Health and Illness

Health and Illness

 HEALTH – is the extent to
which an individual or group is
able to realize aspirations and
satisfy needs and change to
cope with environment.
Health and Illness
 HEALTH – It is the complete
physical, mental and social well
being and not merely the
absence of disease or infirmity
(WHO, 1948)
Health and Illness
 HEALTH – Is the state of being
well and using power the
individual possesses to the
fullest extent (Nightingale,
1969)
Health and Illness
 WELLNESS – Is the integrated
method of functioning oriented
towards maximizing the
potential by which a person is
capable of functioning in a
given time and environment
(Halpert Dunn).
Health and Illness
 ILLNESS – is the response of
the person to a disease; it is an
abnormal process in which the
person’s level of functioning is
changed when compared with a
previous level.
Health and Illness
 DISEASE – is a medical term,
meaning that there is a
pathologic change in the
structure or function of the body
or mind.
Health and Illness
 MODELS OF HEALTH
– Clinical Model
– Role Performance Model
– Adaptive Model
– Eudemonistic Model
Health and Illness
 MODELS OF HEALTH
– Agent-Host-Environment
Model
– Health-Illness Continuum
Health and Illness
 CLINICAL MODEL – Narrowest
interpretation of health;
opposite of health is disease or
injury; Absence of Disease
Health and Illness
 ROLE PERFOMANCE MODEL
– Health is based on the ability
to fulfill societal roles. Sickness
is the inability to perform one’s
work.
Health and Illness
 ADAPTIVE MODEL – Health is
a creative process. Disease is
failure in adaptation or
maladaptation.
Health and Illness
 EUDEMONISTIC – Health is
seen as a condition of
actualization or realization of a
person’s potential while illness
is a condition that prevents self-
actualization.
Health and Illness
 AGENT-HOST-
ENVIRONMENT MODEL –
A.K.A Ecological Model, when
the 3 variables (agent-host-
environment) are in balance,
health is maintained; when
variables are not in balance,
disease occurs.
Health and Illness
 HEALTH-ILLNESS
CONTINUUM – Health and
illness can be viewed as
opposite ends of a health
continuum.
Health and Illness
 ILLNESS
– TYPE OF ILLNESS
• Acute Illness
• Chronic Illness
Health and Illness
 ACUTE ILLNESS – generally,
has a rapid onset of symptoms
and lasts only a relatively short
time. (< 6 months)
Health and Illness
 CHRONIC ILLNESS – is a
broad term that encompasses
many different physical and
mental alterations in health.
(> 6 months)
Health and Illness
 ILLNESS
–STAGES OF ILLNESS
• Injury
• Prodromal
• Convalescent
• Remission
• Recovery
Health and Illness
 ILLNESS
–STAGES OF ILLNESS
BEHAVIOR
• Symptom Experience
• Assumption of the Sick
Role
• Medical Care Contact
Health and Illness
 ILLNESS
–STAGES OF ILLNESS
BEHAVIOR
• Dependent Client Role
• Recovery and
Rehabilitation
Stress
 STRESS – Is the body’s non-
specific response to any
demand made upon it. (Han
Selye, Father of Modern Stress
Theory)
Stress
 STRESSOR – The source of
stress
 EUSTRESS – Positive stress
 DISTRESS – Negative stress
Stress
 STRESS-ADAPTATION
SYNDROME
– STAGES
• Alarm Reaction
• Stage of Resistance
• Stage of Exhaustion
Stress
 STRESS-ADAPTATION
SYNDROME
– ALARM REACTION.
mobilization of body’s
defenses and activation for
possible “fight or flight”
reaction.
Stress
 ALARM REACTION
– PHYSICAL CHANGES: inc. BP,
inc. force of cardiac contraction,
inc. hormone levels, adrenals
enlargement, marked loss of BW,
irritation of gastric mucosa,
atrophy of spleen, thymus and
lymph nodes
Stress
 ALARM REACTION
– PSYCHOSOCIAL
CHANGES: inc. alertness
level, inc. anxiety level (+1 to
+2 anxiety), task-oriented,
defense-oriented, inefficient
behavior
Stress
 STRESS-ADAPTATION
SYNDROME
– STAGE OF RESISTANCE.
Optimal adaptation to stress
within personal capability.
Stress
 STAGE OF RESISTANCE
– PHYSICAL CHANGES:
adjustment of hormone levels,
reduced activity and size of
adrenal cortex, normalization
of lymph node size and BW
Stress
 STAGE OF RESISTANCE
– PSYCHOSOCIAL
CHANGES: intensified use of
coping mechanisms, reliance
on defense-oriented behavior,
psychosomatic symptoms
Stress
 STRESS-ADAPTATION
SYNDROME
– STAGE OF EXHAUSTION.
Loss of ability to resist stress
due to depletion of body
resources: fight, flight or
immobilization occurs.
Stress
 STAGE OF EXHAUSTION
– PHYSICAL CHANGES: dec.
immune response, dec. adrenal
hormone, weight loss, enlarge
lymph nodes and dysfunctional
lymphatic system [worst case:
heart failure, renal failure and
DEATH]
Stress
 STAGE OF EXHAUSTION
– PSYCHOSOCIAL CHANGES:
exaggerated defense-oriented
behavior, disorganization of
thinking, illusions, delusions, and
hallucinations [worst case: stupor
and VIOLENCE]
Stress
 NURSING INTERVENTIONS
– Stress Management
– Promotion of healthy lifestyle
– Enhancing coping strategies
– Teaching relaxation techniques
– Progressive muscle relaxation
Stress
 NURSING INTERVENTIONS
– Guided imagery
– Music therapy
– Use of humor
– Massage
– Therapeutic Touch
DEATH AND DYING
Death and Dying
 GRIEF – is an encompassing
response (physical,
psychological, cognitive and
behavioral) that a person
experiences after the loss of
significant person, object, belief
or relationship.
Death and Dying
 ANTICIPATORY GRIEF – is
the characteristic pattern of
responses a person ,makes to
the impending (real or
imagined) loss.
Death and Dying
 BEREAVEMENT – is the state
of desolation resulting from
loss.
 MOURNING – is a socially
conventional bereavement
behaviors after the death of a
significant other.
Death and Dying
 GRIEF
– MODELS OF GRIEF
• Engel’s Model
• Kubler-Ross Stages of
Dying
• Parkes’ Model
Death and Dying
 ENGEL’S MODEL – resolution
of grief takes 1 year or longer.
Death and Dying
 ENGEL’S MODEL
1. Shock and Disbelief
2. Developing awareness
3. Restitution
4. Resolving the Loss
5. Idealization
6. Outcome
Death and Dying
 1.SHOCK AND DISBELIEF –
survivor either refuses to accept
the loss or shows intellectual
acceptance but denies
emotional impact.
Death and Dying
 2.
DEVELOPING
AWARENESS – when reality
and meaning of the loss
surfaces into the
consciousness.
Death and Dying
 3. RESTITUTION – involves
work of mourning that includes
rituals.
 4. RESOLVING THE LOSS –
focus on thoughts of the
deceased.
Death and Dying
 5. IDEALIZATION – repressing
all the negative feelings toward
the deceased.
 6. OUTCOME – psychological
dependence on the deceased
reduces as interest in new
relationship resumes.
Death and Dying
 KUBLER-ROSS STAGE OF
DYING – Pioneering work that
prompted for increased
attention to the needs of the
dying and the bereaved.
Death and Dying
 KUBLER-ROSS STAGES OF
DYING
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
Death and Dying
 1.DENIAL – from complete
denial of the illness and
impending death to denial of the
effect that dying will have on
self and others
"I feel fine."; "This can't be
happening, not to me!,"
Death and Dying
 2.ANGER – may be directed
toward fate, God, family
members, health care providers
or others.
"Why me? It's not fair!"; "How can
this happen to me!"; "Who is to
blame?"
Death and Dying
 3.
BARGAINING – seeks to delay
the dreaded event, bargains with
their God as promise is made to
repay for more time.
"Just let me live to see my children
graduate."; "I'll do anything for a few more
years."; "I will give my life savings if..."
Death and Dying
 4.DEPRESSION –
acknowledges the reality and
inevitability of the impending
death.
"I'm so sad, why bother with
anything?"; "I'm going to die . . .
What's the point?"; "I miss my loved
one, why go on?"
Death and Dying
 5.ACCEPTANCE – comes to
terms with loss and detach from
supportive people and loss
interest in worldly activities.
"It's going to be okay."; "I can
handle it with change"; "I can't fight
it, I may as well prepare for it."
Death and Dying
 PARKES’ MODEL (4 STAGES
OF GRIEF) – Progression
through the stages of grief
normally takes 2 years or
longer.
Death and Dying
 PARKES’ MODEL (4
STAGES OF GRIEF)
1. Numbness
2. Yearning
3. Disorganization
4. Reorganization
Death and Dying
 1. NUMBENESS – brief denial
as a psychological defense.
 2. YEARNING – last several
months with intense
psychological distress with
thoughts focused on the
deceased.
Death and Dying
 3.DISORGANIZATION –
characterized by severe
depression, social withdrawal,
lack of interest in people and
activities.
Death and Dying
 4.
REORGANIZATION – begins
6-9 months with gradual
renewal of interest in people
and activities.
Death and Dying
SIGNS OF IMPENDING DEATH
1. slow, thready and weaker
pulse
2. lowered blood pressure
3. rapid, shallow, irregular or
abnormally slow breathing
4. mottling of lower extremities
Death and Dying
 INDICATION OF DEATH
1. Total lack of response to
external stimuli
2. No muscular movement
especially breathing
3. No reflexes
4. Flat ECG
Death and Dying
 BODY CHANGES AFTER
DEATH
– Rigor Mortis
– Algor Mortis
– Livor Mortis
Death and Dying
 RIGOR MORTIS – stiffening of
the body 2-4 hours after death
 ALGOR MORTIS – gradual
dec. of the body’s temperature
until it reaches room
temperature
Death and Dying
 LIVOR MORTIS – discoloration
of the surrounding tissues due
to the release of Hgb; appears
in lowermost parts or
dependent areas of the body.
Death and Dying
 NURSING INTERVENTIONS
– Care for the body
• Positioning
• Place dentures
• Close eyes using wet/ moistened
cotton balls
• Close mouth before rigor mortis
sets in
Death and Dying
 NURSING INTERVENTIONS
– All equipments and supplies
must be removed from the
bedside
– Identify client’s religion and
comply
– Apply proper identification bands
Death and Dying
 NURSING INTERVENTIONS
– Make body as natural as
possible
– Place small pillow or folded towel
under the head to prevent
discoloration from blood pooling
Death and Dying
 NURSING INTERVENTIONS
– All valuables and disposition
must be documented in the
patient’s medical record
– Provide emotional support to the
significant other
Pain
 PAIN – unpleasant
sensory/emotional experience
resulting from actual or potential
tissue damage
Pain
 PAIN – is a defense
mechanism when the normal
functioning is threatened by
internal or external sources.
Cell Injury
Cell release prostaglandin

Release of bradykinin

vasodilatation
S/S of inflammation

Stretching of free nerve ending

PAIN
Pain
 PAIN THRESHOLD – is the
intensity of the stimulus
required to cause an individual
to experience pain
Pain
 PAIN TOLERANCE – the point
at which the individual reacts to
pain with verbal or other
responses. Influenced by
culture, age, pain experience
and level of consciousness.
Pain
 TYPES OF PAIN
– According to Pattern
– According to Location
– According to Duration
Pain
 ACCORDING TO PATTERN
– CONSTANT PAIN. Occurs
continuously
– INTERMITTENT PAIN. Occurs
periodically
– INTRACTABLE PAIN. Not
relieved by ordinary measures
Pain
 ACCORDING TO LOCATION
– SUPERFICIAL OR
CUTANEOUS PAIN. Near body
surface
– DEEP OR SOMATIC. Pain in
deeper tissues involves tendons,
ligaments, bones, nerves, and
blood vessels
Pain
 ACCORDING TO LOCATION
– VISCERAL PAIN. Involves
internal organs
– REFERRED PAIN. Perceived in
an area distant from the site of
stimuli.
Pain
 ACCORDING TO DURATION
– ACUTE PAIN. Recent onset
which lasts for a few seconds to 6
months
– CHRONIC PAIN. Constant or
intermittent that persists over a
period of time
Pain
 FACTORSAFFECTING
PERCEPTION OF PAIN:
– Culture - Time
– Age - LOC
– Gender - Past pain
– Experience
Pain
 NURSING INTERVENTIONS
– Provide non-pharmacologic
treatment to pain.
• Deep breathing exercise
• Massage
• Guided Imagery
Pain
 NURSING INTEVENTIONS
– (continued..)
• Music Therapy
• Divertional Activities
• Meditation
• Positioning
• Hypnosis
Pain
 NURSING INTERVENTIONS
– Administer pain medication as
indicated
– Patient advocate when treatment
is ineffective
PERIOPERATIVE
NURSING
Perioperative Nursing
 SURGERY - It is the branch of
medicine concerned with
diseases and conditions which
require or are amenable to
operative procedures. Surgery
is the work done by a surgeon
Perioperative Nursing
 CLASSIFICATION OF
SURGERY
– According to Urgency
– According to Degree of Risk
– According to Purpose
– According to Location
Perioperative Nursing
 ACCORDING TO URGENCY
– Emergent
– Urgent
– Required
– Elective
– Optional
Perioperative Nursing
 EMERGENT - Patient requires
immediate attention ; disorder
maybe LIFE-THREATENING
Examples : Severe bleeding,
extensive burns, bladder or intestinal
obstruction, fractured skull, gunshot
or stab wounds
Perioperative Nursing
 URGENT - Patient requires
prompt attention; indications for
surgery is within 24-30 hours
Examples : Acute gallbladder
infection; Kidney / Ureteral stones
Perioperative Nursing
 REQUIRED - Patient needs to
have surgery; indications for
surgery: plan within few weeks
or months
Examples : Prostatic hyperplasia
without bladder obstruction, Thyroid
disorders, Cataracts
Perioperative Nursing
 ELECTIVE - Patient should
have surgery; Indications for
surgery: Failure to have surgery
not catastrophic
Examples : Repair of scars,
Simple hernia, Vaginal repair
Perioperative Nursing
 OPTIONAL - Decision rests
with patient; Indications for
surgery: Personal preference
Examples : Cosmetic surgery
Perioperative Nursing
 ACCORDING TO DEGREE OF
RISK
– Major
– Minor
Perioperative Nursing
 MAJOR - Maybe complicated /
prolonged, large losses of blood
may occur, vital organs maybe
involved, post-op complications
may be likely
Examples: Organ transplant,
Open heart surgery, Removal of a
kidney
Perioperative Nursing
 MINOR - Little risk with few
complications; Often performed
in a “day surgery”.
Examples: Breast biopsy,
Tonsillectomy, Knee surgery
Perioperative Nursing
 ACCORDING TO PURPOSE
– Diagnostic
– Exploratory
– Curative
– Ablative
– Palliative
– Reconstructive
– Constructive
Perioperative Nursing
 DIAGNOSTIC - verifies
suspected diagnosis, e.g. Bx
 EXPLORATORY - estimates
the extent of the disease or
injury, e.g. ExLap
 CURATIVE - Removes or
repairs damaged tissues
Perioperative Nursing
 ABLATIVE - removing diseased
organ that can’t wait anymore
 PALLIATIVE - relieves symptoms
but does not cure the underlying
disease process
Perioperative Nursing
 RECONSTRUCTIVE – partial
or complete restoration of a
damaged organ/tissue to
bring back the original
appearance & function.
(mammoplasty, face-lift)
Perioperative Nursing
 CONSTRUCTIVE – repairing
the damaged tissue or
congenitally defective organ.
(multiple wound repair)
Perioperative Nursing
 SURGEON - A physician who
treats disease, injury, or
deformity by operative or manual
methods. A medical doctor
specialized in the removal of
organs, masses and tumors.
Perioperative Nursing
 STERILE - free from living
germs or microorganisms
 ASEPSIS - the state of being
free of pathogenic
microorganisms
Perioperative Nursing
 ASEPSIS - The process of
removing pathogenic
microorganisms or protecting
against infection by such
organisms
Perioperative Nursing
 SEPSIS - a toxic condition
resulting from the spread of
bacteria or their toxic products
from a focus of infection
Perioperative Nursing
 DISINFECTANT - any chemical
agent used chiefly on inanimate
objects to destroy or inhibit the
growth of harmful organisms
Perioperative Nursing
 ANTISEPTIC - Is a substance
that prevents or arrests the
growth or action of
microorganisms either by
inhibiting their activity or by
destroying them. The term is
used especially for preparations
applied topically to living tissue
Perioperative Nursing
 STERILIZATION - The
destruction of all living
microorganisms, as pathogenic
bacteria, vegetative forms, and
spores
Perioperative Nursing
 DEFINITION : The identification of
physiological & sociological needs
of the client, & the implementation
of an individualized program of
nursing care in order to restore or
maintain the health & welfare of the
patient before, during & after
surgical intervention
Perioperative Nursing
 GOALS
1. To provide safe, supportive &
comprehensive care.
2. To assist the surgeon by
functioning effectively as a
member of the surgical team.
3. To create & maintain an
aseptic / sterile environment.
Perioperative Nursing
 PHASES OF SURGERY
– Pre-operative Phase
– Intra-operative Phase
– Post-operative Phase
Perioperative Nursing
 PRE-OPERATIVE PHASE -
From the time the decision is
made for surgery to the transfer
of patient to the operating room
Perioperative Nursing
 PRE-OPERATIVE PHASE
– ASSESSMENT:
• Age
• Nutritional Status
• Fluids and Electrolytes
• Infection
Perioperative Nursing
 PRE-OPERATIVE PHASE
– ASSESSMENT:
• Cardiopulmonary Clearance
• System functions
• Use of Medications
• Health Habits
Perioperative Nursing
 PRE-OPERATIVE PHASE
– TEACHINGS
• Deep breathing exercises
• Pursed-lip breathing exercises
• Turning exercises
• Extremity exercises
Perioperative Nursing
 PRE-OPERATIVE PHASE
– PREPARATIONS
• Handle fear of the unknown
• Informed consent
• GIT preparation
• Skin preparation
• Promote rest and sleep
Perioperative Nursing
 PRE-OPERATIVE PHASE
– MEDICATIONS
• Tranquilizer (diazepam [Valium] )
• Sedatives ( Pentobarbital/ Secobarbital)
• Analgesics (MoSO4 and Meperidine
HCl)
• Anticholinergic (AtSO4)
• H2-Blocker ( cimetidine [Tagamet]/
ranitidine [Zantac])
Perioperative Nursing
 INTRA-OPERATIVE PHASE -
From the time the patient is
received in the OR to admission
to the recovery room
Perioperative Nursing
 PRINCIPLES OF SURGICAL
ASEPSIS
– A – lways face the sterile field
– S – hould be above waist level
and on top of sterile field
– E – liminate moisture that
causes contamination
Perioperative Nursing
 PRINCIPLE OF SURGICAL
ASEPSIS
– P – revent unnecessary traffic and
air current
– S – afer to assume “contaminated”
when in doubt
– I – nvolves team effort
– S – terile article unused and
opened are no longer sterile after
procedure
Perioperative Nursing
 POST-OPERATIVE PHASE -
From the time of admission to
the recovery room to the follow
up in the clinical setting/ home
Perioperative Nursing
 POST-OPERATIVE PHASE
– GOALS
• 1. Restore homeostasis and
prevent complication
• 2. Maintain and promote
adequate airway and respiratory
function
Perioperative Nursing
 POST-OPERATIVE PHASE
– GOALS
• 3. Maintain adequate cardiac
function and promote tissue
perfusion
• 4. Maintain adequate fluid and
electrolyte balance and adequate
renal function
Perioperative Nursing
 POST-OPERATIVE PHASE
– GOALS
• 5. Promote comfort and rest
• 6. Promote adequate nutrition
and elimination
• 7. Promote wound healing
Perioperative Nursing
 POST-OPERATIVE PHASE
– COMPLICATIONS
• Pneumonia
• Atelectasis
• Pulmonary Embolism
• Hemorrhage
• Hypovolemic Shock
Perioperative Nursing
 POST-OPERATIVE PHASE
– COMPLICATIONS
• Thrombophlebitis
• Urinary Retention
• Wound Dehiscence
• Wound Evisceration