May 142020
 

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Definition of the Disease

Emphysema is an anatomical alteration of lungs characterized by an abnormal expansion of the airspace located distal to the terminal bronchioles and associated with destructive changes of the alveolar walls. In the book , the authors give the following definition, “Emphysema is characterized by an increase in the volume of the airways distal to the bronchioles” (Silbernagl & ‎Lang, 2011, p. 82). In accordance with this definition, an inherent feature of emphysema is considered to be not only expansion but also destruction of the respiratory portions of the lungs. Moreover, the term destruction should be understood not only as a failure but as a violation of the normal structure. Emphysema, along with chronic obstructive bronchitis and asthma, means a group of chronic obstructive pulmonary disease (COPD). Such diseases are associated with the bronchial obstruction (Silbernagl & Lang, 2011). In such a way, there is the similarity in the clinical picture of these diseases. However, each of the forms of COPD has its specific characteristics, and correct diagnosis of these diseases allows conducting the purposeful prevention and rational therapy.

History of the Disease

Despite numerous studies on the problem of emphysema, many aspects that reflect the essence of this pathological sensation, its causes, patterns of the development, probability of timely diagnosis, as well as prevention and treatment, remain insufficiently studied. In the book it is stated that “inflation of the lung was first introduced by Laennec in the early XIX century, enabling him to make the first adequate description of emphysema” (Churg, Myers, & Tazelaar, 2011, p. 109). a complete description of the clinical picture of emphysema belongs to Sergey Botkin (Churg, Myers, & Tazelaar, 2011). In 1887, he was the first to identify acute reversible pulmonary hypertension as a special form of emphysema (Churg, Myers, & Tazelaar, 2011).

Pathogenesis of this Disease

According to pathogenesis, emphysema may be primary and secondary. Primary emphysema develops without preceding respiratory pathology. It is an independent nosological form. Previously, primary emphysema has been known as idiopathic and self-existing as its causes are still insufficiently clear.restated thesis statement However, in recent years, many researchers affirm that genetic factors, in particular a shortage of Alpha-1 antitrypsin, can be the reason of its development. Secondary emphysema appears on the background of other respiratory diseases, especially chronic obstructive bronchitis. According to the prevalence of lesions, there are diffuse and localized forms of emphysema. Primary and secondary emphysema developed on the background of chronic obstructive bronchitis refers to the diffuse form of the disease (Silbernagl & ‎Lang, 2011).

Exogenous factors that cause the development of emphysema include smoking, air pollution, and lung infections. Tom Smith states that “far and away, the most important cause of COPD is tobacco smoking” (Smith, 2012, p. 57). Cadmium, oxides of nitrogen, and sulfur are among the most likely components of tobacco smoke causing the disease (Smith, 2012). Among the factors causing the development of emphysema, pollutants and occupational hazards are of great importance. They have a damaging effect on the lung tissue and lead to the formation of chronic processes in the respiratory tract. Pulmonary infection is one of the causes of emphysema. Infectious inflammation stimulates the proteolytic activity of macrophages and neutrophils. Bacteria can also act as a additional source of proteolytic agents (Smith, 2012).

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Pathological Anatomy of Emphysema

Changes in the histological pattern of emphysema relate with the bronchi and bronchioles, connective and elastic tissue of the lungs, alveolar epithelium, and pulmonary vessels. The main morphological criteria of diffuse emphysema are the destruction of this respiratory department of lungs (Churg, Myers, & Tazelaar, 2011). Recent studies have shown that how big the entrance of the alveoli in a healthy person is no more than 10 microns. However, during emphysema, alveolar pores exceed 20 microns (Churg, Myers, & Tazelaar, 2011). The walls of the alveoli are presented by vascular smooth muscle. Due to disease, the capillaries become thinner and elastic fibers are in the process of degeneration. All these factors lead to a reduction of the surface in actively operating alveoli. Changed alveoli cause impaction of unchanged (Churg, Myers, & Tazelaar, 2011). This fact is also essential in violation of the lung ventilation function.

Pathological Physiology

Functional changes in emphysema are caused by several interrelated mechanisms: violation of the elastic frame of the lungs leading to a change in the structure of lung volumes and mechanical properties of the lung; bronchial obstruction; as well as destruction of interalveolar walls with progressive decrease in total operating surface of the lungs and decrease in diffusion capacity. One of the important factors is the pathogenetic mechanism of the expiratory closure of small airways (Kandel & Adamec, 2003). Currently, in pathogenesis of emphysema, much attention is also paid to exhaustion of the respiratory muscles. In addition, respiratory failure is aggravated by compression of this giant bullae in the functional relation of the normal lung tissue.

Shortness of breath is the first and main complaint of patients with emphysema (Kandel & Adamec, 2003). At the beginning of the disease, it appears only during the significant physical activity. Initially, patients often do not notice it. Shortness of breath in patients with emphysema is extremely dangerous. It becomes a life-threatening condition of gradually progressing for many years. Shortness of breath usually has the expiratory character. Patients have a short and acute breath and an extended exhale. Coughing is not a specific complaint of patients with emphysema. It is mostly associated with the presence of chronic bronchitis. Typically, a cough is dry with a small amount of sputum of the mucous character. Body weight in emphysema is usually decreased. It is associated with the hard work of respiratory muscles aimed at overcoming the high resistance of the terminal part of the respiratory tract (Kandel & Adamec, 2003).

The color of skin of the patients with emphysema is more pink than cyanotic. Noticeable cyanosis is caused by prolonged retention of blood gas composition. However, cyanosis occurs only in the severe cases of the disease, which can be associated with the development of hypercapnia. Patients may have a blue tint of the tongue which is a clinical indicator of hypercapnia. There is swelling of jugular’s vein during expiration due to an increase of intrathoracic pressure. In addition, barrel chest is observed during the examination of the chest. Sometimes, people with emphysema may have kyphosis. Side respiratory sounds are not typical for such patients.123helpme However, during the forced expiration, meager dry whistling rhonchus may appear (Kandel & Adamec, 2003).

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Diagnostic Methods

The most common method of emphysema diagnosis is X-ray examination (Kandel & Adamec, 2003). The main radiological signs are the increase in transparency of the lung fields and their total area, weakening of the vascular lung pattern, low position and flattening of the diaphragm, and restriction of its mobility. Usually, the size of heart is not increased. Due to the low position of the diaphragm, it is tear-shaped. Currently, there are new methods of emphysema diagnosis (Kandel & Adamec, 2003). Computer tomography reveals changes in the lung tissue which cannot be diagnosed in other ways. It provides an opportunity to identify the smallest elements of emphysema. Along with other diagnostic methods, nuclear magnetic resonance is important in the selection of candidates for conducting the operation to reduce lung volume in patients with the severe form of the disease (Kandel & Adamec, 2003). The method allows determining the location and severity of emphysema. Moreover, perfusion scintigraphy is also an efficient method of diagnosing vascular changes in lungs and this can be detected in the early stages when there are no clinical and radiographic signs of the disease (Kandel & Adamec, 2003).

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Treatment

Treatment of patients with emphysema is a complex task. Joseph Kandel and Christine Adamec claim that “emphysema is an incurable disease” (Kandel & Adamec, 2003, p. 102). Therapy should be directed to the proper treatment of emphysema and such complications associated with the disease as respiratory and heart failure in the case of accession of pulmonary heart. Treatment should also include activities aimed at improving the quality of patients’ life and slowing down the progression of the disease. In addition, smoking cessation is of primary importance during emphysema treatment. Considering medication, doctors may prescribe antibacterial drugs, anticholinergics (flomax, atrovent), sympathomimetic drugs (salbutamol), and theophylline (aminophylline) (Green, 2007). The choice of drug therapy and its intensity depends upon the severity of the symptoms.

The absence of adequate treatment of emphysema makes the prognosis unfavorable. The progression of the disease leads to early disability. It should be emphasized that the prognosis of emphysema is individual. In most cases, much depends upon the patients and their attitude to treatment.

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Introduction

According to World Health Organizations (WHO), the mitigation of zoonoses constitutes an imperative well-being matter. Numerous components characterizing preventive and control measures of zoonotic diseases require a broader perspective than the health sector alone. Achievement in reduced public health significance of zoonotic ailments significantly relies on the level of collaboration between human health services and veterinary divisions. Cooperation between them will aid in informational exchange, well-coordinated and shared surveillance frameworks, regular refresher courses for staff, and promoting community awareness. Commitment and mobilization of resources are essential factors in coping with pertinent challenges in the control of zoonoses. On the other hand, human reservoir diseases or commonly referred to as anthroponoses health problems involve an agent causing disease in the form of an infection carried by humans and they may be transmitted to other humans. Such diseases include measles, viral hepatitis, herpes, AIDS, smallpox, etc.

Proposed research

Researchers have designed a novel framework for the interdisplinary analysis of zoonotic diseases along with its drivers. After studying the different zoonotic aspects, one is expected to have gained some understanding the causes of zoonotic diseases, measures for reducing zoonotic diseases encroachment, and a multifaceted context to focus on the study of human-animal software critically (Michalak et al., 1998). Research studies outline a range of approaches to become infected with most changes that are determinants of infectious agents in the host population being associated with human activities. An example of zoonose disease is West Nile virus that is transmitted from birds to people by a mere mosquito bite (Keusch et al., 2009).

Zoonotic ailments find their way into people through numerous methodologies, for example, animal bites, contact with a different sort of mucous layer, ingestion, inward breath, cuts, and biting insects. However, humans have devised ways of protecting themselves from such infections that are brought on by these animals. For instance, rabies is transmitted from animals to humans through a bite. Another category is that of vector-borne by engaging an infectious agent that transmits the infection from the animal to humans. Among the most affected countries are Nigeria and Tanzania in Africa (Ostfeld & Keesing, 2000). The reason behind this occurrence is attributed to the poor animal administration that results from poverty with most farmers living on less than one dollar per day. However, the resulting infections are simply mild and they are not as perilous as it is recognized because if hygiene is observed, it is possible to keep away most of the zoonotic health problems.

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The lead cause of these infections is poor sanitation; another cause is brought on by individuals surviving in areas that are exceedingly populated by those who live in poverty. If these poor living conditions are eradicated and sound living is initiated, zoonotic health problems are going to be eliminated and it will be possible to treat the infected people by utilizing antibiotics. By having a reserve out of humans, zoonotic diseases become dangerous and difficult to control. Diseases, which are in contact with human beings, are not difficult to control as compared to those taking part in animals. Cholera, for example is eradicated with ease, as getting rid of it only requires a change in human behaviors. In addition, both water and food-borne zoonoses are passed through contaminated soils, drinking water, and food elements. However, the involvement of animal reservoir makes the matter even more complex. In order to prevent human beings from getting the virus, one is supposed to prevent animals from acquiring the virus or control the animals from getting into contact with the human being, which can be equally difficult (Keusch et al., 2009). Zoonotic diseases are highly dangerous as compared to human reservoirs. Consequently, zoonoses are classified into different categories, and particularly the new rising ones are exceptionally hard to control. If there is little emphasis put, it might result in the loss of lives before it is thoroughly examined.

Foodborne diseases present a big challenge in dealing with matters of human health with the rise of global population as well as demand for food from animal origin. The situation is further comprised of the dynamically changing technology in animal husbandry and food production in the food industry. Unfortunately, these upcoming technologies come along with risks in microbiology and toxicology, which leads to complications in the food industry. For instance, slaughterhouses and food processing industries of animal origin destabilize the food chain, particularly in the prevalence of pathogens such as and in domesticated animals (Keusch et al., 2009). Furthermore, poor regulation of antimicrobial application in animal production poses hazards to human health. Globalization of food supply along with increased international travel is one of major factors contributing to the global spread of drug-resistant organisms. For instance, the number of antimicrobial resistant elements of Salmonella has drastically increased due to the growing production of eggs.

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The situation of zoonosis varies from one region to another, with some countries placing active surveillance systems also as prioritizing zoonoses control programs and intersectoral mechanisms in areas such as Oman, Iran, and Saudi Arabia. However, intersectoral collaboration is limited to the control of brucellosis. In the cases of multisectoral committees, there are designed joint plans and coordinated actions. In other regions, the components of diagnosis and reporting are under development with some having no intersectoral collaboration and control activities (Keusch et al., 2009). Other forms of zoonotic diseases that have been in existence have become hazardous to human health, for example, rabies has caused many deaths in Uganda and Africa. There is confusion regarding whether to classify these diseases in the animal or public health. Rabies is a deadly virus transmitted through saliva. If an animal infected with the virus bites a human being, the virus goes up the nervous system to the brain and causes a fatal damage.

West Nile virus is a commonly known zoonotic disease that mainly infects birds. Birds, such as robins, as well as mosquitoes are common agents of transmitting the virus. The virus, unfortunately, causes an infection that has no signs; thus, it is often discovered late. For instance, this lateness results in high fever and inflammation in the vital body organs such as the spinal cord plus the brain. This causes serious effects among the affected individuals while the problem is further compromised by lack of a vaccine for either the birds or the humans (Michalak et al., 1998). According to the report by World Health Organization (WHO) in 2006, infections affiliated with human reservoirs are effectively eradicated. However, when it comes to the zoonotic diseases, it is difficult to eradicate them, and most health organizations and government departments have a big errand in getting rid of them since new diseases often crop up. They then concentrate on new ones and leave aside the ones that already exist, leaving human beings in danger.

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Finally, zoonoses are emphatically connected to people surviving in abject poverty because it is easy to be infected with them through either overpopulation, poor domesticated animals, or poor hygienic conditions. Equally, it is also difficult for these people to get medication due to lack of income whenever they are infected, which leads to their death and physical disabilities. Evidence demonstrates zoonoses are more hazardous than diseases that are associated with human reservoirs (Ostfeld & Keesing, 2000). There is complexity in controlling the diseases that often rise, thus making it hard to control the spread of these diseases and leading to loss of life to both human and animals.

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Objectives

STD is a common health problem in America plus the State of Florida. Statistics show that over 50% of young people reported at least one case of an STD in their teenage life every year. The rates are higher in married and adult couples. The Center for Disease Control and Prevention (CDC) reported that each year about 19 million American people suffer from STDs (Hobbs et al., 2014). The majority of the patients are of the age between 15 to 24 years (Rodriguez-Hart et al., 2015). In order to reduce the prevalence of STDs among this generation, medical researchers and practitioners have designed various objectives to target the groups which are most vulnerable to the STDs. For instance, in Florida, the medical board has developed policies and rules that help healthcare units and centers to give efficient STD care in a quick, effective, and affordable way. One of the challenges that face the identification and treatment of the STDs is the stigma associated with having the disease, some people are likely to shy away from treatment centers for fear of being judged as immoral. Thus, there is a need to encourage people to seek for examination whenever they suspect of having contracted an STD. Early check can help to increase the success level for treating the disease and also prevent the spread to other people. Additionally, the medical boards create public seminars and checkup camps that help experts to discuss the side effects of unprotected sex (Hobbs et al., 2014). Thus, the health care service providers guide people to reduce STDs.

Methods

Medical researchers apply various methods to control or reduce STD in their laboratories and health research centers in Florida. Like in many parts of the world, medical researchers in Florida are using vaccinations to control the prevalence of common STDs. This method of control is still under trial for highly prevalent STD like HIV/AIDS (Hobbs et al., 2014). More commonly, the vaccines are known to prevent Hepatitis A and B, and Human papillomavirus (HPV) among other STDs. Usually, the Florida Medical Board recommends these vaccines to the teenagers who are 11 and 12 years old and who are likely to be more sexually active at this stage (Patrick et al., 2015). In a national level, the CDC suggests American people to have a long-term monogamous relation with a reliable partner. Also, the organization advocates for the use of latex condoms as a control measure of STD (Rodriguez-Hart et al., 2015). Furthermore, the American medical researchers and other researchers all over the world have also discovered that male circumcision can reduce STD to the young males and their partners (Miller, 2015). The findings also indicated that the circumcision process may prevent the transmission of genital human papillomavirus (Mattei et al., 2012).

Moreover, medical researchers use different methods to examine or analyze STDs (Patrick et al., 2015). They suggest that people have A sexually Transmitted Infection (STI) test by investigating their age and sexual habits. For instance, medical experts advise young and sexually active women to perform annual STI tests. People who have unprotected sex with multiple partners may suffer from gonorrhea, chlamydia, syphilis, HIV and other infections. However, STI screening tests can help health practitioners to identify these diseases at the initial stage. Furthermore, medical researchers examine the patients’ urine and sexual organs to identify the infections. They place swab and other instruments inside the penis or cervix to diagnose the type of STD. In addition, there are specific designed tests for complex STDs such as HIV, Hepatitis A, B, and C, and syphilis. Moreover, the Hepatitis A and B screening methods and vaccines help patients to get relief from STD infections (Rodriguez-Hart et al., 2015).

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Sampling Procedure

Sampling procedures are used to help the researchers to identify the subjects or participants that meet the criteria set. For studying STDs, the researcher collects the samples from participants who are suspected of having the STD. Among the samples gathered to be used in the laboratory for testing include, urine and blood. The aim is to analyze them for any type of bacterial and viral infection which might denote the status of the participant with regard to STD. since the sample in this study involve human beings, an important aspect to consider is the ethical practice for using human beings. It is more important because it also touches on the health and privacy of the participants. Thus, anonymity and privacy of the participants must be upheld. The focus is to identify any form of STD yet not the identity of the patient (Mattei, Beachkofsky, Gilson & Wisco, 2012). Mundane characteristics such as age and gender might be revealed during sampling and analysis just to have a clear demographic about the characteristics of the individuals who are affected by STD in a general population

Instruments and Examinations

Medical professionals use various instruments and examination procedures to diagnose STDs. Antibiotic vaccines can control these infections (Hobbs et al., 2014). Additionally, the CDC scientists use swab to collect the discharged fluid from the patients’ different organs. After this process, analysts used antibodies and reagents to identify the parasites that are affecting the organ (Rodriguez-Hart et al., 2015). Furthermore, the expert, Miller indicates using Ultra Violet (UV) lights to analyze the blood, fluid, and urine (Miller, 2015). Also, currently, the advanced methods such as the use of rapid test kits are effective in diagnosing gonorrhea and syphilis in a short time (Rodriguez-Hart et al., 2015). In addition, American medical researchers have designed a medical accessory that uses micro fluidic chip and smartphone to detect HIV and syphilis. This instrument reduces the cost of STD treatment in current medical services (Mattei et al., 2012).

On the other hand, traditional medical settings initially apply diagnostic examinations to determine the main causes and symptoms of sexually transmitted infections. In this practice, the medical practitioners perform screening tests to identify pre-symptomatic and asymptomatic reactions. Furthermore, medical professionals organize for consultation sessions to understand whether or not the patient has engaged in sexual relationships with a single or multiple partners. Experts also take precautions to maintain the health of pregnant women and their babies. After the child is born, doctors check the baby to confirm that he/she does not have any STIs. Finally, medical counselors suggest the patients and common people to use precautions to have safer sex. Thus, examinations and counseling processes reduce STD (Mattei et al., 2012).

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Personnel, Training, and Logistics

Currently, various developed and developing countries organize STD control committees that control sexually transmitted infections through training and empowerment of personnel. Medical personnel organize for seminars, workshops, and checkup camps in remote and inaccessible areas to reach people with the mission to reduce cases of these infections. For example, the CDC experts advice general population to embrace the use condoms during sexual intercourse to as a measure to reduce sexually transmitted diseases (Rodriguez-Hart et al., 2015). In some states, the prevalence rate of STDs is high because the policies and measures that have been put in place are not effective. Therefore, the World Health Organization (WHO) and other American government organizations develop structures to support the effort to improve the sexual health of people in the country (Mattei et al., 2012).

Additionally, medical experts provide training to the nursing specialists and social welfare workers to organize STD control seminars. The training sessions guide social workers to improve their work when dealing with patients of sexually transmitted diseases. Furthermore, various government organizations and logistic departments offer medications and other products to control STDs. For instance, in the state of Florida, the medical board provide free condoms and STD control brochures in hospitals. Meetings are also organized by health care practitioners to discuss the issues of sexual health and treatments. Moreover, in other states around the country, medical boards provide free annual STD checkup camps for communities (Miller, 2015). These precautions, training, and STD control products help medical authorities to reduce various infections.

Demographic and Geographic Data

Demographic and geographic data shows that some specific communities and age groups have more at risk of exposure to STDs. Health reports by medical researchers of different communities’ people that belong to the diverse society, age group, ethnicity, and culture indicate that certain characteristics including sex and age group play a role in the prevalence of STDs. The researches help to identify that some neighborhood have high risk of sexually transmitted infections. For example, the research has shown that residents of in inner city areas often take part in various night events such as parties and clubbing (Workowski & Berman, 2015). The participants are college students and teenagers who are active sexually. Hence, these groups of young people may take part in sexual relationship with random partners. Additionally, the U.S. medical experts have noted that American ethnic minorities have more STD rates than the majority white groups. Part of the reasons is their poor economic and social conditions that increase the exposure to random sex. Studies have also shown that African American and Hispanic people often suffer from infections due to their poor living conditions and unprotected sexual relationships (Workowski & Berman, 2015). Therefore, people surviving in poor conditions may not understand the negative health effects of certain sexual activities. In addition, the remote areas may not receive medical support and healthcare services that can control sexual infections (Workowski & Berman, 2015). Thus, these situations increase infections in specific communities.

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Statistics, prevention Challenges

The U.S. Government’s statistical report shows that in 2011 the majority of young black Americans faced STDs due to their unprotected sexual relationships (Hobbs et al., 2014). Additionally, these reports indicated that the minorities often suffer from HIV and syphilis due to their careless behavior. The following graph shows that Hispanic and native Hawaiian people experience high prevalence of STDs in their communities.

Implementation of Plan

The nurse practitioners can help societies to reduce STD by applying various healthcare Quality Improvement (QI) policies. They can inform communities, common people, and patients that STDs can cause serious health issues. Also, the nursing teams can organize seminars and medical camps to educate the common people that are surviving in remote areas. During these seminars, they discuss the sexual health issues of patients and their possible solutions. Also, the nurses can advice teenagers to take antibiotics and vaccines by following the doctors’ instructions. These precautions can prevent them from future infections. Furthermore, nurse experts can take support from Government organizations to distribute condoms and other STI prevention measures in poor communities (Miller, 2015). Thus, the nursing professionals can reduce STD in diverse communities.

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Thiazide drugs are clinically indicated in hypertension, mild heart failure, idiopathic hypercalciuria, nephronic diabetes insipidus, and resistance edema, when combined with loop diuretics. Though all thiazide drugs can be administered orally, their mechanisms of action differ.

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