Unit 1 Health

Unit One: Health

Definitions of Health:

oĀ Ā  ā€œState 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, 1860’s: ā€œstate of being well; using every power . . . to fullest extent . . .ā€ – Working on individual potential

Talcott Parsons, 1951, ā€œability to maintain normal rolesā€

Pres. Commission, 1953: ā€œadjustmentā€, not a condition: ā€œprocess 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: ā€œdynamic stateā€, ā€œpotential realizedā€; ā€œexperienceā€; ā€œwellness/illness, not disease or injuryā€Ā  - 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 can’t 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 – 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 – Be aware of your perception of ā€œhealthyā€ may be different then your patient.

-Ā Ā Ā Ā Ā Ā  Individual’s 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 – 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  Person’s 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  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

Ø  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 ā€œhealthyā€

oĀ Ā  Illness Wellness continuum

oĀ Ā 

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.

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

Ā·Ā Ā Ā Ā Ā Ā 

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

oĀ Ā  Implications for Nursing

Ā·Ā Ā Ā Ā Ā Ā  Prioritizing needs – 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 – sum of all nonspecific changes that occur in response of use, function or damage. Or ā€œthe 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

Ø  Mental (depression) vs physical (disease)

Ā·Ā Ā Ā Ā Ā Ā  Positive vs negative

Ā·Ā Ā Ā Ā Ā Ā  Duration

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

Ā·Ā Ā Ā Ā Ā Ā  Intensity

Ø  How severe -> how much it affects equilibrium

Ā·Ā Ā Ā Ā Ā Ā  Multiplicity

Ø  How many stressors?

Ā·Ā Ā Ā Ā Ā Ā  Categories:

Ø  Developmental (milestones, children leaving)

Ø  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 – 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)

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

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

Ø  Ex) Blood drawn = bruising

Non-Specific Responses to Stress

oĀ Ā  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

Ā·Ā Ā Ā Ā Ā Ā  Heat (hyperemia) – 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) – 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!!!

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

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Ā·Ā Ā Ā Ā Ā Ā  Clinical Manifestations of Alarm Stage of GAS

Ø  Cardiovascular

ß Increases

§  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

ß Decreases

Ø  Urinary

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

Ø  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

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

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Human Adaptive Capacity

oĀ Ā  Heredity/Congenital factors

Ā·Ā Ā Ā Ā Ā Ā  Ex) genetic predisposition – sickle cell anemia, HTN

oĀ Ā  Developmental level / Critical time

Ā·Ā Ā Ā Ā Ā Ā  Age! -> very young / very old – 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 – it’s 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 -> ā€œI 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) – 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

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

Ø  Hair – thins

Ø  Hormonal changes

Ā·Ā Ā Ā Ā Ā Ā  Musculoskeletal

Ø  Bone mass loss

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

Ø  Slower reaction time

Ā·Ā Ā Ā Ā Ā Ā  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

Ā·Ā Ā Ā Ā Ā Ā  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

Ā·Ā Ā Ā Ā Ā Ā  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

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Ā·Ā Ā Ā Ā Ā Ā  Gastrointestinal

Ø  Delayed swallow time -> GERD

Ø  Decreased changes in taste and smell

Ø  Indigestion and constipation

§  Due to decrease in peristalsis

Ā·Ā Ā Ā Ā Ā Ā  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

Ā·Ā Ā Ā Ā Ā Ā  Genitals

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

Ø  Male – prostate enlargement

Ā·Ā Ā Ā Ā Ā Ā  Immune / Endocrine

Ø  Decrease immune response

Ø  Increase in insulin resistance (erratic blood sugars)

Ā·Ā Ā Ā Ā Ā Ā  Body Temperature

Ā·Ā Ā Ā Ā Ā Ā  Presbyopia – needs glasses

oĀ Ā  Psychosociocultural

Ā·Ā Ā Ā Ā Ā Ā  Retirement – 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 – 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