Unit One: Health
Definitions of Health:
oĀ Ā āState of complete physical, mental and social well-being, and not merely the absence of disease or infirmityā. WHO (1947)
oĀ Ā Free from symptoms; feel good
oĀ Ā Health is holistic, idealistic
Ā·Ā Ā Ā Ā Ā Ā Inclusive of mental, physical, social, etc.
Nightingale, 1860ās: āstate of being well; using every power . . . to fullest extent . . .ā ā Working on individual potential
Talcott Parsons, 1951, āability to maintain normal rolesā
Pres. Commission, 1953: āadjustmentā, not a condition: āprocess adapting physically, and sociallyā
oĀ Ā Humans have to constantly adjust to change
oĀ Ā Each person is different
Ā·Ā Ā Ā Ā Ā Ā Different definitions to what it is to be healthy
American nurses Assoc, 1980, 2004: ādynamic stateā, āpotential realizedā; āexperienceā; āwellness/illness, not disease or injuryāĀ - Constantly changing = dynamic
Remember: -Ā Ā Ā Ā Ā Ā Ā Everyone has a different perception of what it means to be healthy -Ā Ā Ā Ā Ā Ā You canāt just look at someone and determine they are healthy Ex: an individual can be older and be spiritually healthy while a person can be young and look healthy but be mentally unstable Body = healthy Mind= unhealthy -Ā Ā Ā Ā Ā Ā Culture can influence the perception of health ā Beware of the background of a patient which can influence health |
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Personal Definitions of Health:
-Ā Ā Ā Ā Ā Ā Health is a highly individualized perception ā Be aware of your perception of āhealthyā may be different then your patient.
-Ā Ā Ā Ā Ā Ā Individualās definition/perception of health influences behavior related to health and illness.
-Ā Ā Ā Ā Ā Ā Nurses can help others maintain, regain, or attain a state of health ā Educate them!!!
Components of Health: (affects our perception of health)
oĀ Ā Biophysical / Physiological- (functioning of the body)
Ā·Ā Ā Ā Ā Ā Ā Personās ability to achieve fitness (body systems)
Ā·Ā Ā Ā Ā Ā Ā Genetics and gender linked diseases/predispositions
oĀ Ā Psychological- (mind/emotions)
Ā·Ā Ā Ā Ā Ā Ā How an individual may feel about themselves
oĀ Ā Environmental- (weather, temperature, pollution, etc.ā¦)
Ā·Ā Ā Ā Ā Ā Ā Living / household conditions
Ā·Ā Ā Ā Ā Ā Ā Pollution, socioeconomic status, water conditions, etc.
oĀ Ā Developmental- (age, gender, pollution etc..)
Ā·Ā Ā Ā Ā Ā Ā Very old / very young more at risk
oĀ Ā Socio-cultural / Spiritual (Embrace spiritually or blame God for getting sick)
Ā·Ā Ā Ā Ā Ā Ā Belief of religious aspects
ĆĀ has an effect on recovery and how an individual sees their illness
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The Individual: A Unified Being Who Strives to Maintain Health
oĀ Ā Holism
Ā·Ā Ā Ā Ā Ā Ā Must see the patient as a whole!!!
oĀ Ā Open System
Ā·Ā Ā Ā Ā Ā Ā Constantly changing with environment
oĀ Ā Dynamic Equilibrium / Homeostasis
Ā·Ā Ā Ā Ā Ā Ā Concept of Negative feedback- Something is wrong (out of range). Body will fully attack to attempt to go back to Homeostasis
Ā·Ā Ā Ā Ā Ā Ā Body must maintain a state of balance to remain āhealthyā
oĀ Ā Illness Wellness continuum
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Ā·Ā Ā Ā Ā Ā Ā State of well being
Ā·Ā Ā Ā Ā Ā Ā Ranges from death, to high-level wellness
Ā·Ā Ā Ā Ā Ā Ā Perception of health affects your placement in the Illness-wellness continuum
Ā·Ā Ā Ā Ā Ā Ā Perception of health is ALWAYS changing DAILY
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oĀ Ā Healthy People 2020
Ā·Ā Ā Ā Ā Ā Ā Initiative Of HHS Office of Disease Prevention and Health Promotion
Ā·Ā Ā Ā Ā Ā Ā Global goals try to increases the quality and the quantity of life. Keep people healthy as long as possible.
ĆĀ Lower health disparities- (not everyone has access to healthcare)
Ex) Low SES individuals have less resources, money, accessibility to health initiatives
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Concept of Nursing
oĀ Ā Human responses are on a continuum that ranges from wellness to illness
oĀ Ā People are integrated beings (biophysical, psychological, sociocultural, developmental, environmental dimensions)
oĀ Ā Continually interact with the environment
oĀ Ā Nurses assist people in moving as far as possible in the direction of wellness- Ā Help people maximize their potential in the direction of wellness
oĀ Ā Maslowās Hierarchy of Needs ā Use to prioritize patientās needs
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ĆĀ Ex) Answering patient call light promptly -> safety
ĆĀ Ex) Asking patient about personal preferences -> esteem
ĆĀ Ex) suctioning patientās airway -> physiological
ĆĀ Ex) dialing phone so patient can speak with spouse -> love
oĀ Ā Implications for Nursing
Ā·Ā Ā Ā Ā Ā Ā Prioritizing needs ā Basic needs to be dealt with first before anything else
-Ā Ā Ā Ā Ā Ā Who needs me first?
-Ā Ā Ā Ā Ā Ā Who do I prioritize?
Ā·Ā Ā Ā Ā Ā Ā Organizing care
Ā·Ā Ā Ā Ā Ā Ā Understanding behavior
Ā·Ā Ā Ā Ā Ā Ā Facilitating growth
What is Stress? (Negative Feedback)
Change of external or internal environment that challenges dynamic equilibrium
Selye ā sum of all nonspecific changes that occur in response of use, function or damage. Or āthe rate of wear and tear on the body
Universal Phenomenon
Stress causes Anxiety!
Causes of Stress
Adaptation is how we react to stress
oĀ Ā Characteristics
Ā·Ā Ā Ā Ā Ā Ā Internal vs external
ĆĀ Mental (depression) vs physical (disease)
Ā·Ā Ā Ā Ā Ā Ā Positive vs negative
Ā·Ā Ā Ā Ā Ā Ā Duration
ĆĀ More time stressed -> more it can affect the individual
Ā·Ā Ā Ā Ā Ā Ā Intensity
ĆĀ How severe -> how much it affects equilibrium
Ā·Ā Ā Ā Ā Ā Ā Multiplicity
ĆĀ How many stressors?
Ā·Ā Ā Ā Ā Ā Ā Categories:
ĆĀ Developmental (milestones, children leaving)
ĆĀ Situational (life events, failing a test, red light ticket)
Anxiety:
Ā·Ā Ā Ā Ā Ā Ā Source of anxiety may not be identifiable
Ā·Ā Ā Ā Ā Ā Ā Anxiety is related to the future
Ā·Ā Ā Ā Ā Ā Ā Anxiety is vagueĀ - (vague = non-specific)
Ā·Ā Ā Ā Ā Ā Ā Anxiety results from psychological or emotional conflict.
Fear:
Ā·Ā Ā Ā Ā Ā Ā Emotion or feeling of apprehension arouse by immediate or seeming danger, pain or other perceived threat
Ā·Ā Ā Ā Ā Ā Ā Source is identifiable ā Specific
Ā·Ā Ā Ā Ā Ā Ā Related to past, present or future
Ā·Ā Ā Ā Ā Ā Ā Fear is definite
Ā·Ā Ā Ā Ā Ā Ā Fear results from a specific physical or psychological entity
Categories of Contributing Factors
oĀ Ā Chemical
Ā·Ā Ā Ā Ā Ā Ā Acids, bases, medication, hormones, allergens, alcohol, drugs
oĀ Ā Developmental
Ā·Ā Ā Ā Ā Ā Ā Milestones, different behaviors at different ages
Ā·Ā Ā Ā Ā Ā Ā ***Critical Period / time*** (when you are more prone to stress)
ĆĀ 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
oĀ Ā Microbiological
Ā·Ā Ā Ā Ā Ā Ā Viruses, microbes, parasites
oĀ Ā Physical (the environment)
Ā·Ā Ā Ā Ā Ā Ā Sound, temperature, pressure, radiation, etc.
oĀ Ā Physiological
Ā·Ā Ā Ā Ā Ā Ā Anything affecting organs or their functions of them
oĀ Ā Psycho-social-cultural
Ā·Ā Ā Ā Ā Ā Ā Emotions (real or imagined), economic status, religious beliefs
oĀ Ā Iatrogenic
Ā·Ā Ā Ā Ā Ā Ā Health care interventions that result in medical errors
ĆĀ Ex) Blood drawn = bruising
Non-Specific Responses to Stress
oĀ Ā Local Adaptation Syndrome (LAS / inflammation) ā Occurs in a small area of the body (local injury)
ĆĀ Ex) cut on the finger, bee sting
§ Isolated to one area of the body
Ā·Ā Ā Ā Ā Ā Ā Heat (hyperemia) ā Increased Blood Flow -> allows wounds to heel!
Ā·Ā Ā Ā Ā Ā Ā Redness (erythema)
Ā·Ā Ā Ā Ā Ā Ā Swelling (edema) ā Capillary permeability
Ā·Ā Ā Ā Ā Ā Ā PainĀ ( pressure from edema and chemical mediators- Histamines, bradykinin, prostaglandins)
Ā·Ā Ā Ā Ā Ā Ā Loss of function
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oĀ Ā General Adaptation Syndrome (GAS) -> endocrine and sympathetic nervous system
Ā·Ā Ā Ā Ā Ā Ā Stages of GAS-Ā another word for GAS = Systemic!!!
ĆĀ Alarm reaction (initial) ā Our body becomes alert & activates the sympathetic nervous system
§ Alerts bodyās defenses
§ Stimulates pituitary, adrenals and hypothalamus
§ Excretes epinephrine and norepinephrine
ĆĀ Resistance stage
§ Adaptation
§ Limit stress to the smallest part of the body (conserve energy)
ĆĀ Exhaustion stage
§ Adaptation can no long be maintained
§ Return to normalcy, or death
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Ā·Ā Ā Ā Ā Ā Ā Clinical Manifestations of Alarm Stage of GAS
ĆĀ Cardiovascular
Ć Increases |
§ Elevated BP, tachy, increased cardiac output
ĆĀ Respiratory
§ Increased breath rate, tachypnea, bronchodilation (help increase oxygen intake)
ĆĀ Perceptual
§ Pupil dilation, mental alertness
ĆĀ Integumentary
§ Paler (paleness), peripheral vasoconstriction (extremities), sweat
ĆĀ Metabolic/Other
§ Increased muscle tension (stiff body)
§ Dry mouth
Ć Decreases |
ĆĀ Urinary
§ Sodium/water retention ā decreased urinary output -> Kidneys are on overdrive
ĆĀ Gastrointestinal
§ Decrease peristalsis, possible diarrhea
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Ā·Ā Ā Ā Ā Ā Ā Prolonged Effects of GAS
§ Failure to limit stress = fever, loss of appetite, lethargy
ĆĀ Water retention
§ edema
ĆĀ Delayed healing
§ Body is fatigued
ĆĀ Increased blood sugar
- Stored Glucose for energy
ĆĀ Decreased immunity
ĆĀ Gastrointestinal Ulcers
§ Immune system is compromised, increase in gastric acids
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Human Adaptive Capacity
oĀ Ā Heredity/Congenital factors
Ā·Ā Ā Ā Ā Ā Ā Ex) genetic predisposition ā sickle cell anemia, HTN
oĀ Ā Developmental level / Critical time
Ā·Ā Ā Ā Ā Ā Ā Age! -> very young / very old ā harder time dealing with changes
oĀ Ā Psycho-socio-cultural factors
Ā·Ā Ā Ā Ā Ā Ā Emotional stability, finances?
oĀ Ā Level of wellness
Ā·Ā Ā Ā Ā Ā Ā If you are already sick ā itās very hard to deal with another disease
Ā·Ā Ā Ā Ā Ā Ā Staying healthy or maintaining weight
oĀ Ā Values, beliefs, myths
Ā·Ā Ā Ā Ā Ā Ā Can affect motivation to recover -> āI deserve this because . . .ā
oĀ Ā Past experiences
Ā·Ā Ā Ā Ā Ā Ā Can make coping harder or easier
Ā·Ā Ā Ā Ā Ā Ā Past Experiences in Healthcare
Critical Time for Psychosocial Development
oĀ Ā Infancy: trust vs. mistrust
oĀ Ā Early childhood (toddler): autonomy vs. shame and doubt
oĀ Ā Late childhood: initiative vs. guilt
oĀ Ā School age: industry vs. inferiority
oĀ Ā Adolescence: identity vs. isolation
oĀ Ā Young Adult: intimacy vs. isolation
oĀ Ā Adults: generativity vs. stagnation
oĀ Ā *** Older Adult (maturity): integrity vs. despair ***
Ā·Ā Ā Ā Ā Ā Ā Integrity: they lived their life to the best of their ability. Ready to accept death (positive resolution)
Ā·Ā Ā Ā Ā Ā Ā Despair: Sense of loss, contempt, regret about past decisions that lead them to this point in their life. (negative resolution) ā Bitter, angry, & dissatisfied with life
Aging
Changes Related to Aging
oĀ Ā Physiological: (All over the body)
Ā·Ā Ā Ā Ā Ā Ā Integumentary
ĆĀ Skin ā sags, susceptible to skin tears, wrinkles (loss of elasticity)
ĆĀ Hair ā thins
ĆĀ Hormonal changes
Ā·Ā Ā Ā Ā Ā Ā Musculoskeletal
ĆĀ Bone mass loss
ĆĀ Muscle atrophy ā lack of muscle use and range of motion
ĆĀ Slower reaction time
Ā·Ā Ā Ā Ā Ā Ā Sensory
ĆĀ Difficulty in complex learning
ĆĀ Memory loss
ĆĀ Shrinking of cortex
§ Affects level or orientation and alertness
ĆĀ Decrease in visual acuity, increase risk of cataracts
§ Increase glare sensitivity, adjustment to light
ĆĀ Increased threshold for pain (decrease sensory perception)
ĆĀ Loss of elasticity in eyes
Ā·Ā Ā Ā Ā Ā Ā Pulmonary
ĆĀ Decreased lung expansion (decreased vital capacity)
§ Ability to exhale -> retention of CO2
§ Increase risk of acidosis
ĆĀ Diaphragm elasticity decreases
ĆĀ Kyphosis ā changes proportions of body frame
Ā·Ā Ā Ā Ā Ā Ā Cardiovascular
ĆĀ Decreased cardiac output (the <3 is a muscle! -> atrophy!)
ĆĀ Exertional dyspnea
ĆĀ Orthostatic hypotension
§ Body canāt adjust to activity changes (from sitting to standing ā dizziness)
ĆĀ Blood vessels lose elasticity
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Ā·Ā Ā Ā Ā Ā Ā Gastrointestinal
ĆĀ Delayed swallow time -> GERD
ĆĀ Decreased changes in taste and smell
ĆĀ Indigestion and constipation
§ Due to decrease in peristalsis
Ā·Ā Ā Ā Ā Ā Ā Genitourinary
ĆĀ Decrease in filtering ability
ĆĀ 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
Ā·Ā Ā Ā Ā Ā Ā Genitals
ĆĀ Female ā decrease in vaginal lubrication (due to decrease in estrogen)
ĆĀ Male ā prostate enlargement
Ā·Ā Ā Ā Ā Ā Ā Immune / Endocrine
ĆĀ Decrease immune response
ĆĀ Increase in insulin resistance (erratic blood sugars)
Ā·Ā Ā Ā Ā Ā Ā Body Temperature
Ā·Ā Ā Ā Ā Ā Ā Presbyopia ā needs glasses
oĀ Ā Psychosociocultural
Ā·Ā Ā Ā Ā Ā Ā Retirement ā older age of retirement = more elderly in work force
Ā·Ā Ā Ā Ā Ā Ā Fixed income
Ā·Ā Ā Ā Ā Ā Ā Relocation
Ā·Ā Ā Ā Ā Ā Ā Death/illness of spouse
Ā·Ā Ā Ā Ā Ā Ā Cognitive decline
Ā·Ā Ā Ā Ā Ā Ā Short-term memory loss
Healthy Aging
oĀ Ā What would help older people age well physically?
ü Preventative care ā regular checkups with primary care providers
ü Dressing appropriately for cold/heat
ü Maintaining independence
oĀ Ā What would help older people age psychologically?
ü Stay mentally active
ü Maintain contact with family and friends