0133427269 Module07 HWI LectureOutline

Module 7 Health, Wellness, and Illness The Concept of Health, Wellness, and Illness Concepts of health, wellness, and well-being Health Has been defined in terms of presence, absence of disease Nightingale ( state of being well and using every power the individual possesses to the fullest extent World Health Organization (WHO) ( a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity Concern for individual as total person Places health in context of environment ANA ( dynamic state of being in which the developmental and behavioral potential of an individual is realized to the fullest extent possible Personal definitions of health Highly individual perception Many define, describe health as being free from symptoms of disease, pain as much as possible Being able to be active, do what they want or must Be in good spirits most of the time Many factors affect individual definitions of health See Box 71 DEVELOPING A PERSONAL DEFINITION OF HEALTH, p.407 Wellness and well-being Wellness ( state of well-being Basic aspects Self-responsibility Ultimate goal Dynamic, growing process Daily decision making (nutrition, stress management, physical fitness, preventive health care, emotional health Whole being of the individual Components of wellness Environmental Occupational Intellectual Spiritual Physical Emotional Social Well-being is a component of health Healthillness continuum Measure persons perceived level of wellness Move back and forth within this continuum day by day See Figure 73 AN ILLNESSWELLNESS CONTINUUM, p. 408 Illness and disease Illness ( highly personal state, persons physical, emotional, intellectual, social, developmental, spiritual functioning diminished Disease ( alteration in body functions that results in reduction of capacities or shortening of normal life span Classifications of illness Acute illness ( severe symptoms of relatively short duration Chronic illness ( one that lasts for 6 months or longer Usually slow onset Periods of remission, exacerbation Examples Arthritis Heart, lung disease Diabetes mellitus Illness behaviors ( coping mechanisms, involves ways individuals describe, monitor, and interpret symptoms Effects of illness on the client and family Illness brings change ( individual, family Behavioral, emotional changes, self-concept, body image, lifestyle changes Loss of autonomy ( state of being independent, self-directed without outside control Illness often necessitates a change in lifestyle Lifestyle changes ( nurses role Providing explanations about necessary adjustments Making arrangements wherever possible to accommodate the clients lifestyle Encouraging other health professionals to become aware of persons lifestyle, support healthy aspects of it Reinforcing desirable changes in practices with goal of making them permanent part of clients lifestyle Health promotion Healthy People ( Surgeon General 1979 ( Healthy People 2000 ( Healthy People 2010 ( Healthy People 2020 Improving the Health of Americans Two major goals Increase quality and years of healthy life (aging population) Eliminate health disparities (diversity in population) See Box 72 THE 42 TOPIC AREAS IN HEALTHY PEOPLE 2020, p. 409 See Box 73 THE 12 TOPICS OF THE LEADING HEALTH INDICATORS IN HEALTHY PEOPLE 2020, p.410 Foundation of Healthy People 2020 is belief that individual health closely linked to community health and the reverse Health promotion, health protection, and disease prevention Prevention Narrow sense avoiding the development of disease in the future Broader sense all interventions to limit progression of disease Promotion ( behavior motivated by the desire to increase well-being and actualize human potential Protection ( behavior motivated by a desire to actively avoid illness, detect it early, or maintain functioning within the constraints of illness Difficulty in separating terms health promotion, disease prevention/health protection lies in fact that an activity may be carried out for numerous reasons Health promotion can be offered to all clients regardless of their health, illness, status, or age See Box 74 DIFFERENCES BETWEEN HEALTH PROMOTION AND HEALTH PROTECTION, p. 411 Nurses role in health promotion Health promotion ( way of thinking that revolves around philosophy of wholeness, wellness, well-being Nurses influence on health promotion ( disseminate information Programs to be used to promote health Information dissemination (most basic Consider culture, age group Critical to know where people get misinformation Health risk appraisal, wellness assessment Used to teach individuals about risk factors inherent in lives Motivate them to reduce specific risks, develop positive health habits Lifestyle and behavior change Require participation of individual Geared toward enhancing quality of life, extending life span Environmental control programs Developed in response to continuing increase of contaminants of human origin being introduced into environment Health promotion activities involve collaborative relationships with clients, primary care providers Nurse works with people, not for them See Box 75 THE NURSES ROLE IN HEALTH PROMOTION, p. 412 Nursing process basic tool Emphasizes teaching the client self-care responsibility Quality nursing care seeks to emphasize illness prevention, health promotion Assessing, planning care enhanced ( nurse understands individuality, holism, homeostasis, human needs Health promotion across the life span ( see LIFESPAN CONSIDERATIONS HEALTH PROMOTION TOPICS ACROSS THE LIFE SPAN, p. 412 Variables influencing health Many variables influence health status, beliefs, behavior, practices Regular health exams and appropriate screening for early detection of health problems are important See Table 7-1 HEALTH SCREENINGS AND IMMUNIZATION GUIDELINES ACROSS THE LIFE SPAN, p. 413 Biological dimension Genetic makeup influences biologic characteristics Innate temperament Activity level Intellectual potential Susceptibility to specific diseases Gender influences distribution of disease Age significant factor in distribution of disease Developmental level has major impact on health status Because infants lack physiologic, psychologic maturity, defenses against disease lower during the first years of life Toddlers learning to walk more prone to falls, injury Adolescents who need to conform to peers are more prone to risk-taking behavior, subsequent injury Declining physical, sensory-perceptual abilities limit ability of older adults to respond to environmental hazards, stressors Psychological dimension Mindbody interactions can affect health status positively, negatively ( increase susceptibility to organic disease, precipitate it Minds ability to direct the bodys functioning Emotional reactions occur in response to body conditions Self-concept ( affects how we view, handle situations Cognitive dimension Cognitive, intellectual factors influencing health ( lifestyle choices, spiritual, religious beliefs Lifestyle ( persons general way of living Includes living conditions Individual patterns of behavior Risk factors ( potentially negative effects on health See Box 76 EXAMPLES OF HEALTHY LIFESTYLE CHOICES, p. 11 Spiritual and religious beliefs affect health behavior Jehovahs Witnesses oppose blood transfusions Jews perform circumcision on eighth day of male babys life Nursing process Assessment Health history and physical examination Means for detecting existing problems Age ( safety assessment See LIFESPAN CONSIDERATIONS Factors Affecting Health Promotion and Illness Prevention in Children and Older Adults, p.412 Nutritional assessment Physical fitness assessment Muscle endurance Flexibility Body composition Cardiorespiratory endurance Lifestyle assessment Personal lifestyle, habits of client Physical activity Nutritional practices Stress management Habits( smoking, alcohol consumption, drug use Lifestyle assessment tools Opportunity for clients to assess impact of their present lifestyle on their health Basis for decisions related to desired behavior, lifestyle change Special consideration may need to be given to lifestyles of children, older adults Spiritual health assessment Ability to develop inner nature to fullest potential Social support systems review Social context in which person lives Contribute to health by creating environment that encourages healthy behaviors, self-esteem, wellness Life stress review Validating assessment data Client and nurse ( review, validate, summarize information Any existing health problems Clients perceived degree of control over health status Key health beliefs Level of physical fitness, nutritional status Illness for which client is at risk Current positive health practices Spirituality Sources of life stress, ability to handle stress Social support systems Information needed to enhance healthcare practices Diagnosis Wellness diagnoses ( describes human responses to levels of wellness in an individual, family, or community that have a readiness for enhancement Applied at all levels of prevention Examples of wellness diagnoses Readiness for Enhanced Spiritual Well-being Readiness for Enhanced Coping Readiness for Enhanced Nutrition Readiness for Enhanced Knowledge (specify) Readiness for Enhanced Parenting Readiness for Enhanced Self-Concept Readiness for Enhanced Immunization Status Readiness for Enhanced Self-Care Planning Health promotion plans developed ( needs, desires, priorities of client Nurse acts as resource person Steps in planning Review and summarize data from assessment Reinforce strengths, competencies of client Identify health goals, related behavior-change options Identify behavioral or health outcomes Develop a behavior-change plan Reiterate benefits of change Address environmental, interpersonal facilitators, barriers to change Determine time frame for implementation Formalize commitment to behavior-change plan Exploring available resources ( community resources, educational programs Implementation Provide individual counseling sessions Provide telephone or internet counseling Offer group support Facilitate social support Provide health education Enhance behavior change Provide modeling Evaluation Ongoing basis as short-term goals attained After long-term goals completed Date determined during planning phase for attaining specific results Collaborative effort Review The Concept of Health, Wellness, and Illness Relate Link the Concepts Ready Go to Companion Skills Manual Refer Go to Student Nursing Resources Reflect Case Study Exemplar 7.1 Physical Fitness and Exercise Overview Physical fitness ( enables body to perform to its potential Condition that helps individuals look, feel, do their best The ability to perform daily tasks vigorously and alertly, with energy left over for enjoying leisure-time activities and meeting emergency demands Involves performance of bodys heart, lungs, muscles Influences qualities such as mental alertness, emotional stability Healthy People 2020 objectives Increase proportion of people who engage in moderate physical activity for at least 30 minutes a day Increase proportion of adults, children who perform physical activities that enhance, maintain muscle strength, endurance, flexibility Increase proportion of work sites offering employer-sponsored physical activity, fitness programs Reduce activity limitation due to chronic back conditions Reduce number of overweight people Research Exercise improves health status of individuals with cardiovascular, pulmonary diseases, disabilities, of aging, depression Exercise can prevent, reverse many of chronic diseases experienced by aging adults Activity-exercise pattern ( routine of exercise, activity, leisure, recreation ADLs that require energy expenditure Type, quantity, quality of exercise Physical activity and exercise Definitions Physical activity ( bodily movement produced by skeletal muscle contraction that increases energy expenditure Exercise ( type of physical activity defined as planned, structured, repetitive bodily movement performed to improve, maintain one or more components of physical fitness Activity tolerance ( type and amount of exercise, ADLs individual able to perform without experiencing adverse effects Functional strength ( bodys ability to perform work Types of exercise Isotonic exercises ( those in which muscle shortens to produce muscle contraction and active movement Isometric exercises ( muscles contract without moving the joint (muscle length does not change) Isokinetic exercises ( resistive exercises, muscle contraction or tension against resistance ( either isotonic or isometric Aerobic exercise ( activity in which amount of oxygen taken into body is greater than that used to perform the activity Use large muscle groups that move repetitively Improves cardiovascular conditioning and physical fitness ( measure goal heart rate Anaerobic exercise ( muscles cannot draw out enough oxygen from bloodstream ( anaerobic pathways used to provide additional energy for a short time Weight lifting, sprinting Endurance training Benefits of exercise Maintain mental, physical health See Table 72 BENEFITS OF EXERCISE BY BODY SYSTEM, p. 422 Musculoskeletal system Strenuous exercise ( muscles hypertrophy Joints receive nourishment through activity Bone density, strength maintained through weight bearing Cardiovascular system Emphasis on physical activity for primary prevention of stroke, cardiovascular disease Increases heart rate, strength of heart muscle contractions, blood supply to heart and muscles Mediates harmful effects of stress Types of exercise that provide cardiac benefit vary Respiratory system Ventilation and oxygen intake increase during exercise Toxins eliminated Problem solving, emotional stability enhanced Prevents pooling of secretions Gastrointestinal system Improves appetite Increases GI tract tone Metabolic/endocrine system Elevates metabolism Weight loss, exercise stabilize blood sugar, make cells more responsive to insulin Urinary system Promotes efficient blood flow ( body excretes wastes more efficiently Immune system Lymph fluid more efficiently pumped from tissues into lymph capillaries, vessels throughout body Strenuous exercise may reduce immune function ( adequate rest important after vigorous training Psychoneurological system Mental, affective disorders (depression, chronic stress) may affect persons desire to move Research supports role of exercise in elevating mood, relieving stress, anxiety across the life span Regular exercise increases levels of endorphins, releases stress, improves quality of sleep Cognitive function Research supports positive effects of exercise on cognitive functioning Athletic older adults have denser brains than inactive adults Brain Gym ( series of easy cross-lateral movements ( enhance right-, left-brain integration ( improves mood, learning, problem solving, performance Contralateral movements have been shown to help individuals with ADD, ADHD, learning disorders, mood disorders Physical exercise provides positive effects in individuals with Parkinson, Alzheimer disease Spiritual health ( exercise enhance students experience of mindbodyspirit connection Soothes nervous, cardiorespiratory systems Review Physical Fitness and Exercise Relate Link the Concepts and Exemplars Ready Go to Companion Skills Manual Refer Go to Nursing Student Resources Reflect Case Study Exemplar 7.2 Oral Health Overview Anatomy Mouth (oral or buccal cavity lined with mucous membranes, enclosed by lips, cheeks, palate, tongue Lips, cheeks ( skeletal muscle covered externally by skin Palate consists two regions ( hard and soft Hard provides hard surface against which tongue forces food Soft palate rises as reflex to close off oropharynx when food swallowed Tongue ( skeletal muscle, connective tissue Mixes food with saliva Forms food into a mass (bolus) Initiates swallowing Saliva ( moistens food, dissolves food chemicals so they can be tasted Provides enzymes that begin chemical breakdown of starches Salivary glands ( include parotid, submaxillary, sublingual glands Teeth ( chew, grind food Three parts to teeth Crown ( exposed part of tooth, outside gum Root ( embedded in jaw covered by cementum Pulp cavity ( center of tooth contains blood vessels, nerves Review Figure 75 ORAL CAVITY, p. 424 Lifespan considerations Appearance of teeth Teeth usually appear 58 months after birth By 2 years old ( usually have all 20 deciduous teeth Risk of periodontal disease increases during pregnancy Aging process Teeth turn yellowish Lack of fluoridated water, preventive dentistry in developmental years ( tooth, gum problems in older adults Periodontal disease more than dental caries Gums recede, pigmentation of gums Nursing process Assessment Health history Oral hygiene practices Self-care abilities Physical assessment Tartar ( visible, hard deposit of plaque, dead bacteria that forms at the gum lines Plaque ( invisible soft film that adheres to enamel surface of teeth See ASSESSMENT INTERVIEW Oral Hygiene, p. 425 and LIFESPAN CONSIDERATIONS CHILD ORAL HYGIENE ASSESSMENT QUESTIONS FOR PARENTS, p. 425 Gingivitis Pyorrhea Identifying clients at risk Lack of knowledge, inability to maintain oral hygiene Seriously ill, nasogastric tubes, receiving oxygen Healthy-appearing individual may be at risk Nutrition Lack of money, insurance Excessive intake of refined sugars Family history of periodontal disease Dry mouth can be aggravated by poor fluid intake, heavy smoking, alcohol use, high salt intake, anxiety, medications Clients with history of receiving radiation to head and neck may have damaged salivary glands See Table 73 COMMON PROBLEMS OF THE MOUTH, p. 426 Diagnosis Bathing Self-Care Deficit Impaired Oral Mucous Membrane Planning Monitor for dryness of the oral mucosa Monitor for signs, symptoms of glossitis, stomatitis Assist dependent clients with oral care Provide special oral hygiene for clients who are debilitated, unconscious, or have lesions of mucous membranes Teach clients about good oral hygiene practices Reinforce oral hygiene regimen Implementation Good oral hygiene ( daily stimulation of guns, mechanical brushing, flossing your teeth, flushing the mouth Promoting oral health throughout the life span Infants and toddlers Beginning at 18 months, brush with soft toothbrush Give fluoride supplement daily or as recommended Schedule initial dental visit at about 23 years of age Some dentists recommend an inspection type of visit when child is about 18 months old ( early, pleasant introduction to dental examination Seek professional dental attention for any problems Preschoolers, school-age children Dental care to keep teeth in good repair Establish good dental habits early Adolescents and adults Diet, tooth and mouth care Older adults At risk for cavities, periodontal disease Self-care deficits ( put client at increased risk Brushing and flossing teeth Mechanical action of brushing removes particles that can harbor, incubate bacteria Caring for artificial dentures Plates ( lower, upper, or both Bridge ( only a few teeth, fixed or removable Ill fitting ( pain, chewing difficulties Collect microorganisms ( clean regularly Assisting clients with oral care Wear gloves Curved basin Foam swabs Privacy when teeth out to clean them Clients with special oral hygiene needs Debilitated, unconscious client ( clean oral mucosa, tongue in addition to teeth Mouths tend to become dry ( predisposing them to tooth decay, infections Focus on removing plaque, microorganisms Soft bristled toothbrush Oral swab, gauze soaked in saline Lemon glycerin swabs irritate, dry mucosa, decalcify teeth Hydrogen peroxide diluted with saline cleans, antimicrobial Water soluble moisturizer See LIFESPAN CONSIDERATIONS Oral Hygiene in Older Adults, p. 24 See CLIENT TEACHING Measures to Prevent Tooth Decay, p. 427 Evaluation Determine whether outcomes achieved If not, determine whether Nurse overestimated clients functional abilities Clients hand coordination, cognitive function impaired Clients condition changed Clients energy level and/or motivation changed Review Oral health Relate Link the Concepts and Exemplars Ready Go to Companion Skills Manual Refer Go to Nursing Student Resources Reflect Case Study Exemplar 7.3 Normal SleepRest Patterns Overview Sleep is basic human need ( universal Important to quality of life Chronic sleep disorders common IOM ( recommendations Increase financial investments in interdisciplinary somnology Increase public awareness by establishing multimedia public education campaign Increased education, training of healthcare professionals in somnology, sleep medicine Develop new technologies for diagnosis, treatment of sleep disorders Monitor American populations sleep patterns and the prevalence and health outcomes of sleep disorders Physiology of sleep Altered state of consciousness ( individuals perception, reaction to environment decreased Minimal physical activity, variable levels of consciousness, changes in the bodys physiologic processes, decreased responsiveness to external stimuli Cyclic nature thought to be controlled by centers located in lower part of brain Neurotransmitters affect sleepwake cycles Beginning of daylight ( melatonin at lowest level in body, cortisol at highest (stimulating hormone) Circadian rhythms Biological rhythms ( plants, animals, humans Sleepwake cycle Circadian synchronization ( person awake when body temperature highest, asleep when body temperature lowest Begins to develop by sixth week of life Types of sleep Sleep architecture ( organization of sleep NREM ( four stages Stage I ( very light sleep, lasts only a few minutes Stage II ( light sleep during which body processes continue to slow down Stage III and IV ( deepest stages of sleep Essential for restoring energy, releasing important growth hormones See Box 77 PHYSIOLOGICAL CHANGES DURING NREM SLEEP, p. 431 REM ( recurs every 90 minutes ( brain highly active Dreaming sleep Paradoxical sleep ( EEG activity resembles that of wakefulness Sleep cycles ( pass through NREM, REM sleep 90110 minutes/cycle First cycle ( first three NREM stages in about 2030 minutes Stage IV lasts about 30 minutes Back to stages II, III over 20 minutes 46 cycles of sleep during 78 hours Sleep varies through sleep period Functions of sleep Physiologic effects Restores normal levels of activity, balance on nervous system, other body structures Necessary for protein synthesis Psychological well-being Inadequate sleep ( irritable, poor concentration, difficulty making decisions Normal sleep patterns and requirements Newborns ( 1618 hours/day, irregular schedule Put newborn to bed when sleepy but not asleep Put on back Infants ( awaken every 34 hours, eat, back to sleep ( establish pattern of naps ( 1415 hours/day of sleep Half of sleep time spent in light sleep Fall asleep ( put self back to sleep at night independently Toddlers ( 1214 hours/day, with nap Nighttime fears, nightmares common Security object Preschoolers (35 years old) ( 1113 hours/night Needs fluctuate in relation to activity, growth spurts Maintain regular, consistent sleep schedule School age (512 years old)( 1011 hours/night Spending more time at computer, watching TV Difficulties falling asleep Regular, consistent sleep schedule, bedtime routine Adolescents (1218 years old) ( 910 hours/night Circadian rhythms shift Later sleep, wake patterns Boys begin to experience nocturnal emissions Adults ( 79 hours/night, individual variation Signs of not enough sleep ( falling asleep, drowsy during task not fatiguing, inability to concentrate, unreasonably irritable Vulnerable to insufficient sleep ( students, shift workers, travelers Stress, childrens sleep patterns Older adults (6575) ( awaken earlier, go to bed earlier Relationship between quality of life (( quality, quantity of sleep Better the health of older adults ( more likely they sleep well Several medical conditions ( may cause sleeping problems Discuss with healthcare provider Older adult clients with dementia may experience sundown syndrome Factors affecting sleep Quality, quantity affected by many factors Irregular morning, nighttime schedule can affect sleep Night shift workers frequently obtain less sleep Emotional stress Number one cause of short-term sleeping difficulties Stimulants, alcohol Caffeine-containing beverages Alcohol disrupts REM sleep Diet Weight gain associated with reduced total sleep time Weight loss associated with increased total sleep time, less broken sleep Smoking Nicotine has stimulating effect on body Easily aroused, light sleepers Motivation Can increase alertness in some situations Wont overcome sleepiness due to insufficient sleep Medications Some affect quality of sleep May suppress deep REM Review Normal sleeprest patterns Relate Link the Concepts and Exemplars Ready Go to the Companion Skills Manual Refer Go to Nursing Student Resources Reflect Case Study 2015 by Education, Inc. Lecture Outline for Nursing A Concept-Based Approach to Learning, 2e, Volume 1 PAGE PAGE 28 Y, dXiJ(x(I_TS1EZBmU/xYy5g/GMGeD3Vqq8K)fw9 xrxwrTZaGy8IjbRcXI u3KGnD1NIBs RuKV.ELM2fiVvlu8zH (W uV4(Tn 7_m-UBww_8(/0hFL)7iAs),Qg20ppf DU4p MDBJlC5 2FhsFYn3E6945Z5k8Fmw-dznZxJZp/P,)KQk5qpN8KGbe Sd17 paSR 6Q