Hampton Community Nursing Diagnosis
Hampton Community Nursing Diagnosis
Lisa Armstrong
NURS 624C: Nursing in the Community (Fall 2011)
Prof. A. Sweatt
November 7, 2011
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Hampton Community Nursing Diagnosis
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Top 3 Hampton Nursing Diagnoses
Based on the qualitative, quantitative, interview, and windshield survey data collected
during the health assessment process, Hampton town’s top three nursing diagnoses are identified
as risk for radon poisoning, risk for narcotic poisoning, and risk for suicide.
Top Priority Health Issue
The top priority health issue is identified as risk for poisoning, related to the unintentional
overdose of acetaminophen, as evidenced by a lack of consumer knowledge regarding the daily
maximum safe dosage of acetaminophen.
“Nationally, deaths from drug overdose were second only to motor vehicle crashes
among leading causes of unintentional injury death in 2007” (Centers for Disease Control and
Prevention, 2011). The CDC also report that 82 people die every day as a result of unintentional
poisoning, and that nationally, poisoning deaths in the United States increased by 145% from
1999 to 2007.
In New Hampshire, 73 percent of the poisoning deaths from 2003 to 2007 were
unintentional and 21 percent were due to suicide. New Hampshire’s poison-related death rate is
significantly higher than that of the United States average, with 20-24 year-olds at highest risk
(NH State Health Profile, 2011).
In a Food and Drug Administration (FDA) report, acetaminophen is cited as one of the
most commonly used drugs in the United States for treating pain, with more than 28 billion doses
consumed annually. Summarizing data from five different surveillance systems, there were an
estimated 56,000 emergency room visits, 26,000 hospitalizations, and 458 deaths related to
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acetaminophen-associated overdoses per year during the 1990-1998 period (Food and Drug
Administration, 2008).
The FDA cite a variety of potential reasons for unintentional acetaminophen overdose,
including lack of consumer knowledge regarding overdose potential: “Acetaminophen is a
familiar product that has been marketed for decades and therefore [consumers] assume that the
medicine is completely safe. This perception may be reinforced by the fact that the drug is
widely available over-the-counter in very large quantities” (Food and Drug Administration,
2008). Difficulty in identifying acetaminophen as an ingredient, as well as the sheer variety of
over-the-counter and prescription acetaminophen products available in a range of doses for a
variety of different indications may also be contributing factors to unintentional overdose
incidence.
According to the International Health Behavior in School-aged Children (HBSC) study,
U.S. students, both boys and girls, rank first or second among all countries in reporting of
backache, stomachache, and headache at least weekly, significantly higher than the vast majority
of other countries, with headache ranked the highest at 57 percent. Additionally, U.S. students
also rank first in taking medication for headache at age 15, and first or second at ages 11 and 13
years.
In the Winnacunnet high school clinical setting, headache is the most prominent
diagnosis treated the Health Office, and the most common medication administered is
acetaminophen. Anecdotal evidence gathered during the Health Assessment supports the theory
that students lack adequate knowledge regarding the safe use of acetaminophen products, and the
dangers inherent with long-term exposure and potential for overdose. When asked what the
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maximum daily dosage of acetaminophen (Tylenol products) was upon administering the
medication, students either didn’t know the answer or cite incorrectly.
The 2010 study “Re-visit to the school nurse and adolescents’ medication use” found that
medicine use has increased among adolescents during the past couple of decades, and that many
teenagers are allowed to use medicine at home without asking permission from their parents or
buy their own medicine. The study concludes that those adolescents that re-visit the school nurse
may buffer the student’s use of medicine when they experience common symptoms (Borup,
Andersen, & Holstein, 2010).
The school nurse is in a unique position to provide health teaching to students about the
short and long term effects of medication use, as well as offer non-pharmacological alternatives
to acetaminophen administration for complaint of headache.
Psychological interventions such as relaxation training, biofeedback, and cognitivebehavioral treatment have demonstrated proven efficacy as viable treatment options for recurrent
headache in childhood and adolescence (Trautmann & Kroner-Herwig, 2009).
Moreover, research analysis in the June 2011 issue of the Journal of Manipulative and
Physiological Therapeutics which included data on more than 7,000 patients with migraines or
tension headaches participating in 119 clinical trials of pharmaceutical and non-pharmaceutical
headache treatments demonstrated that: “The placebo effect was highest for trials involving drug
treatments given to children. Almost half (45%) of children in the placebo arms of these trials
got better after taking the dummy pills, compared to 36% of adults” (Boyles, 2011).
An appropriate intervention for the Winnacunnet High School population at risk is to
research the extent of the knowledge deficit in the school environment using the clinical
resources available, and develop a teaching strategy that will enhance student knowledge
Hampton Community Nursing Diagnosis
regarding the safe daily administration dosage of acetaminophen, reducing the potential for
future unintentional overdose.
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References
Borup, I., Andersen, A., & Holstein, B. (2011). Re-visit to the school nurse and adolescents’
medicine use. Health Education Journal, 70(3), 274-284.
doi:10.1177/0017896910375884
Boyles, S. (2011). WebMD. Migraines & Headaches Health Center. ‘Placebo Effect’ May Be Common in
Headache Treatment. Retrieved November 2, 2011 from http://www.webmd.com/migraines-
headaches/news/20110523/placebo-effect-may-be-common-in_headache-treatment
Centers for Disease Control and Prevention. (2011). Injury Prevention and Control: Home and
Recreational Safety. Unintentional Poisoning. Retrieved November 2, 2011 from
http://www.cdc.gov/HomeandRecreationalSafety/Poisoning/
Department of Health and Human Services. (2011). 2011 New Hampshire State Health Profile.
Retrieved October 25, 2011 from
http://www.dhhs.nh.gov/dphs/documents/2011statehealthprofile.pdf
Food and Drug Administration. (2008). Acetaminophen Overdose and Liver Injury –
Background and Options for Reducing Injury. Retrieved November 2, 2011 from
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drug
s/DrugSafetyandRiskManagementAdvisoryCommittee/UCM164897.pdf
The International Health Behavior in School-aged Children (HBSC) Study. (1998). U.S. Teens in
our World. Retrieved November 2, 2011 from
http://mchb.hrsa.gov/mchirc/_pubs/us_teens/main_pages/ch_1.htm
Trautmann, E., & Kröner-Herwig, B. (2010). A randomized controlled trial of Internet-based
self-help training for recurrent headache in childhood and adolescence. Behavior
Research And Therapy, 48(1), 28-37.