Chapter 2 Concepts of health, illness , stress and health promotion

What do nurses seeks to help patients with?

1) Adjust or accept challenges 2) Develop good health habits

Parasympathetic

1) Eyes -Pupils constrict 2) Bronchial tubes- Constrict 3) Salivary glands- Stimulate watery secretions 4) Heart- Decrease rate 5) Blood vessels- No effect for many 6) Intestines- Stimulate motility and secretion

Sympathetic

1) Eyes become dilated-Pupil larger 2) Bronchial tubes- Dilate 3) Salivary glans - Stimulate thick secretions- dry mouth 4) Heart - Increases rate and strength of contractions 5) Blood vessels- Generally constrict- Increase blood pressure 6) Sweat glands- Stimulate sweat production 7) Intestines- Inhibit mobility- Possible constipation. 8) Liver - Stimulates glycogen breakdown. 9) Adrenal medulla- Stimulates secretion of epinephrine and norepinephrine.

Self-Esteem needs

1) Independence 2) Competence 3) Exploration 4) Roles 5) Motivation 6) Learning 7) Leisure 8) Spiritual beliefs

Physiological needs

1) Oxygen- air 2) Nutrition- Food and water 3) Elimination 4) Safety- Protection from injury 5) Rest and comfort- Relief from pain 6) Hygiene 7) Activity- Movement and mental stimulation 8) Sexual procreation

Health promotion behaviors

1) Primary prevention 2) Secondary prevention 3) Tertitary prevention

Safety and Security needs

1) Psychological comfort 2) Assistance in meeting needs 3) Comfortable environment

Self - Actualization needs

1) Self knowledge and acceptance 2) Achievement 3) Openness 4) Universal knowledge 5) Aesthetics a) Artistic appreciation b) Talent

Love and belonging needs

1) Social interaction 2) Communication 3) Human caring 4) Family community 5) Loving- Giving and receiving 6) Affection 7) Intimacy 8) Sexual expression

What are the stages of illness?

1) Transition stage 2) Acceptance stage 3) Convalescence Stage

Common patient stressors

1) Wearing ill fitting gown open in back 2) Sharing a room with a stranger 3) Being dependent on other for toileting or bathing. 4) Eating at different times than usual 5) Being awakened all hours of the night 6) Too many or too few visitors 7) Worrying about medical costs 8) Uncertainty of diagnosis 9) Dealing with many health care workers 10) Not being able to get desired foods & drinks 11) Having to wait for tests to be done 12) Being stuck with a needle repeatedly 13) Different personal providing care each day

Primary Prevention

1) Wearing seat belts 2) Eating well balanced meals 3) Not smoking 4) Avoiding dangerous behaviors 5) Consume no or minimal alcohol. 6) Get scheduled immunizations and annual flu vaccine 7) Maintain ideal body mass index 8) Wearing sunscreen

Secondary Prevention

1) Women having regular PAP smears 2) Men performing monthly testicular self-examination 3) Having mammograms and colonoscopy as recommended 4) Getting skin tests for TB 5) Glaucoma test

Jane has hypertension and has recently suffered a mild stroke . This diagnosis is an example of a/an? 1) Primary Illness 2) Secondary illness 3) Idiopathic illness 4) Terminal illness

2) Secondary illness

Illness occurs in three ( 3 ) Stages. Allof the following are stages of illness except the: 1) Transition stage 2 Acceptance stage 3) Terminal stage 4) TACT

3) Terminal stage

How is health evaluated ?

A graduated scale or continuous spectrum. Ranges from obvious disease through absence of disease to a state of optimum functioning in every aspect of life. Self- Actualized- reaching one's full potential Dunn: ( Active state ) Each person accepts responsibility for , and takes an active part in improving ones health Dubos: ( Passive state ) Health is primarily a measure to do or become what he wants to become- influenced by environment and heredity

Disease

A pathologic process that causes illness

Miller - Keane defines health

A relative state in which one is able to function well ; 1) Physically 2) Mentally 3) Socially 4) Spiritually to express the full range of one's unique potential. The World Health Organization ( WHO ) - Not only the absence of disease but also a state of physical, mental and emotional well being.

Health

A relative state in which one is able to function well physically, mentally, socially and spiritually in order to express the full range of one's unique potential within the environment in which one is living.

Homeostatis

A tendency of the biological systems to maintain stability of the internal environment by continually adjusting to changes necessary for survival.

Which system is responsible for the increased supply of oxygen to the tissues during vigorous exercise? A) Sympathetic nervous system (SNS) B) Parasympathetic nervous system (PNS) C) Central nervous system (CNS) D) Endocrine system

A) Sympathetic nervous system (SNS)

A patient suffered a stroke and was stabilized on an acute medical unit for 7 days. After stabilization, the patient was transferred to a post-acute rehabilitation unit. Which level of prevention includes rehabilitation? A) Tertiary B) Primary C) Long-term D) Secondary

A) Tertiary

Which are basic beliefs central to the holistic approach to caring for the sick and promoting wellness? (Select all that apply.) A) The unified whole is more than the sum of the body parts. B) Each person has potential for growth in knowledge. C) Humans are naturally inclined to be healthy. D) The focal point of healthy effects is the person. E) Biologic and psychological needs take precedence over spiritual needs.

A) The unified whole is more than the sum of the body parts. B) Each person has potential for growth in knowledge. C) Humans are naturally inclined to be healthy. D) The focal point of healthy effects is the person.

Health means different things to people

Absence of disease Optimum functioning on every level

Coping

Adjusting to or accepting challenges Nurses seek to help patients use these abilities to best take advantage and to adapt to conditions that cannot be changed. Nurses can help a patient with chronic and incurable illness to minimize its harmful effects and encourage them to continue to set and attain goals in other dimensions of life. These mechanisms help us to resist and master stressors.

Adaptation

Adjustment in structure or habit If an illness or disease is chronic , a total recovery phase is replaced by adaptation to limitations and positive use of remaining capabilities.

Stressor

Adverse stimulus This may be physical, mental, or emotional and can come from within the body or from the environment. Stress disturbs the organism's homeostasis and causes the body to attempt to adapt. Example: 1) Having a baby 2) Getting married

Holistic

An approach that considers the persons biological, psychological, sociological, and spiritual aspects and needs.

Congenital

An illness present at birth. Examples: 1) Spina Bifida 2) Fetal Alcohol syndrome ( FAS )

Acute Illness

An illness that develops suddenly and resolves in a short time. Examples: 1) Appendicitis

Terminal Illness

An illness with no cure available. Ends in death Example: 1) ALS 2) Some cancers

Defense mechanism - Reaction formation

An intense feeling regarding an object, person, or feeling is out of awareness and is unknowingly acted out consciously in an opposite manner. Example: 1) You treat someone whom you unconsciously dislike intensely in an overly friendly manner.

Health behaviors

Any action taken to promote health, prevent disease, or detect disease in early asymptomatic ( without symptoms ) stage, ( diet, exercise, immunizations, avoiding smoking ) If not participating in healthy behavior why? 1) Religion- Fasting or immunizations 2) Knowledge deficit Examples: 1) Watching your dietary intake to avoid becoming over weight. 2) Exercising regularly 3) Obtaining available immunizations against communicable diseases 4) Regular physical exams These are perceived as valuable to health care providers.

Illness behaviors

Any activity a person takes to determine her actual state of health and seek a suitable remedy for a health problem; Consult 1) Consulting a physician 2) Consulting a Nurse 3) Consulting a Pharmacist 4) Visiting a neighborhood health care clinic 5) Taking prescribed medications. These behaviors also include: A) How people monitor the body B) Define and interpret symptoms C) Seek health care D) Follow advice and self-care measures to regain wellness. These behavior vary according to stage of illness and the persons beliefs.

Defense mechanism - Projection

Attributing an unconscious impulse, attitude, or behavior to someone else. Blaming or scapegoating) Example: 1) A man who is attracted to his friend's wife on an unconscious level accuses his own wife of flirting with his friend.

A patient has had long-term exposure to stress and has developed loss of energy and loss of appetite. The patient is in which stage of the general adaptation syndrome (GAS)? A) Stage of exhaustion B) Alarm stage C) Stage of resistance D) Stage of recovery

B) Alarm stage

Which is an acute illness? A) Diabetes mellitus B) Influenza Correct C) Hypertension D) Emphysema

B) Influenza Correct

Which of Maslow's high-level needs may be affected when an elderly person loses a mate? A) Self-actualization B) Self-esteem and love C) Safety D) Nutrition

B) Self-esteem and love

Stress

Biological reactions to an adverse stimulus

A patient seeks medical attention after worsening of her symptoms, which include a persistent productive cough and fever. She requests an "off work" note from her physician. The patient is in which stage of illness? A) Terminal B) Transition C) Acceptance D) Convalescence

C) Acceptance

Who described the general adaptation syndrome that occurs in response to long-term exposure to stress? A) Erikson B) Maslow C) Selye D) Skinner

C) Selye

Etiology

Cause or origin

Defense mechanisms: A) Increase anxiety. B) Reduce self-esteem. C) Increase stress. D) Reduce secretion of stress hormones.

D) Reduce secretion of stress hormones.

Objective

Data that is observable and measurable. Example: 1) Physical examination 2) Lab results 3) Diagnostic testing

Chronic Illness

Develops slowly over a long period of time and lasts throughout life. Examples: 1) Hypertension (HTN) 2) High blood pressure

Primary Illness

Develops without being caused by another health problem.

Defense mechanism - Displacement

Discharging intense feelings for one person onto another subject or person who is less threatening , thereby satisfying an impulse with a substitute object. Example: 1) A child who has been scolded by her mother hit her doll with a hairbrush.

Illness

Disease of the body or mind.

Defense mechanism - Denial

Escaping unpleasant , anxiety - causing thoughts by refusing to acknowledge their existence. Example: 1) A women whose husband died a year ago still speaks of him in the present tense and keeps his wardrobe in the closet.

Maslow's Hierarchy of needs

From the bottom up 1) PHYSIOLOGIC 2) SAFETY AND SECURITY 3) LOVE AND BELONGING 4) SELF- ESTEEM 5) SELF-ACTUALIZATION

Alarm stage

Hormone release mobilizes the bodies defenses. Nonspecific signs of illness such as: 1) Slight increase in temperature 2) Loss of energy 3) Decreased appetite 4) General feeling of malaise Ex: Dog attacks man Man strikes back and pulls away Dog retreats and man jumps fence

Genetic Illness

Illness inherited Example: 1) Sickle cell anemia

_________ behavior is any activity a person takes in order to determine his or her actual state of health and to seek a suitable remedy for a health problem.

Illness.

Health Literacy

Knowledge and skill making health care decisions

Maladaptation

Lack of adjustment

Defense mechanism - Identification

Modeling behavior after someone else Example: 1) A 6 year old girl dresses up in her mother's dress and high heeled shoes.

Autonomic

Not subject to voluntary control 1) Blood pressure 2) Heart 3) Breathing rates

Stage of Exhaustion

Occurs if the stressor is severe enough or is present over a long enough time to deplete the bodies resources for adaption.

General Adaptation Syndrome ( GAS )

Occurs in response to LONG TERM exposure to stress Stages: 1) Alarm stage 2) Stage of resistance 3) Stage of Exhaustion Examples: 1) Trauma 2) Burns 3) Infection 4) Severe cold 5) Emotional upsets

Idiopathic

Of unknown cause

Subjective

Perceived symptoms only by the individual. Include feelings, perceptions and concerns obtained through interviews. Example: 1) I feel sick or pain

Signs of stress

Physical Effects: 1) Dry mouth 2) Rapid pulse 3) Rapid, shallow breathing 4) Sweaty palms 5) Shakiness and tremors 6) Increase blood pressure 7) Inability to concentrate Psychological: 1) Confusion 2) Anxiety 3) Irritibility' 4) Labile moods 5) Quick to anger 6) Depression

Wellness

Physical and mental well being

Defense mechanism - Sublimation

Re channeling an impulse into a more socially desirable object. Example: 1) A student satisfies sexual curiosity by conducting sophisticated research into sexual behaviors.

Self actualization

Reaching one's full potential People do not advance to this stage until the physiologic, security and belonging, self-esteem, and love needs are met.

Secondary Illness

Results from or is caused by a primary illness. Examples: 1) Peripheral vascular disease resulting from diabetes. It occurs because of the effect diabetes has on blood vessels. 2) Cerebral vascular accident ( CVS ) resulting from Hypertension ( HTN )

Defense mechanism - Regression

Returning to an earlier level of adaptation when severely threatened. Example: 1) A child resumes bed-wetting , after having long since stopped, after the birth of her baby brother or being in the hospital.

Transition stage

Stage 1 ONSET May deny feeling ill, but recognize symptoms of illness are present. This stage may consist of vague, nonspecific symptoms. With symptoms continuing to worsen, self-medication may be used or medical assistance may be sought.

Acceptance stage

Stage 2 ACCEPTANCE Sick role begins Illness behaviors 1) Acknowledging illness and takes measures to become well 2) Withdraws from responsibility and roles 3) Illness persists and may seek medical help ( Fear of knowing the problem makes many stay away from doctor; anxiety)

Convalescence Stage

Stage 3 RECOVERY Recovering after the illness and begin regaining health. Adaption vs maladaptation If the illness or disease is chronic, a total recovery phase is replaced by adaptation ( Adjustment in structure or habits ) to limitations and positive use of remaining capabilities. Maladaptation is the lack of adjustment

Defense Mechanisms

Strategies that protect us from increasing anxiety. They reduce both anxiety and the secretion of stress hormones

Convalescence

The 3rd stage of illness. The recovery stage The process of recovering after the illness and regaining health.

Hierachy

The arrangement of objects, elements, or values in order of their importance

Stage of Resistance

The body is battling for equilibrium

Defense mechanism - Repression

The unconscious blocking of a wish or desire from conscious awareness. Example: 1) You forget the name of someone for whom you have intense negative feelings

Defense mechanism - Rationalization

Unconsciously falsifying a experience by giving a contrived , socially acceptable , and logical explanation to justify an unpleasant experience or questionable behavior. Example: 1) A student who did not study for an exam blames his failures on the teacher's poor lecture material and the unfairness of the exam.

Asymptomatic

Without symptoms

Alarm reactions

compare sympathetic vs Parasympathetic