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Care Plan

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Submitted By nmaracle3834
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Name of community and zip code:
Plymouth, MI

Brief history of the community:
City in Wayne County with a population of 9,132. Population includes 93 % Caucasian, 2.6% Hispanic, 1.5% Black, 1.5% Asian and 1.4% other. Total square miles of 2.22 (2.21 is land and 0.01 is water).

Community health nursing assessment (Priority problem for this zip code and justification for the identified problem):
The priority problem for Plymouth, MI 48170 is heart disease. During my survey of the community, I did notice a lot of people dining in restaurants/bars, eating outside on restaurant patios smoking and drinking alcohol. Some of these people were obese. Smoking, drinking and obesity are contributors to heart disease that could be easily modified; ethnicity cannot be modified which is a small factor in this community. Hispanics are more susceptible to diabetes and African-Americans to hypertension. These are disease processes that may lead to heart disease. Sometimes lack of knowledge and education can also contribute to these problems.

Community health nursing diagnosis (Used at least one nursing diagnosis for the community).
Deficient knowledge regarding condition, treatment plan, selfcare r/t unavailability of health education as evidenced by increased heart disease in community.
Risk of decreased cardiac output r/t smoking, drinking and obesity.

Community health nursing plan (Identified at least one short term and one long term goal for the community. The goal/objective is related to the priority problem and is a measurable statement):
Short Term Goal: By 2017, 25% of people will be educated on heart disease and risk factors. They will be provided with programs to help quit smoking, diet and exercise programs and pamphlets on alcohol.
Long Term Goal: By 2020, there will be a 5% decrease in heart disease for this community.

Community health nursing interventions (State at least three interventions that would achieve the identified short and long term goals. These interventions are supported by the evidence-based literature. Use APA when citing the source of your interventions):
At least 3 interventions that could help us achieve our short and long goals would be: 1) Provide informational pamphlets on diet, exercise and low cholesterol. Information would include meal plans . Also pamphlets or information on ways to quit smoking including oral medications, patches, gum and nasal sprays 2) Work in collaboration with hospitals, clinics or outpatient facilities to devise dietary programs; alcohol, smoking and obesity support groups. 3) Work with insurance companies to help decrease insurance premiums for those who are compliant non smokers, non drinkers and those with a normal BMI <30 4) Work with local government to help fund programs in the community to aid patients with risk factors and provide preventative cardiac rehab for high risk patients. 5) Community health nurses to be provided with assistance to provide education, pamphlets to raise awareness.

Community health nursing evaluations (State how you would evaluate the interventions to meet the short and long term goals):
The interventions may be evaluated in various ways. We could have surveys and/or interviews done before the interventions. Later take those same surveys or interview questions to the people we have evaluated and see what the outcome of the goals are short term in 2017. At that point, we can reevaluate the goals and make adjustments as needed then repeat the process in 2020 to see the outcomes at that point. We can then take the numbers and see if our short term and long term goals were met.

Leading Causes of Death by Age. (n.d.). Retrieved November 20, 2015, from http://www.mdch.state.mi.us/pha/osr/chi/Deaths/31DP/MiniDPObject.asp?AreaCode=1785&AreaType=M&JS=No
Lloyd-Jones, D. (n.d.). Defining and Setting National Goals for Cardiovascular Health. Retrieved November 22, 2015, from http://circ.ahajournals.org/content/121/4/586.full

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