Health and Illness Exam 1

Health

a person's physical or mental condition

Disease

alteration in body functions, reduction of capacities, shortens normal lifespan (example: diabetes)

Disease characteristics

Last for an extended period; Periods of remission and exacerbations; Need medical interventions; Frequently untreatable and progressive

Illness

acute, severe symptoms of relatively short duration, treatable (example: strep throat)

Can illness become a disease?

Yes, if untreated or progresses, it can cause long-term effects

Aspects of health

Physical; Emotional; Social; Intellectual; Spiritual; Occupational; Environmental

Physical aspect of health

Able to perform ADLs

Emotional aspect of health

Adapts to stress, expresses emotions

Social aspect of health

Interactions with others

Intellectual aspect of health

Effectively learns and shares information

Spiritual aspect of health

Adopts a belief that provides meaning to life

Occupational aspect of health

Balance occupational activities with leisure time

Environmental aspect of health

Create measures to improve standards of living and quality of life

Types of elder abuse

Physical abuse; Financial abuse; Emotional abuse; Neglect

Physical abuse

Use of physical force resulting in bodily harm (example: hitting, punching, biting)

Financial abuse

Mismanagement of patient’s property or resources

Emotional abuse

Intentional use of threats, humiliation, or intimidation

Neglect

Failure to provide patient’s basic needs (examples: food, clothing, bathing)

Ways to intervene in elder abuse

Case management; Advocacy

Risks of immobility - respiratory

Atelectasis; Reduced cough effort; Pneumonia

Risks of immobility - cardiovascular

Reduced cardiac output; DVT

Risks of immobility - musculoskeletal

Muscle atrophy; Contractures

Risks of immobility - integumentary

Skin breakdown; Pressure ulcers

Risks of immobility - GI

Constipation; Reduced peristaltic motility

Risks of immobility - GU

Loss of bladder tone; Inability to empty bladder; UTI

Risks of immobility - psychological

Boredom; Isolation; Hopelessness

Interventions for impaired mobility

Frequent turns; Skin care; ROM; Deep breathing; Weight bearing; Measures to optimize elimination/nutrition/prevent falls

Complications of immobility and prevention

Regular physical activity; Protection against injury; Fall prevention; Optimal nutrition; Osteoporosis screening; Fall assessment

Manifestations of hip fractures

Severe pain in hip/thigh/groin/lower back; Unable to walk/stand; Stiffness, bruising, swelling; Leg short/outward turned; Often caused by a fall

Complications of hip fractures

Immobility; DVT; Pneumonia; UTI; Pressure ulcers; Muscle atrophy; Infection; Avascular necrosis; Death

6 P’s for neuromuscular assessment

Pain; Paresthesia; Paralysis; Pulselessness; Pallor; Pressure

Common post-op complications of hip replacements

Blood clots

Safety guidelines for hip fractures

No bending >90°; Don’t bend to pick up items; Don’t cross legs; Don’t let toes turn inward; Take small steps

Safety guidelines for hip arthroplasty

Check environment (no loose rugs); Wear grippy socks/shoes; Install handrails; Elevated toilet seat; No bending at waist (>90°); Use assistive device; Keep appointments; Follow PT instructions

Key point in hip rehab

Successful rehab is the most important for returning home

If a patient is found on the floor

Assess the patient before moving them back to bed

Risk factors for falls

Unstable gait; Unbalanced posture; Loss of strength; Cognitive loss; Vision/proprioception deficits; Osteoporosis; Environmental hazards (poor lighting, stairs, uneven surfaces, bad shoes)

Safety measures after a fall

Locked wheelchairs/bed; Handrails; Cleared, dry floors

Adult failure to thrive

Mini nutritional assessment; Severe decreases in food intake; Weight loss >6.6 lbs; BMI <19

Greatest at risk for failure to thrive

Isolation/bereavement; Cognitive disorder; Physical illness

Importance of individualized care for nutrition

Needs change across lifespan; Culture impacts food choices; Obesity in minorities/low SES; Stroke = 4th leading cause of death; Heart disease = #1 cause of death

Risk factors for nutrition: fluid & electrolytes

Renal failure

Risk factors for nutrition: tissue integrity

Wound healing

Risk factors for nutrition: elimination

Constipation

Risk factors for nutrition: mobility

Fractures

Risk factors for nutrition: perfusion

Hypertension

Risk factors for nutrition: metabolism

Obesity

Risk factors for impaired nutrition in older adults

Increased obesity risk; Allergies; Hospitalization; Limited food choices; Lifestyle/cultural impacts; Convenience of unhealthy food; Food deserts

CBC (complete blood count)

Low blood counts = anemia

Electrolytes (K, Mg, Na, Ca)

Play role in cardiac function; Medications can increase/decrease levels

Total proteins

6.4–8.3 g/dL

Albumin

3.5–5.0 g/dL; Low albumin predicts mortality >60; Wounds decrease levels; Poor protein intake/absorption lowers albumin

Triglycerides

35–135 mg/dL (f), 40–160 mg/dL (m); Elevated = obesity & diabetes

Total cholesterol

<200 mg/dL

Mini Nutritional Assessment

Lower score = higher risk; Zero category = greatest risk

Anthropometry

Height and weight trends; BMI as alternative measure

BMI <18.5

Underweight

BMI 18.5–24.9

Normal

BMI 25–29.9

Overweight

BMI 30–34.9

Obese class I

BMI 35–39.9

Obese class II

BMI ≥40

Obese class III

Under-nutrition s/s

Nausea; Vomiting; Diarrhea; Constipation; Weakness; Fatigue; Poor posture

Who is at risk for under-nutrition?

Chronic illness; Poverty; Older adults; Alcohol abuse; Hospitalization; Self-restricted eating

Effects of under-nutrition

Increased infection risk (kids); Failure to thrive; Growth failure; Poor wound healing; Physical decline

Physical activity guidelines

30 minutes most days of the week

Cardiac diet

Low sodium; Lean protein; Low saturated fat

Dysphagia

Difficulty swallowing

Dysphagia can lead to

Increased length of stay & cost; Increased likelihood of institutional discharge; Increased mortality

Risk factors for dysphagia

Malnutrition; Aspiration

Dysphagia diet

Pureed food; Thickened liquids

Evidence-based nutrition care team

RD; Surgeon (bariatric); Physician + Dietician (enteral/parenteral); Speech therapy; PT/OT; Medical nutrition therapy; Supplements; Tube feedings

Basic therapeutic diets

Low salt; Low fat; Calorie reduction; High fiber

Benefits of increased fiber

Decreases cholesterol; Slows sugar absorption; Improves bowel regularity (with fluids)

Nurse’s role in pain management

Believe patient reports; Assess pain

Pain assessment methods

PQRST; Numeric scale; FACES scale; FLACC scale

Numeric pain scale

Adults

FACES pain scale

Children

FLACC pain scale

Infants & children

Nociceptive pain

Tissue pain

Somatic pain

Connective tissue pain

Visceral pain

Internal organs pain

Neuropathic pain

Nerve pain

Types of pain

Acute; Chronic; Nociceptive; Somatic; Visceral; Neuropathic; Mixed syndromes; Phantom; Psychogenic

Non-pharmacologic pain management

Massage; TENS; Positioning; Splinting; Heat/cold therapy

Pharmacologic pain management

NSAIDs; Opioids; Tylenol; IcyHot; Lidocaine patches

Physiological effects of unrelieved pain

Respiratory dysfunction; Metabolic imbalances; Developmental issues; Reduced immunity; Cardiovascular instability

WHO pain ladder

Step 1: Non-opioid; Step 2: Non-opioid + mild opioid; Step 3: Add stronger opioid (morphine, fentanyl, hydromorphone); Breakthrough pain = fentanyl patch

Sleep - older adults

7–9 hrs; Earlier bed/wake; Fragmented sleep; Less REM/deep sleep; Medications/illness affect sleep

Sleep - adults

7–9 hrs/night

Sleep - teens

9–10 hrs needed, average 7.5; Later sleep/wake; Lifestyle reduces hours

Sleep - school-age kids

10–11 hrs; Sacrifice sleep for activities; Sleep hygiene important

Sleep - toddlers

11–13 hrs/day; Night fears/nightmares common; Need consistent routine

Sleep - infants

15 hrs/day; 1/3 REM

Sleep - newborns

16 hrs/day; No circadian rhythm first 4 wks; Enter REM immediately

OSA risk factors (STOPBANG)

Snoring; Tired; Observed apnea; Pressure (HTN); BMI; Age; Neck circumference >40cm; Male gender; ≥3 = high risk

Sleep hygiene

Good habits to sleep soundly & stay alert during the day

Patient teaching for sleep

Only sleep in bed; Avoid alcohol before bed; Exercise; Limit caffeine

Fatigue

Extreme tiredness, exhaustion

Who is at greatest risk for fatigue?

Patients receiving chemo, radiation, surgery, or with chronic/acute conditions