls club relocation to South Cheyenne. However, these have yet to be completed. There still remains the need for additional recreation opportunities such as a golf course, more pathways, ball fields, and parks. Noted is an incomplete greenway that could serve as a means of recreation for all age groups once completed.
Medical services in South Cheyenne are limited and what services that are available are not centrally located but dispersed throughout the community. South Cheyenne does house the City County Health Department which provides minimal medical care for a minimum fee. Accessibility to such services is further complicated by minimal public transportation options. Problem Being a community with obesity, lack of medical care, healthy food choices, and recreation whether indoors or outdoors, places this community at a high risk to developing diabetes.
According to the Wyoming city data in 2010, there is a population of 7. 9% with diabetes. With the high diversity of Hispanics, black, and Asian peoples living within this community, research has shown them to have a higher prevalence to this disease (Sherard, 2010). Increasing prevention behaviors in persons at high risk for diabetes with pre-diabetes is just one of many objectives stated by Healthy People 2020. Within this objective, the goal is to: 1). Increase the proportion of persons at high risk for diabetes with pre-diabetes who report increasing their levels of physical activity. ). Increase the proportion of persons at high risk for diabetes with pre-diabetes who report to lose weight. 3). Increase the proportion of persons at high risk for diabetes with pre-diabetes who report reducing the amount of fat calories in their diet. A. Historical Significance: According to the article The Causes, Complications and Impact of Diabetes on Wyoming and and its Residents by Brent Sherard, MD, more than 7% of Wyoming’s adult population has diabetes. In 2007, diabetes was the 6th leading cause of deaths in Wyoming.
Just in a year’s time-frame, 50 lower extremity amputations occurred, there were 625 hospitalizations where the primary diagnosis was diabetes at a cost of $7. 5 million. Wyoming’s small population and lack of diabetes-related specialists present problems treating individuals with diabetes. With Cheyenne being a community of military and retired vets, the estimation of increased population aging is estimated to be 113% by 2020 and with age being a significant risk factor, the increased burden of diabetes in the community will be a direct result (Sherard, 2010).
C. History of Diabetes: Prepathogenesis of diabetes lies in the risk factors such as obesity, increased girth circumference, hypertension, hypercholesteremia, lack of physical activity. If the risk factors are not eliminated, the risk increases for the patient to develop diabetes. According to Bardsley & Want, pathogenesis of diabetes of both IDDM and NIDDM are heterogeneous diseases with environmental and genetic determinants.
Diabetes mellitus is a syndrome with disordered metabolism and inappropriate hyperglycemia due to either a deficiency of insulin secretion or to a combination of insulin resistance and inadequate insulin secretion to compensate (Bradsley & Want, 2004). Type 1 diabetes is due to pancreatic islet B cell destruction predominantly by an autoimmune process, and these patients are prone to ketoacidosis. Type 2 diabetes is the more prevalent form and results from insulin resistance with a defect in compensatory insulin secretion.
The resolution for diabetes is to take steps towards healthy places for physical activity such as incorporating health into local planning decisions, increasing access to parks and green spaces, offering incentives for employers to provide workplace wellness programs, improving the access to nutritious produce and products, and involve schools in creating models of healthy behavior for the community. Summary Diabetes is part of the Healthy People 2020 chronic diseases and is number five of the twenty-eight focus areas.