Health and Illness

Nursing practice is directed and guided by an understanding of the definition of health and the factors that impact a client’s health framework.

Health-complete state of physical, mental and social well being w/o merely an absence of dse. -it is ever changing-. Portray of health and illness on an interactive continuum with multiple configurations ranging from high level wellness- extremely poor health

Man- is a living system, with internal and external environment Information and matter exchange continuously from one environment to the other. With in the body itself each organ, tissue , or cell is a system or subsystem with internal and external environment Each exchange information. This communication/interaction- dynamic balance or steady state. Health promotion is impt =fostering awareness influencing attitudes and identifying alternatives so that people can make choices to achieve optimal level of physical and mental health. Health of man are affected by diff risk factors such as Genetic or biologic= age, race and family history Behavioral its lifestyle- stress/diet/lack of exercise/smoking/drugs/uncleanliness

Internal Constancy

Constancy – ( Fluid bathing the cells) is maintained by both physiologic and biochemical processes Homeostasis –necessary adjustment body can rapidly make to maintain its internal composition Adaptation –responses the individual make to function adequately under changed conditions of the environment Maintenance of steady state to the health of man is under the control of the body regulating processes. The compensatory mech are always on operation to maintain balance state== if CM is inadeq =function is distorted ==prob = may lead to dse==threat to the steady state==disruption in cell function==limit to act in the external world.

Cellular Processes Level The process of health and diseases occurs at all levels at any time. Adaptation and maladaptation may occur at cellular level because cell is considered the smallest unit. It exist on a continuum function and structure= Normal==Adapted==injured==dead cell. Changes fr one state to another occur rapidly and may not be readily detected . Cells and tissues respond to stimuli and stressors with different patterns and rates of response ===depend on the nature of the stressor, duration and severity. E x BARBITURATES - tolerance may dev in small regular amount but if on large dose = unconsciousness

Health Assessment
In health assessment seek gather information as much as you can both subjective and objective data and analyze these data to determine the client’s needs and responsestop otential and actual health problem. Then formulate the nursing diagnosis, establish realistic goals and outcome and plan interventions. Know the normal from abnormal.

1. Inspection –visual examination of the entire clients body or body region. Size, shape, color, texture, symmetry, position and deformities, Conduct it in a well lighted setting. Make sure you uncover or exposed the area you are examining but cover other parts not examined.

2. Palpation= use of touch, pressure is exerted to determine information about masses, pulsation, organ size, tenderness or pain, swelling , tissue firmness and elasticity, vibration, crepitation, temperature, texture variation and moisture, consistency and mobility. In palpation, start from light to deep.

3. Percussion=assess tissue density with sound produced from striking the skin. The underlying structures containing air, fluid and solid produces various sounds depending on density.

4. Auscultation= listening to internal body sounds using the stethoscope. The sounds commonly assessed are those produced by the heart, lung , abdomen Type of sounds: 1. Pitch –low or high pitch sound 2. Intensity= the amplitude of a sound wave, the greater the amplitude the louder the sound 3. Duration-the length of time the sound endures, long, medium or short 4. Quality- description of sound’s character, blowing, gurgling whistling.

Health Perception /Health Mgt Pattern What do they do when they get sick Self -Med? Cnsult? Over the counter Metabolic-Nutritional Pattern Likes-Dislikes Vegetarian Teeth GIT Prob Tubes Calculated/special diet Elimination Pattern Urine and Stool Color? Amount? Odor? Pain? Cognitive Perception Pattern Happy go lucky Easily can understand his condition Sleep/ Rest Pattern Sleep hours? Late or early sleep hours Easily disturb Noise/ VS etc Exercise-Activity Wheelchair? Stretcher? Ambulatory CBR with or without BRP Role Relationship Number of children Breadwinner Position in the family Sexuality/Reproductive Male? Female Value Belief Go to mass every day? Sunday?, pray

Control Systems Negative Feedback Process Deviation from a pre-determined set point or range of adaptability are detected and trigger a response in which the action offsets the deviation Ex. Bp, Acid-base balance, Blood sugar level, body temp and Fluid and electrolyte balance If there is or (-) feedback will trigger the activity to cause a return to the optimal level. The goal is to counter the influence of an initiating structures or disturbance. Does not change the disturbance only its effect. Control systems are integrated at the level of the Nervous and endocrine systems Stimulation and compensatory responses are in the muscles and glands of the body. They either alter the rate of the activity or alter the amount of the secretions produces.

Cellular Adaptation and Injury
Common Adaptation Cells adopt to environmental stress by structural and functional changes Hypertrophy and atrophy –changes in the size of cells and organs Hypertrophy- enlargement Atrophy- disease and old age Hyperplasia –increase in the number of new cells in an organ or tissue, cells and volume increase. When stimulus is removed it become reversible. Neoplasm or malignant growth – growth cont even if the stimulus is removed. Occurs in response to a body loss or may be hormonally induced Metaplasia –cell transformation from highly to less specialized cells. With protective function/ less specialized are resistant to stress.

Injury
Disorder in steady state regulation
Occurs if a stressor alters the ability of the cell or system to maintain the optimal balance of its adjustment process
Structural and functional changes occur, may be reversible ( RECOVERY) or irreversible (LEADS TO DEATH)
Causes of disorder and injury in the system may arise from external or internal environment of the system 1. Physical Agents High temp- Hypermetabolism occurs -increases the RR, HR, BMR ===high temp causes coagulation of cell protein= cells may die. Low temperature- causes vasoconstriction, blood flow sluggish and clot may form—ischemic Changes Radiation- radiant energy may be used for dx and tx of dses but may cause injury by its ionizing action. Electric shock---( If Excessive) results when electric current travel through the body --may also cause fibrillation of the heart. Mechanical trauma- wounds that disrupt cells/tissues of the body. Severe-blood loss =nerve damage 2. .Chemical agents Poisons- corrosive action on epithelial cells/tissues Heavy metals ( mercury, lead) –with destructive action Alcohol – chemical irritant 3. Infectious agent Virus –parasite of the living cells they invade, replicate with in the cells they invade- burst to invade other cells. Bacteria - produce exotoxins –create cell damage Rickettsiae Fungi Protozoa == Severity depends on the number , virulence and host defense- age, health immune Defense ( Antibiotic) 4. Nutritional imbalance may be less or more of one or more essential nutrient. Malnutrition and Obesity 5. Hypoxia- inadequate cellular O2 which will interfere with the cells ability to transform energy Causes - decrease blood supply to the area Decrease O2 carrying capacity of th blood Resp problem or ventilation-perfussion problem Problem in the cells enzyme system Usually Seen in MI and intravenous clots 6. Genetic defects/disorder – congenital abnormalities

Responses to injury/ Inflammation Cells or tissues of the body may be injured or killed by any of the agents----inflammatory response occur in a healthy tissue adjacent to the site of injury. This is a defensive reaction to neutralize, control and /or eliminate the offending gent and to prepare the site for repair

5 signs of inflammation: Redness, heat, swelling, pain and loss of function

Injury

Vasoconstriction

Vasodilation

Increase Blood flow (Resulting to local heat & redness)

Increase vascular permeability (& plasma fluids)

Leak to the inflamed tissues(swelling) pain loss of function

*As bld flow increases and body fluids leak into the surrounding tissue, RBC, WBC platelet becomes viscous and sluggish. WBC collect into the vessels, exit and migrate to the site of the injury=engulf offending microorg remove cellular debris (phagocytosis)

Levels of prevention:= avering the devpt and progression of disease.
Primary= health promotion activities that provide protection against the occurrence of a specific illness or disease. Interventions are done before the client develops a disease and do not include therapeutic treatment or identification of manifestations.Increase immunity and strengthen the body and mind.
Ex. Patient with arthritis without mobility problem=encourage to eat a well balanced diet and engage in exercise to delay development of mobility problem.
Secondary= promote early detection ( cae finding and screening)and treatment of disease

STRESS

Stress- upset feeling or response Rate of wear and tear in the body Any real or perceived threat to one’s physical ,emotional and social well-being can create stress Processes originating either in the external environment or with-in a person imposing a demand or requirement to resolve it before any other system is involved or activated. State produced by a change in the environment that is perceived as challenging, threatening or damaging to the persons equilibrium. Every person has a range of adaptability ; successful positive adaptation to stressors represents health, unsuccessful or maladaptive outcome—illness
Stressor –is a change or stimulus that evokes stress

Sources of Stress
Physiologic
Chemical agents- drugs, poison, alcohol Physical agents- heat, cold, radiation, trauma Infectious- virus, bacteria and fungi Faulty immune mechanisms Genetic disorder Nutritional Imbalance Hypoxia
Psychosocial
Day- to day stressors Major complex occurrences Stressors fall in between

• Stressor can be interpreted differently- conditioning factors in each person’s environment may affect the tolerance for stress. Some may develop migraine headache, HPN while others appear unaffected.

Indices of stress
Sleep disturbances
Eating disturbances
GIT disturbances
Changes in menstrual cycle
Easy fatigability, depressed
Inability to concentrate

Category of Stressors 1. Acute 2. Time –limited 3. Chronic

Stress Response
Perception of the stressor is coordinated by structures of the brain and may be a conscious or unconscious process. Once there is perception there are responses and may be
Global response- generalized state of anxiety involving psychoneuroendocrine activation or
Specific response –develops as the person has more time to appraise the stressor and the resources avail to cope with it.

Perseption of stress involves taking in a sensation occurs in brain controlling the giving a meaning activities of the body

1 Perception of Stress: Mind-Body Reaction Appraisal and Coping –important processes in stress response Appraisal –event is evaluated and what is its effect and the coping resources available. Coping –effort to manage external and internal demands that tax persons resources Emotion focused –makes a person feel better by lessening emotional distress. Problem focused – deals with managing the problem causing the distress. The ability to cope effectively is influenced by a persons resources which include internal capabilities as health and energy, problem solving skills and social skills. Sense of control or power in a situation, money and materials are also important factors in coping.

2. Physiologic Response Neural under the control of the hypothalamus are activated in the Neuroendocrine pathways stress response.

2.1. Sympathetic Nervous System Response Rapid and short lived NorEpinephrine and epinephrine are released Increased function of the vital organs –state of general body arousal Constriction o the blood vessels of the skin –trauma Blood from the abdominal organs –shunt away - vital organs are given importance 2.2 Sympathetic-Adrenal –Medulla Response SNS stimulates the Medulla of the Adrenal Glanda to release hormones epinephrine and nor-epinephrine into the blood stream. The effect is similar to SNS but this is for sustainability and prolonged action 2. Hypothalamic-Pituitary Response- The hypothalamus secretes Corticotropin RF –stimulates APG to produce adrenocorticotropic hormone ---adrenal cortex produces glucocorticoids ( Cortisol) to be used as energy in stressful situation.

2. Social Support to Stress Emotional support – Nurses support to Patient –especially if there is involvement and concern. 1. Caring and dedication 2. Esteemed and valued 3. Belongingness

GAS= General Adaptation Syndrome
Phases
Alarm- Fight and flight response is activated, release of adrenal medullary hormones and the ACTH – adrenal cortex response. Resistance – adaptation to noxious stressor occurs. Cortisol activity increases Exhaustion- sets in if prolonged exposure to stressor endocrine activity increases, producing deleterious effect on the body system. State of chronic arousal develops leading to HPN, arteriosclerotic changes and cardiovascular diseases. Behavioral changes are seen Infections and tumor may develop Immune response decreased

Selye compared GAS to life process Childhood –few stressors, promote development Adulthood –encounter number of life stressful events Develop resistance or adaptation Senility- accumulation of life’s stressors, wear and tear defects, ressistance falls---death

Local Adaptation Syndrome:
This syndrome includes the inflammatory response and repair processes that occur at the local site of tissue injury
Occurs in small topical injuries ( Bee stings)

Stimuli are sent to the NS to elicit the Hypothalamic –Pituitary Adrenocortical response (GAS response) Cortisol are released super-imposing their effect on the LAS.
Stress Management :
Living individual will always experience stress, it is everywhere, anywhere and comes anytime, however how he perceives and reacts to situations depends on him: his inner capabilities, external support and the nature of the stressor. One will perceive stress differently with another person, can be challenging or can be serious. 1. Health History The person is provided with his information and health teachings may be given to help him alter his activities 1. Biographical and Demographic data=provide clues about personal health risk= age gender and family history. 2. Psychosocial history = involves areas of human development and behaviors, decision making, motivation speech and communications and lifestyle factors- such as eating and sleeping habits, exercise, smoking and drinking 3. Physical measurements –BP, Ht, Wt /// lab analysis of blood and urine 2. Coping behaviors= many practical methods exist to cope with stress Planning is one effective wayto reduce adverse effects We plan by establishing goals, develop a belief system that allows us to to dictate our life and our experiences Person – interact constantly with environment –constant change The functions of coping are Emotion and problem focused Ex. Patient for operation=Motivation and cooperation ;explain what will be expected. 3. Stress Reduction Method 1. Biofeedback- gain mental control over the Autonimc Nervous System and possibly lowers Bp, control HR and prevent disorders as migraine HA and hyperactive stomach. Electronic instrumentation monitors biological function of a person- he is informe what is the level of its function –alter/adjust the machine accordingly ---through practice and reinforcement the person will learn to control even without the machine . 2. Relaxation –calm person under stress Quiet environment Comfortable position Passive attitude Mental demand or object- to occupy the mind and keep out thoughts. * Yoga, meditation, listening to sounds like mountain stream 3. Social support – Emotional support

Health and Illness

Nursing practice is directed and guided by an understanding of the definition of health and the factors that impact a client’s health framework.

Health-complete state of physical, mental and social well being w/o merely an absence of dse. -it is ever changing-. Portray of health and illness on an interactive continuum with multiple configurations ranging from high level wellness- extremely poor health

Man- is a living system, with internal and external environment . Health of man are affected by diff risk factors such as Genetic or biologic= age, race and family history Behavioral its lifestyle- stress/diet/lack of exercise/smoking/drugs/uncleanliness

Cellular Processes Level The process of health and diseases occurs at all levels at any time. Adaptation and maladaptation may occur at cellular level because cell is considered the smallest unit. It exist on a continuum function and structure= Normal==Adapted==injured==dead cell. Changes fr one state to another occur rapidly and may not be readily detected . Cells and tissues respond to stimuli and stressors with different patterns and rates of response ===depend on the nature of the stressor, duration and severity. E x BARBITURATES -

Health Assessment
In health assessment seek gather information as much as you can both subjective and objective data and analyze these data to determine the client’s needs and responsestop otential and actual health problem. Then formulate the nursing diagnosis, establish realistic goals and outcome and plan interventions. Know the normal from abnormal.

Inspection –visual examination of the entire clients body or body region. Size, shape, color, texture, symmetry, position and deformities, Conduct it in a well lighted setting. Make sure you uncover or exposed the area you are examining but cover other parts not examined.

Palpation= use of touch, pressure is exerted to determine information about masses, pulsation, organ size, tenderness or pain, swelling , tissue firmness and elasticity, vibration, crepitation, temperature, texture variation and moisture, consistency and mobility. In palpation, start from light to deep.

Percussion=assess tissue density with sound produced from striking the skin. The underlying structures containing air, fluid and solid produces various sounds depending on density.

Auscultation= listening to internal body sounds using the stethoscope. The sounds commonly assessed are those produced by the heart, lung , abdomen Type of sounds: Pitch –low or high pitch sound Intensity= the amplitude of a sound wave, the greater the amplitude the louder the sound Duration-the length of time the sound endures, long, medium or short Quality- description of sound’s character, blowing, gurgling whistling. ------------------------------------------------------------------------------------------ Health Perception /Health Mgt Pattern What do they do when they get sick Self -Med? Cnsult? Over the counter Metabolic-Nutritional Pattern Likes-Dislikes Vegetarian Teeth GIT Prob Tubes Calculated/special diet Elimination Pattern Urine and Stool Color? Amount? Odor? Pain? Cognitive Perception Pattern Happy go lucky? Easily can understand his condition Sleep/ Rest Pattern Sleep hours? Late or early sleep hours Easily disturb Noise/ VS etc Exercise-Activity Wheelchair? Stretcher? Ambulatory CBR with or without BRP Role Relationship Number of children Breadwinner Position in the family Sexuality/Reproductive Male? Female Value Belief Go to mass every day? Sunday?, pray

Control Systems Negative Feedback Process Deviation from a pre-determined set point or range of adaptability are detected and trigger a response in which the action offsets the deviation

Cellular Adaptation and Injury
Common Adaptation Cells adopt to environmental stress by structural and functional changes Hypertrophy and atrophy –changes in the size of cells and organs Hypertrophy- enlargement Atrophy- disease and old age Hyperplasia –increase in the number of new cells in an organ or tissue, cells and volume increase. When stimulus is removed it become reversible. Neoplasm or malignant growth – growth cont even if the stimulus is removed. Occurs in response to a body loss or may be hormonally induced Metaplasia –cell transformation from highly to less specialized cells. Less specialized are resistant to stress.

Injury
Disorder in steady state regulation
Occurs if a stressor alters the ability of the cell or system to maintain the optimal balance of its adjustment process
Structural and functional changes occur, may be reversible ( RECOVERY) or irreversible (LEADS TO DEATH)
Causes of disorder and injury in the system may arise from external or internal environment of the system 1. Physical Agents High temp- Hypermetabolism occurs -increases the RR, HR, BMR ===high temp causes coagulation of cell protein= cells may die. Low temperature- causes vasoconstriction, blood flow sluggish and clot may form—ischemic changes Radiation- radiant energy may be used for dx and tx of dses but may cause injury by its ionizing action. Electric shock---( If Excessive) results when electric current travel through the body --may also cause fibrillation of the heart. Mechanical trauma- wounds that disrupt cells/tissues of the body. Severe-blood loss =nerve damage 2. .Chemical agents Poisons- corrosive action on epithelial cells/tissues Heavy metals ( mercury, lead) –with destructive action Alcohol – chemical irritant 7. Infectious agent Virus Bacteria Rickettsiae Fungi Protozoa- = Severity depends on the number , virulence & host defense- age, health immune , defenses 8. Nutritional imbalance may be less or more of one or more essential nutrient. Malnutrition and Obesity 9. Hypoxia- inadequate cellular O2 which will interfere with the cells ability to transform energy Causes - decrease blood supply to the area Decrease O2 carrying capacity of th blood Problem in the cells enzyme system Resp problem or ventilation-perfussion problem Usually Seen in MI and intravenous clots 10. Genetic defects/disorder – congenital abnormalities

Responses to injury/ Inflammation Cells or tissues of the body may be injured or killed by any of the agents----inflammatory response occur in a healthy tissue adjacent to the site of injury. This is a defensive reaction to neutralize, control and /or eliminate the offending gent and to prepare the site for repair

5 signs of inflammation: Redness, heat, swelling, pain and loss of function

Injury

Vasoconstriction

Vasodilation

Increase Blood flow

Increase vascular permeability

Leak to the inflamed tissues(swelling) pain loss of function

*As bld flow increases and body fluids leak into the surrounding tissue, RBC, WBC platelet becomes viscous and sluggish. WBC collect into the vessels, exit and migrate to the site of the injury=engulf offending microorg remove cellular debris (phagocytosis)

STRESS

Stress- upset feeling or response Rate of wear and tear in the body Any real or perceived threat to one’s physical ,emotional and social well-being can create stress Processes originating either in the external environment or with-in a person imposing a demand or requirement to resolve it before any other system is involved or activated. State produced by a change in the environment that is perceived as challenging, threatening or damaging to the persons equilibrium. Every person has a range of adaptability ; successful positive adaptation to stressors represents health, unsuccessful or maladaptive outcome—illness
Stressor –is a change or stimulus that evokes stress

Sources of Stress
Physiologic
Chemical agents- drugs, poison, alcohol Physical agents- heat, cold, radiation, trauma Infectious- virus, bacteria and fungi Faulty immune mechanisms Genetic disorder Nutritional Imbalance Hypoxia
Psychosocial
Day- to day stressors Major complex occurrences Stressors fall in between

• Stressor can be interpreted differently- conditioning factors in each person’s environment may affect the tolerance for stress. Some may develop migraine headache, HPN while others appear unaffected.

Indices of stress
Sleep disturbances Eating disturbances
GIT disturbances Changes in menstrual cycle
Easy fatigability, depressed Inability to concentrate

Category of Stressors Acute Time –limited Chronic

Stress Response
Perception of the stressor is coordinated by structures of the brain and may be a conscious or unconscious process. Once there is perception there are responses and may be
Global response- generalized state of anxiety involving psychoneuroendocrine activation or
Specific response –dev as the person has more time to appraise the stressor and the resources avail to cope with it.

Perseption of stress involves taking in a sensation occurs in brain controlling the giving a meaning activities of the body

1 Perception of Stress: Mind-Body Reaction Appraisal and Coping –important processes in stress response Appraisal –event is evaluated and what is its effect and the coping resources available. Coping –effort to manage external and internal demands that tax persons resources Emotion focused –makes a person feel better by lessening emotional distress. Problem focused – deals with managing the problem causing the distress. The ability to cope effectively is influenced by a persons resources which include internal capabilities as health and energy, prob solving skills, social skills. Control or power in a situation, money and materials are also important

2. Physiologic Response Neuroendocrine pathways under the control of the hypothalamus are activated during stress.in the

2.1. Sympathetic Nervous System Response Rapid and short lived NorEpinephrine and epinephrine are released Increased function of the vital organs –state of general body arousal Constriction o the blood vessels of the skin –trauma Blood from the abdominal organs –shunt away - vital organs are given importance 2.2 Sympathetic-Adrenal –Medulla Response SNS stimulates the Medulla of the Adrenal Glanda to release hormones epinephrine and nor-epinephrine into the blood stream. The effect is similar to SNS but this is for sustainability and prolonged action 2. Hypothalamic-Pituitary Response- The hypothalamus secretes Corticotropin RF –stimulates APG to produce adrenocorticotropic hormone ---adrenal cortex produces glucocorticoids ( Cortisol) to be used as energy in stressful situation.

Social Support to Stress Emotional support – Nurses support to Patient –especially if there is involvement and concern. Caring and dedication Esteemed and valued Belongingness

Stress Management :
Living individual will always experience stress, it is everywhere, anywhere and comes anytime, however how he perceives and reacts to situations depends on him: his inner capabilities, external support and the nature of the stressor. One will perceive stress differently with another person, can be challenging or can be serious. Health History The person is provided with his information and health teachings may be given to help him alter his activities 1. Biographical and Demographic data=provide clues about personal health risk= age gender and family history. 2. Psychosocial history = involves areas of human development and behaviors, decision making, motivation speech, communications and lifestyle 3. Physical measurements –BP, Ht, Wt /// lab analysis of blood and urine Coping behaviors= many practical methods exist to cope with stress

Stress Reduction Method Biofeedback- gain mental control over the Autonimc Nervous System and possibly lowers Bp, control HR and prevent disorders as migraine HA and hyperactive stomach. Electronic instrumentation monitors biological function of a person- he is informe what is the level of its function –alter/adjust the machine accordingly ---through practice and reinforcement the person will learn to control even without the machine .

Relaxation –calm person under stress Quiet environment Comfortable position Passive attitude Mental demand or object- to occupy the mind and keep out thoughts. * Yoga, meditation, listening to sounds like mountain stream

Social support – Emotional support