Unit One: Health

Definitions of Health:

o   “State of complete physical, mental and social well-being, and not merely the absence of disease or infirmity”. WHO (1947)

o   Free from symptoms; feel good

o   Health is holistic, idealistic

·       Inclusive of mental, physical, social, etc.

Nightingale, 1860’s: “state of being well; using every power . . . to fullest extent . . .” – Working on individual potential

Talcott Parsons, 1951, “ability to maintain normal roles”

Pres. Commission, 1953: “adjustment”, not a condition: “process adapting physically, and socially”

o   Humans have to constantly adjust to change

o   Each person is different

·       Different definitions to what it is to be healthy

American nurses Assoc, 1980, 2004: “dynamic state”, “potential realized”; “experience”; “wellness/illness, not disease or injury”  - Constantly changing = dynamic

Personal Definitions of Health:

-       Health is a highly individualized perception – Be aware of your perception of “healthy” may be different then your patient.

-       Individual’s definition/perception of health influences behavior related to health and illness.

-       Nurses can help others maintain, regain, or attain a state of health – Educate them!!!

Components of Health: (affects our perception of health)

o   Biophysical / Physiological- (functioning of the body)

·       Person’s ability to achieve fitness (body systems)

·       Genetics and gender linked diseases/predispositions

o   Psychological- (mind/emotions)

·       How an individual may feel about themselves

o   Environmental- (weather, temperature, pollution, etc.…)

·       Living / household conditions

·       Pollution, socioeconomic status, water conditions, etc.

o   Developmental- (age, gender, pollution etc..)

·       Very old / very young more at risk

o   Socio-cultural / Spiritual (Embrace spiritually or blame God for getting sick)

·       Belief of religious aspects

Ø  has an effect on recovery and how an individual sees their illness

The Individual: A Unified Being Who Strives to Maintain Health

o   Holism

·       Must see the patient as a whole!!!

o   Open System

·       Constantly changing with environment

o   Dynamic Equilibrium / Homeostasis

·       Concept of Negative feedback- Something is wrong (out of range). Body will fully attack to attempt to go back to Homeostasis

·       Body must maintain a state of balance to remain “healthy”

o   Illness Wellness continuum

o  

·       State of well being

·       Ranges from death, to high-level wellness

·       Perception of health affects your placement in the Illness-wellness continuum

·       Perception of health is ALWAYS changing DAILY

o   Healthy People 2020

·       Initiative Of HHS Office of Disease Prevention and Health Promotion

·       Global goals try to increases the quality and the quantity of life. Keep people healthy as long as possible.

Ø  Lower health disparities- (not everyone has access to healthcare)

Ex) Low SES individuals have less resources, money, accessibility to health initiatives

Concept of Nursing

o   Human responses are on a continuum that ranges from wellness to illness

o   People are integrated beings (biophysical, psychological, sociocultural, developmental, environmental dimensions)

o   Continually interact with the environment

o   Nurses assist people in moving as far as possible in the direction of wellness-  Help people maximize their potential in the direction of wellness

o   Maslow’s Hierarchy of Needs – Use to prioritize patient’s needs

·      

Ø  Ex) Answering patient call light promptly -> safety

Ø  Ex) Asking patient about personal preferences -> esteem

Ø  Ex) suctioning patient’s airway -> physiological

Ø  Ex) dialing phone so patient can speak with spouse -> love

o   Implications for Nursing

·       Prioritizing needs – Basic needs to be dealt with first before anything else

-       Who needs me first?

-       Who do I prioritize?

·       Organizing care

·       Understanding behavior

·       Facilitating growth

What is Stress? (Negative Feedback)

Change of external or internal environment that challenges dynamic equilibrium

Selye – sum of all nonspecific changes that occur in response of use, function or damage. Or “the rate of wear and tear on the body

Universal Phenomenon

Stress causes Anxiety!

Causes of Stress

Adaptation is how we react to stress

o   Characteristics

·       Internal vs external

Ø  Mental (depression) vs physical (disease)

·       Positive vs negative

·       Duration

Ø  More time stressed -> more it can affect the individual

·       Intensity

Ø  How severe -> how much it affects equilibrium

·       Multiplicity

Ø  How many stressors?

·       Categories:

Ø  Developmental (milestones, children leaving)

Ø  Situational (life events, failing a test, red light ticket)

Anxiety:

·       Source of anxiety may not be identifiable

·       Anxiety is related to the future

·       Anxiety is vague  - (vague = non-specific)

·       Anxiety results from psychological or emotional conflict.

Fear:

·       Emotion or feeling of apprehension arouse by immediate or seeming danger, pain or other perceived threat

·       Source is identifiable – Specific

·       Related to past, present or future

·       Fear is definite

·       Fear results from a specific physical or psychological entity

Categories of Contributing Factors

o   Chemical

·       Acids, bases, medication, hormones, allergens, alcohol, drugs

o   Developmental

·       Milestones, different behaviors at different ages

·       ***Critical Period / time*** (when you are more prone to stress)

Ø  Stress that occurs during a developmental time that can cause catastrophe

§  Ex) ingesting harmful substances while pregnant -> can be lethal to fetus

§  Ex) traumatic death during childhood -> psychological damage

o   Microbiological

·       Viruses, microbes, parasites

o   Physical (the environment)

·       Sound, temperature, pressure, radiation, etc.

o   Physiological

·       Anything affecting organs or their functions of them

o   Psycho-social-cultural

·       Emotions (real or imagined), economic status, religious beliefs

o   Iatrogenic

·       Health care interventions that result in medical errors

Ø  Ex) Blood drawn = bruising

Non-Specific Responses to Stress

o   Local Adaptation Syndrome (LAS / inflammation) – Occurs in a small area of the body (local injury)

Ø  Ex) cut on the finger, bee sting

§  Isolated to one area of the body

·       Heat (hyperemia) – Increased Blood Flow -> allows wounds to heel!

·       Redness (erythema)

·       Swelling (edema) – Capillary permeability

·       Pain  ( pressure from edema and chemical mediators- Histamines, bradykinin, prostaglandins)

·       Loss of function

o   General Adaptation Syndrome (GAS) -> endocrine and sympathetic nervous system

·       Stages of GAS-  another word for GAS = Systemic!!!

Ø  Alarm reaction (initial) – Our body becomes alert & activates the sympathetic nervous system

§  Alerts body’s defenses

§  Stimulates pituitary, adrenals and hypothalamus

§  Excretes epinephrine and norepinephrine

Ø  Resistance stage

§  Adaptation

§  Limit stress to the smallest part of the body (conserve energy)

Ø  Exhaustion stage

§  Adaptation can no long be maintained

§  Return to normalcy, or death

·       Clinical Manifestations of Alarm Stage of GAS

Ø  Cardiovascular

§  Elevated BP, tachy, increased cardiac output

Ø  Respiratory

§  Increased breath rate, tachypnea, bronchodilation (help increase oxygen intake)

Ø  Perceptual

§  Pupil dilation, mental alertness

Ø  Integumentary

§  Paler (paleness), peripheral vasoconstriction (extremities), sweat

Ø  Metabolic/Other

§  Increased muscle tension (stiff body)

§  Dry mouth

Ø  Urinary

§  Sodium/water retention – decreased urinary output -> Kidneys are on overdrive

Ø  Gastrointestinal

§  Decrease peristalsis, possible diarrhea

·       Prolonged Effects of GAS

§  Failure to limit stress = fever, loss of appetite, lethargy

Ø  Water retention

§  edema

Ø  Delayed healing

§  Body is fatigued

Ø  Increased blood sugar

- Stored Glucose for energy

Ø  Decreased immunity

Ø  Gastrointestinal Ulcers

§  Immune system is compromised, increase in gastric acids

Human Adaptive Capacity

o   Heredity/Congenital factors

·       Ex) genetic predisposition – sickle cell anemia, HTN

o   Developmental level / Critical time

·       Age! -> very young / very old – harder time dealing with changes

o   Psycho-socio-cultural factors

·       Emotional stability, finances?

o   Level of wellness

·       If you are already sick – it’s very hard to deal with another disease

·       Staying healthy or maintaining weight

o   Values, beliefs, myths

·       Can affect motivation to recover -> “I deserve this because . . .”

o   Past experiences

·       Can make coping harder or easier

·       Past Experiences in Healthcare

Critical Time for Psychosocial Development

o   Infancy: trust vs. mistrust

o   Early childhood (toddler): autonomy vs. shame and doubt

o   Late childhood: initiative vs. guilt

o   School age: industry vs. inferiority

o   Adolescence: identity vs. isolation

o   Young Adult: intimacy vs. isolation

o   Adults: generativity vs. stagnation

o   *** Older Adult (maturity): integrity vs. despair ***

·       Integrity: they lived their life to the best of their ability. Ready to accept death (positive resolution)

·       Despair: Sense of loss, contempt, regret about past decisions that lead them to this point in their life. (negative resolution) – Bitter, angry, & dissatisfied with life

Aging

Changes Related to Aging

o   Physiological: (All over the body)

·       Integumentary

Ø  Skin – sags, susceptible to skin tears, wrinkles (loss of elasticity)

Ø  Hair – thins

Ø  Hormonal changes

·       Musculoskeletal

Ø  Bone mass loss

Ø  Muscle atrophy – lack of muscle use and range of motion

Ø  Slower reaction time

·       Sensory

Ø  Difficulty in complex learning

Ø  Memory loss

Ø  Shrinking of cortex

§  Affects level or orientation and alertness

Ø  Decrease in visual acuity, increase risk of cataracts

§  Increase glare sensitivity, adjustment to light

Ø  Increased threshold for pain (decrease sensory perception)

Ø  Loss of elasticity in eyes

·       Pulmonary

Ø  Decreased lung expansion (decreased vital capacity)

§  Ability to exhale -> retention of CO2

§  Increase risk of acidosis

Ø  Diaphragm elasticity decreases

Ø  Kyphosis – changes proportions of body frame

·       Cardiovascular

Ø  Decreased cardiac output (the <3 is a muscle! -> atrophy!)

Ø  Exertional dyspnea

Ø  Orthostatic hypotension

§  Body can’t adjust to activity changes (from sitting to standing – dizziness)

Ø  Blood vessels lose elasticity

·       Gastrointestinal

Ø  Delayed swallow time -> GERD

Ø  Decreased changes in taste and smell

Ø  Indigestion and constipation

§  Due to decrease in peristalsis

·       Genitourinary

Ø  Decrease in filtering ability

Ø  Decrease in bladder control (leakage!)

§  Incontinence due to decrease in urinary sphincter control

§  Urinary retention (risk for UTI) due to inability to tell if bladder is full

·       Genitals

Ø  Female – decrease in vaginal lubrication (due to decrease in estrogen)

Ø  Male – prostate enlargement

·       Immune / Endocrine

Ø  Decrease immune response

Ø  Increase in insulin resistance (erratic blood sugars)

·       Body Temperature

·       Presbyopia – needs glasses

o   Psychosociocultural

·       Retirement – older age of retirement = more elderly in work force

·       Fixed income

·       Relocation

·       Death/illness of spouse

·       Cognitive decline

·       Short-term memory loss

Healthy Aging

o   What would help older people age well physically?

ü  Preventative care – regular checkups with primary care providers

ü  Dressing appropriately for cold/heat

ü  Maintaining independence

o   What would help older people age psychologically?

ü  Stay mentally active

ü  Maintain contact with family and friends