Impaired Homeostasis
Page 3: What is Health?
World Health Organization defines health as a state of complete physical, mental, and social well-being.
Personal health is influenced by inherited and environmental or lifestyle factors.
Good health requires maintaining the entire body over one's lifetime.
Page 4: What is Disease?
Disease is a condition where the normal function of a body system is compromised and homeostasis is impaired.
Acute disease has a rapid onset, severe symptoms, and brief duration.
Chronic disease has a long duration.
Page 5: Categories of Disease
Categories of disease include infectious, environmental, social, genetic, deficiency, degenerative, and mental diseases.
Page 6: Society & Disease
Social diseases are inflicted by humans on themselves, often related to poor diet, lifestyle, or substance abuse.
Examples of social diseases include drug abuse, smoking-related diseases, diseases related to alcoholism, cardiovascular disease, and diabetes.
Page 7: Environment & Disease
Many human diseases are a direct result of harmful agents in the environment.
Harmful agents can be natural or due to human activity.
Examples of diseases caused by environmental factors include dermatitis, asbestosis, and melanoma.
Page 8: Genetics & Disease
Genetic disorders are caused by a malfunction in a person's genes.
Genetic disorders can be present at birth or inherited.
Spontaneous mutations can also cause genetic disorders.
Page 9: Cardiovascular Disease (CVD)
CVD involves the heart or blood vessels.
1 in every 5 people who reach the age of 60 will have a heart attack.
Up to 90% of CVD may be preventable.
Page 10: Risk Factors for CVD
Risk factors for CVD include high blood pressure, high blood cholesterol, cigarette smoking, obesity, lack of exercise, diabetes, family history of heart disease, and sex and age.
Page 11: Atherosclerosis
Atherosclerosis is the hardening of the arteries and the formation of plaques.
It obstructs blood flow and can lead to heart disease, heart attack, stroke, and peripheral artery disease.
Severe damage to the heart muscle can result in heart failure and arrhythmias.
Page 13: Aortic Aneurysm
Aortic aneurysm is the weakening and ballooning of the wall of the aorta.
It is usually a result of generalized heart disease and hypertension.
Ruptured aortic aneurysms can be fatal due to significant internal bleeding and circulatory shock.
Page 14: Murmurs & Valve Defects
Unusual heart sounds (murmurs) can result from improper closure of heart valves.
Murmurs can lead to heart valve diseases.
Congenital defects and aging are associated with valve defects.
Page 16: Hole in the Heart Defects
Hole in the heart defects are congenital defects that allow oxygen-rich blood to mix with oxygen-poor blood.
They are the most common congenital heart defect and often heal spontaneously.
Page 17: Heart Disease & NZ
Coronary heart disease is the biggest killer of New Zealanders and the highest ranked cause of premature death.
Māori have an increased risk of early heart disease.
Nurse-led Rapid Access Chest Pain Clinics are in place in New Zealand to support early detection of coronary artery disease.
Page 18: Diagnosing CVD
The cardiac exercise tolerance test is used to diagnose CVD.
It is a diagnostic tool for determining angina pectoris and signs of coronary artery disease.
An ECG is performed during exercise to monitor changes in wave patterns.
Page 20: Correcting Heart Problems
Medical technology provides means to correct major and minor heart problems.
Bypass surgery, angioplasty, endarterectomy, and cardiac pacemakers are used to correct heart problems.
Page 21: Coronary Bypass Surgery
Coronary bypass surgery uses blood vessels from elsewhere in the body to bypass blocked coronary arteries.
It is a common procedure to restore blood flow to the heart.
Page 22: Angioplasty
Angioplasty is an alternative procedure for patients with coronary artery disease.
A balloon-tipped catheter is used to reduce blockage in the artery.
Page 23: Angioplasty
Angioplasty involves inflating a balloon to compress the blockage in the artery.
Page 24: Endarterectomy
Surgical procedure to remove the lining of an artery affected by atherosclerosis
Usually performed for cerebrovascular disease or peripheral vascular disease
Diseased lining is removed and a new lining forms after a few weeks
Page 25: Heart Valves
Biological valves made of animal tissue (pig or human valves)
Do not last long (7-10 years)
Reduced risk of blood clot formation
Often used in older patients
Synthetic valves made of non-biological materials
Last a long time
Tend to create blood clots, requiring long-term anti-clotting drugs
Higher risk of valve infection
Page 26: Heart Valve Surgery
Heart bypass replacement
Site for new valve
Page 27: Cardiac Pacemakers
Used to maintain heart rate in cases of irregular or slow heartbeats
Provides regular electrical stimulation to the heart muscle
Pacemakers allow for a normal lifestyle
Page 28: Types of Pacemakers
Permanent pacemakers: implanted in the heart muscle
Temporary pacemakers: used after cardiac surgery or heart attacks until the heart has healed
Page 29: Cancer
Group of diseases caused by uncontrolled cell growth
Cancer cells can spread to other parts of the body
Metastases can form new tumors
Page 30: Incidence of Cancer
Percentage of people getting cancer increases with age
Page 31: Susceptibility to Cancer
Genetic makeup and exposure to carcinogens determine susceptibility
Carcinogens include UV light, tobacco, viruses, chemicals, ionizing radiation, alcohol, and diet
Familial factors can also contribute to susceptibility
Page 32: Types of Cancer
Carcinoma: most common form of cancer, arises from skin, glands, uterus, respiratory and gastrointestinal tracts
Leukemia: cancer of blood-forming tissues in the bone marrow
Lymphatic cancer: malignant tumor of lymph tissue
Sarcoma: malignant tumor arising in connective tissues
Page 33: Cancer Cells
Cancer begins when genes controlling cell growth are transformed into oncogenes by carcinogens
Abnormal cells divide more rapidly than surrounding cells
Cancer cells are undifferentiated and no longer perform specialized functions
Page 34: Tumor Formation and Metastasis
Benign tumor cells form due to mutations in controlling genes
Malignant tumor cells can form due to additional mutations
Malignant cells can break away from the tumor mass and travel to other parts of the body, forming metastases
Page 35: Features of Cancer Cells
Cancer cells have a bloated, lumpy shape
Metabolism may be disturbed and cell function is altered
Cancer cells may have unusual numbers of chromosomes
Cancer cells lose their attachments to neighboring cells and can divide indefinitely
Page 36: Cancer Symptoms
Symptoms depend on the site, tissue of origin, and extent of the cancer growth
Symptoms may include lumps, bleeding, and disruption of organ function
Page 37: Treating Cancer
Surgical removal of tumors is the primary treatment
If surgery is not possible or metastases remain, radiotherapy and/or chemotherapy are used
Page 38: Chemotherapy
Treatment of cancer with drugs that selectively act on cancer cells
Drugs can destroy tumor cells or stop them from multiplying
Side effects include hair loss, oral ulcers, thinning of the intestinal lining, reduced white blood cell production
Page 39: Radiotherapy
Ionizing radiation is used to treat cancer tumors
Radiation destroys or slows the development of abnormal cells
Side effects are usually short-lived and involve minor burning of the skin or localized hair loss
Page 41: Breast Cancer
Most common cancer in women in the developed world
Incidence increases with age
Most deaths occur because the cancer has metastasized beyond the breast
Average survival time after metastasis is 2 years
Page 42: Breast Cancer Characteristics
Cysts: fluid-filled sacs not associated with cancer
Fat deposits
Cancer: Malignant tumor of the breast tissue
Nipple Fibroadenoma: One of a number of common benign tumors
Cancer cells may detach from the tumor mass and enter the blood vessels and lymph ducts where they can form secondary tumors
Page 43: Detecting Breast Cancer
Regular self-examination to detect lumps
X-rays, ultrasound scanning, and blood tests will determine the extent of the disease if cancer is discovered
Mammography is a common detection method and involves an X-ray of the breast
Mammography can detect tumors less than 1.5 cm in diameter
Biopsy will be performed if there is a possibility that a lump may be a malignant tumor
Breast self-examination is a recommended practice for women
Page 44: Mammography
A regular mammogram can lower a woman's risk of dying from breast cancer by 30%
Mammography is used for breast cancer screening
X-ray plate
Front unit is able to rotate to image the breast from any angle
Plastic cover screen is lowered to flatten the breast on the X-ray plate
X-ray generator
The breast is gently compressed between the X-ray plate and the plastic cover screen to ensure that as much tissue as possible is imaged
Page 45: Breast Screening & NZ
Breast cancer remains the most commonly diagnosed cancer and one of the leading causes of cancer death in NZ women
Māori females have a higher rate of breast cancer than non-Māori females and a mortality rate from breast cancer approximately 50% higher than non-Māori
NZ women between 45-69 years are eligible for free mammograms provided at clinics and mobile units by a BreastScreen Aotearoa breastcare nurse
The rate of breast screening in New Zealand has improved incrementally over the past five years but is still below target
Page 46: Treatment of Breast Cancer
Surgical removal cures 1/3 of women with early breast cancer
Studies have shown that survival is not improved radical mastectomy; lumpectomy, combined with radiotherapy and/or anticancer drugs, such as tamoxifen is now the most common treatment
Lumpectomy: only the area of cancerous tissue is removed
Quadrantectomy: Removal of the tumor plus a wedge of surrounding tissue
Radical mastectomy: removal of the entire breast, chest muscle, associated lymph nodes, and fat and skin
Page 47: Smoking
Tobacco is a member of the nightshade family, native to tropical America
The leaves of the plant are cured (fermentation and drying)
Became popular at the end of World War I
They are more addictive than other forms of tobacco
The milder smoke can be more readily inhaled, allowing nicotine to be quickly absorbed into the bloodstream to exert its addictive effects
Page 48: Smoking and Disease
Lung cancer is the most widely known and most harmful effect of smoking
Tobacco smoking is also directly associated with chronic bronchitis, emphysema, coronary artery disease, peripheral vascular disease, stroke
Estimated percentage of deaths attributable to smoking in the UK by cause (1997)
Deaths from lung cancer in smokers and non-smokers (UK) 1992
Page 49: Composition of Tobacco Smoke
The damaging components of smoke include: tar, carbon monoxide, nitrogen dioxide, nitric oxide
Many of these harmful chemicals occur in greater concentrations in sidestream smoke (passive smoking) than in mainstream smoke (breathed in by the smoker)
Tar
Carbon monoxide
Nitrogen dioxide
Nitric oxide
Page 50: Smoking: Short Term Effects
Dulling of the sense of smell and taste
Very sharp rise in carbon monoxide levels in the lungs, contributing to breathlessness
Increase in hand unsteadiness
Raised blood pressure (by 10-30 points)
Increase in pulse rate by up to 20 beats per minute
Reduction in the capacity of the lungs
Suppression of appetite
Increase in overall muscle tension
Surface blood vessel constriction drops skin temperature by up to 5°C
Page 51: Smoking: Long Term Effects
Smoking damages the arteries of the brain and may result in a stroke
In a young man who smokes 20 cigarettes a day, the risk of coronary artery disease is increased by over three times relative to a non-smoker
Smokers are twice as likely to get diabetes
Smoking may seriously affect the arteries that supply the legs, leading to peripheral vascular disease
In severe cases, this may require leg amputation
Oral cancers such as mouth cancer, lip cancer, and cancer of the throat
Lung cancer
Cancer of the stomach
Cancer of the kidneys and liver
Cancer of the bladder
The risk of developing osteoporosis (weakening and loss of bone density) is four times more likely
Page 52: Smoking: Lung Damage
Tobacco smoking has only recently been accepted as a major health hazard, despite its practice for thousands of years in some other parts of the world
This lung tissue is from a lifelong smoker who died of lung cancer and had severe emphysema
Numerous, large, black tar deposits are evident
Page 53: Smoking: Lung Damage
Smoke particles
Smoker
Coalesced alveoli
Smoke particles indirectly destroy the walls of the lung’s alveoli
Cancerous cell
Extra mucus produced
Normal arrangement of alveoli
Non-smoker
Cells lining airways
Thin mucus layer
Page 54: Smoking: Lung Cancer
The most common of all malignant tumors
98% of all cases are associated with cigarette smoking
Symptoms are generally caused by the tumor impairing lung function and include:
Coughing up blood
Chest pain
Breathlessness
Headaches
Chest X-ray showing a large, dense mass indicating the presence of a tumor in one lung
Tumor
Page 55: Help Q smokefree advice
Nurses play a key role in supporting patients
We want Smokefree by 2025 to become smoke-free
Government 2011 Zealand Home Health Info S Smokefree by 2025. becoming Breathe Hawke's Bay
Having a respiratory condition doesn't mean life has to be difficult
Breathe Hawke's Bay is here to help support you to manage your lifestyle home, work, and play, so that you can breathe easy
Our respiratory nurse educators (registered nurses) travel throughout Hawke's Bay delivering a range of FREE services
Number Street; and our board of trustees
We also facilitate Dickens supported by an administrator based at our Napier clinic
They 199 and of annual events with the help of members, volunteers, and community partners
Page 56: Substance Abuse
Marijuana
Cocaine
Metamphetamines
Heroin/morphine
'P'
LSD
Pain killers
Alcohol
Cocaine
Marijuana
Drug-induced collapse
Page 57: Drugs and their Effects
Stimulants
Stimulate or speed up the CNS and give the feeling of increased alertness and physical activity
Include caffeine, amphetamines, and cocaine
The effects of abuse include restlessness, insomnia, psychosis, and death
Cocaine
Page 58: Drugs and their Effects
Depressants
Slow down or suppress the CNS
Include alcohol, barbiturates, and tranquilizers
Low doses have a calming effect. High doses can cause unconsciousness and death
A range of barbiturates
Page 59: Drugs and their Effects
Analgesics
Provide relief from pain
Include paracetamol and aspirin, and opiates, e.g. codeine, morphine, and heroin which are among the most powerful analgesics
Opiates abuse - effects include restlessness, nausea, vomiting, loss of consciousness, breathing slows, and death may occur
Various forms of codeine
Page 60: Drugs and their Effects
Hallucinogens (psychedelics)
Affect a person's sensory perception
Have no official medical applications
Include LSD and ecstasy
The effects of hallucinogens vary from mild distortion of vision to intense anxiety and psychosis
Ecstasy tabs
Page 61: Health Nursing and Addiction Kaupapa Response
Māori must be central to mental health and addiction response
New Zealand Nurses Organisation media release, 29 May 2019
Page 62: Dietary Disorders
Dietary deficiencies are a major problem in poorer countries.
In developed countries, dietary deficiencies generally fall into one of the following categories:
Alcoholics
People with intestinal disorders
People with very restricted diets or eating disorders
Much more common in western culture today are disorders due partly to overconsumption of food.
Page 63: Vitamins
Vitamins are essential in small amounts for the normal functioning of the body and are critical to many metabolic processes.
There are 13 vitamins: A, B1, B2, B6, B12, C, D, E, H (biotin), K, niacin, pantothenic acid, and folic acid.
With the exception of vitamin D and niacin, the body cannot manufacture these substances and we must obtain them from food.
Page 64: Severe case Mild case Beriberi
Beriberi is caused by the lack of vitamin B1.
Vitamin B1, or thiamin, is essential for glucose metabolism.
Symptoms of beriberi include sweating, warm skin, diarrhea, loss of appetite, elevated heart rate, breathlessness, nerve degeneration, heart failure, wasting of the muscles, numbness, burning sensation in legs accompanied by swelling (edema).
Page 65: Severe cases Mild cases Scurvy
Scurvy is caused by the lack of vitamin C.
Scurvy is rare in developed countries as a result of increased consumption of fresh fruit and vegetables.
Symptoms of scurvy include brain hemorrhages, internal muscular bleeding, bleeding between the joints, swollen gums and loose teeth, small black and blue spots on the skin, bleeding from capillaries, general anemia, and painful and tender limbs.
Page 66: Vitamin D Deficiency
Lack of vitamin D leads to rickets in children and osteomalacia in adults, both of which can lead to permanent bone deformities.
Vitamin D is necessary for absorption and utilization of calcium and phosphorus and promotes bone mineralization.
If calcium is in short supply, the body metabolizes it from the skeleton. Vitamin D is needed to restore the bone matrix.
Page 67: Calcium Deficiency
Calcium is required for enzyme function, blood clotting, nerve and muscle function, and bones and teeth formation.
Calcium deficiency causes poor bone growth and structure, muscular spasms, and poor blood clotting.
Page 68: Marasmus
Marasmus is the most common form of deficiency disease globally.
Marasmus is a severe form of protein and energy malnutrition that usually occurs in famine or starvation conditions.
Causes children to be stunted and extremely emaciated, with no resistance to disease and common infections being typically fatal.
Page 69: Kwashiorkor
Kwashiorkor is child malnutrition as a result of a diet deficient in protein and energy.
Prevalent in parts of the world where the diet consists mainly of starchy vegetables.
Develops when an infant is weaned onto a diet lacking in milk or meat.
Page 70: Symptoms of Kwashiorkor
Symptoms of kwashiorkor include an emaciated appearance, swollen abdomen, hair appears reddish because of loss of pigment, edema of the limbs, diarrhea, enlargement of the liver.
Page 71: Nurses in Humanitarian Aid
Nurses are key members of the Médecins Sans Frontières / Doctors Without Borders (MSF) team, providing vital medical care to patients in emergencies around the world.
Nurses are the largest group of healthcare professionals, delivering 80-90% of healthcare worldwide.
They are the largest cohort of international staff that MSF sends to the field and are considered the largest untapped potential for improving quality care.
Page 72: The Body Mass Index
There is no specific weight that can be regarded as ideal, as everyone is different.
The body mass index (BMI) is used as a measure of the general weight condition for people.
BMI ranges:
< 17: Extremely underweight
17 - 19: Underweight
19 - 25: Normal weight range
25 - 30: Overweight
30 - 40: Obese
40 < : Extremely obese
Page 73: Eating Disorders
People may develop unhealthy eating habits while trying to lose weight and reduce their BMI.
Unhealthy eating habits are those in which energy or nutrient needs are not met.
Behaviors such as starving, binging, and purging can lead to irreversible damage to the body and even death.
Page 74: Anorexia nervosa
Anorexia nervosa is self-imposed starvation resulting from a distorted body image.
It occurs most often in females between the ages of 12 and 21.
The causes of anorexia are unknown, but some believe it is a response to social attitudes, and there is evidence that it runs in families and can be inherited.
It is estimated that 6% of all sufferers will die as a result of the chronic damage done to their bodies.
Page 75: Anorexia Health Risks
Left untreated, anorexia can cause irreversible physical damage to the body, even death.
Health risks of anorexia include depression leading to suicide, disruption of the body's fluid and mineral balance resulting in permanent liver and kidney damage or failure, ion imbalances leading to irregular heartbeat and cardiac arrest, permanent loss of bone mass resulting in fractures and osteoporosis, excessive downy hair on face, arms, legs, and back, anemia, deficiency in saliva resulting in cavities and tooth loss, constantly feeling cold (hypothermia), and menstrual periods stopping (amenorrhea).
Page 76: Obesity
Obesity is the most common form of malnutrition in affluent societies.
BMI is 30 or higher.
In New Zealand, one in three adults falls into this group, and one in ten children.
Page 77: Causes of Obesity
Obesity is caused by the consumption of more calories than are burned.
Some individuals have specific physiological problems such as a malfunctioning thyroid or pituitary gland.
Physical problems or disabilities that severely limit or prohibit exercise, strenuous work, and other physical activity contribute to obesity.
Page 78: Obesity Health Risks
Obesity always results in premature death unless the sufferer's weight is lowered.
Health risks of obesity include atherosclerosis, stroke, breathing problems and lung diseases, hypertension, heart disease, and Type II diabetes, gall bladder disease, arthritis and other skeletal problems, hormonal imbalances, increased risk of cancers of the rectum and colon, and breast and cervix in women, irregular menstrual cycles.
Diabetes
Diabetes is a general term for a range of disorders characterized by excessive production of urine (polyuria) and excessive thirst (polydipsia).
The most common forms of diabetes are Type I and Type II diabetes mellitus.
Type I diabetes is the least common and most severe form, resulting from insufficient or no insulin production.
Type II diabetes occurs when the pancreas produces insulin, but not enough to meet the body's needs, often due to insulin resistance.
Symptoms of Type I diabetes include increased urine production, excessive thirst, hunger, weakness, and susceptibility to infections.
Type II diabetes is often undiagnosed and can lead to long-term health problems such as cataracts, cardiovascular disease, and kidney damage.
Treatment of Diabetes
Type I diabetes is treated with regular insulin injections, dietary management, and monitoring of blood glucose levels.
Type II diabetes can be managed through weight reduction, dietary modifications, and sometimes the use of antidiabetic drugs.
Insulin pumps are programmable devices that replace traditional methods of insulin replacement.
Cell therapy is an option for the treatment of Type I diabetes, where pancreatic cells from organ donors are transplanted to secrete human insulin.
Kidney Disease
Diabetes is the most common cause of end-stage renal failure.
Other causes of kidney disease include nephritis, polycystic kidney disease, and reflux nephropathy.
Chronic kidney disease (CKD) can be managed through nurse-led clinics and intensive management for high-risk individuals.
Kidney dialysis is a technique used to remove waste products and excess fluid from the body in cases of kidney failure.
Aging
Aging is the progressive decline in the body's systems due to cell death and slowed cell renewal rates.
Aging increases vulnerability to stress and disease and reduces the ability to recover from illness.
Changes caused by aging include fertility decline, increased risk of cancers, atherosclerosis, brain cell loss, graying and loss of hair, decline in sensory functions, metabolic rate decline, and reduced cell replacement.
Arthritis and joint problems are common in older individuals.
Note: The transcript does not provide information on pages 30-52, 117-118, and 123 of the workbook activity.
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Page 97: Photo Credits
Photographic images used under license from commercial photo libraries:
Corel Corporation Professional Photos
ArtToday.com