Illness vs Disease

• Functioning


  Levels reflected in terms of performance/social expectations; loss indicator of need for nursing intervention
• Health


  State of physical, mental, spiritual, and social functioning within developmental context<|>Both individual and societal responsibility
• Disease


  Failure of adaptive mechanisms<|>Results in functional or structural disturbances
• Illness


  Subjective experience of individual and physical manifestation of disease
• Evidence-Based Practice

  Conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients<|>Integrating individual clinical expertise with the best available external clinical evidence from systematic research
• Improving Prospects for Health

  • Population effects: Increased diversity, Changes in age distribution (older population)
  • Shifting problems: Environmental pollution, Stress, Lifestyle (obesity, substance abuse), Increase in chronic conditions
  • Moving toward solutions: Individual involvement (lifestyle changes, motivation), Governmental involvement (legislation and financing)
• Homeostasis


  Stressors<|>Crisis
• Fight-or-flight response


  Neurophysiological responses<|>Medulla oblongata<|>Reticular formation<|>Pituitary gland
• General Adaptation Syndrome


  1. Alarm reaction

  2. Resistance stage

  3. Exhaustion stage
• Primary appraisal


  Identification
• Secondary appraisal


  Coping strategies
• Coping Mechanisms


  • Problem-focused coping
  • Emotion-focused coping
  • Ego-defence mechanisms
• Distress


  Damaging stress
• Eustress


  Stress that protects health
• Post-traumatic stress disorder


  An acute stress disorder that begins when a person experiences, witnesses, or is confronted with a traumatic event
• Developmental crisis


  Vary as life stages
• Situational crisis


  Arise from job changes, illness, caregiver stress
• Sociocultural factors


  Environmental and social stressors perceived by children, adolescents, and adults
• Nursing Diagnosis


  • Compromised family coping
  • Ineffective coping
  • Post-trauma syndrome
  • Disturbed sleep pattern
  • Impaired social interaction
• Compensation


  1. Physiologic mechanisms for homeostatic stability

  2. Catecholamines—stimulate sympathetic nervous system; increase heart rate, myocardial contractility; increase venous return, bronchial dilatation

  3. Renin-angiotensin-aldosterone system—restores blood pressure; increase blood volume

  4. Antidiuretic and corticosteroid hormones—ADH and ACTH; control sodium and water balance
• Decompensation (Progressive Stage)


  1. Failure of compensatory mechanisms

  2. Cellular hypoxia: decreased oxygen in cells; cellular damage and destruction

  3. Coagulation defects: inflammatory response; formation of microemboli

  4. Cardiovascular changes: impaired myocardial cells; insufficient heart rate and force of contraction
• Irreversible (Refractory Stage)


  1. Significant cell and organ damage

  2. No response to medical interventions

  3. Multiple system fail; kidney, lungs, liver, and brain

  4. Death is imminent