Objectives

Discuss the wellness-illness continuum.

Discuss the following as they impact a persons ability to

achieve, maintain, and manage their health and wellness.

Physical fitness/exercise
Oral health

Michelle Norris RN MSN

Nutrition
Immunizations
Life style choices
Health beliefs
Self management
Sleep and rest pattern

Objectives

Health: Professional definitions

Identify screening procedures used for early diagnosis

Presence or absence of disease

of illness or other health conditions.

Identify consumer education designed to reduce risk
factors associated with illness or other health
conditions.
Identify consumer education designed to reduce risk
factors associated with illness or other health
conditions.

"State of being well and using every power the

Health: Personal Definitions

Wellness and Well-Being

Highly individualized

State of well-being
Self-responsibility
Ultimate goal
Dynamic, growing
process
Daily decision making
Whole being of
individual

Free from symptoms, pain

Being able to be active, in good spirits
Developing personal definition of health
Individual's previous experiences
Expectations of self
Age
Sociocultural influences

individual possesses to the fullest extent" (Florence

Nightingale)
"State of complete physical, mental, and social wellbeing, and not merely the absence of disease or
infirmity" (WHO)
"Dynamic state of being in which the developmental
and behavioral potential of an individual is realized to
the fullest extent possible" (ANA)

Components of wellness
Environmental
Occupational
Intellectual
Spiritual
Physical
Emotional
Social
Well-being is a

component of health

An IllnessWellness Continuum

Illness and Disease

Health and illness/disease can

Illness
Highly personal state
Diminished physical, emotional, intellectual, social
developmental or spiritual functioning
May or may not be related to disease
Disease
Alteration in body functions
Reduction of capacities
Shortening of normal life span

be seen as opposite ends of a

health continuum
Individuals move back and forth

day by day
No distinct boundary
Perceptions of self, others'

perceptions affect placement on

continuum

Illness and Disease, continued

Illness Behaviors

Acute illness
Severe symptoms of relatively short duration
Symptoms appear abruptly, subside quickly
May or may not require intervention
Chronic illness
Lasts for an extended period
Usually lasts 6 months
Slow onset, often periods of remission and exacerbation

Coping mechanisms

Effects of Illness on the Client and Family

Brings changes
Behavioral and emotional
Self-concept and body image
Lifestyle
Loss of autonomy
Often means change in lifestyle

Involves ways individuals:

Describe, monitor, interpret symptoms
Take remedial action
Use healthcare system
Highly individualized

Effects of Illness on the Client and Family:

Nurses Role
Provide explanations about necessary adjustments
Make arrangements to accommodate client's
lifestyle
Encourage other health professionals to become
aware of client's lifestyle
Support healthy aspects

Reinforce desirable changes in practices

Health Promotion

Health Promotion, continued

Healthy People 2020: Improving the Health of

Healthy People 2020: Improving the Health of

Americans
Four major goals
1.
Attain high-quality, longer lives free of preventable
disease, disability, injury, and premature death
2.
Achieve health equality, eliminate disparities, and improve
the health of all groups
3.
Create social and physical environments that promote
good health for all
4.
Promote quality of life, healthy development, and healthy
behaviors across all life stages

Health Promotion, Health Protection, and

Disease Prevention

Americans
42 topic areas, nearly 600 objectives
26 leading health indicators in 12 categories
Each indicator relates to several health objectives
Individual health linked to community health, so

partnerships important

Nurse's Role in Health Promotion

Way of thinking
Revolves around philosophy of
wholeness, wellness, wellbeing
Nurses have opportunities to:

Illness/disease prevention
Narrow meaning: averting development of disease in the future
Broad meaning: consists of all measures, including definitive

therapies, that limit disease progression

Health promotion

Motivated by desire to increase well-being

Can be offered to all clients, regardless of health or illness status,

age

Health protection
Motivated by desire to actively avoid illness

Nurse's Role in Health Promotion

Information dissemination
Most basic health promotion program
Offer information about risks of lifestyle choices,
behaviors
Educate about specific benefits of changing behavior,
improving quality of life
May use variety of media
Consider culture, age group, literacy level
Critical to know where misinformation originates

Strengthen profession's
influence on health promotion
Disseminate information to
educate public, assist individuals
and communities to improve
health behaviors

Nurse's Role in Health Promotion

Health risk appraisal, wellness assessment
Teach about risk factors
Motivate to reduce specific risks, develop positive health habits

Lifestyle and behavior change

Requires participation of individual
Geared toward enhancing quality of life, extending life span

Environmental control
Toxic and nuclear wastes
Nuclear power plants
Air, water pollution
Herbicide, pesticide use

Nurse's Role in Health Promotion

Health promotion activities
Collaborative relationships

Work with, not for, people

Nursing process basic tool

Teach self-care responsibility
Emphasize illness prevention, health promotion
Assessing, planning care enhanced by understanding of

individuality, holism, homeostasis, human needs

Community health affects individual health and vice

versa

Variables Influencing Health

External variables
Lifestyle choices
Healthy or unhealthy activities
Internal variables
Biological

Genetic factors

Psychological

Presence of mental illness

Cognitive

Disorders of cognition such as autism spectrum disorder

Biological Dimension

Psychological Dimension

Genetic makeup

Mindbody interactions affect health status positively,

Gender
Age
Developmental level
Infants
Toddlers
Adolescents
Older adults

negatively
Can increase susceptibility to organic disease
Alterations in immune system
Mind's ability to direct body's functioning

Relaxation, medication, biofeedback

Emotional reactions occur in response to body

conditions
Self-concept, self-perceptions
Self-concept affects how we handle situations

Cognitive Dimension

Nursing Process

Intellectual factors influencing health

Lifestyle choices
Living conditions
Patterns of behavior
Risk factors

Basic health promotion

Focus on greater autonomy in client care

Health beliefs
Internal vs. external locus of control
Spiritual and religious beliefs

Assessment

Assessment, continued

Health history and physical examination

Existing problems
Age
Safety assessment
Nutritional assessment
Physical fitness assessment
Muscle endurance
Flexibility, body composition
Cardiorespiratory endurance

Lifestyle assessment
Personal lifestyle, habits of client
Physical activity
Nutritional practices
Smoking, alcohol and drug consumption
Lifestyle assessment tools

Assessment, continued

Assessment, continued

Social support systems review

Social context in which person lives
Creates environment for healthy behavior
Life stress review
Stress affects mental, physical well-being

Validating assessment data

Client and nurse together review, validate, summarize
information

Spiritual health assessment

Ability to develop inner being to fullest
Beliefs can affect individual's interpretation of life events

Diagnosis
Domain 1: Health Promotion

Existing health problems

Perceived degree of control over health status
Key health beliefs
Level of physical fitness, nutritional status
Current positive health practices
Spirituality
Sources of life stress, ability to handle
Social support systems
Information to enhance healthcare practices

Planning

Domain 2: Nutrition

Health promotion plan developed in response to

Domain 3: Elimination and Exchange

Domain 4: Activity/Rest

Nurse acts as resource person

Domain 5: Perception/Cognition
Domain 6: Self-Perception
Domain 7: Role Relationships
Domain 8: Sexuality

needs, desires, priorities

Explore available resources
Community resources
Educational programs

Domain 9: Coping/Stress Tolerance

Domain 10: Life Principles
Domain 12: Comfort

Planning, continued

Implementation

Steps in planning

Client self-responsibility

Review and summarize assessment data

Emphasize strengths, competencies of client
Identify health goals, related options
Identify behavioral or health outcomes

Ongoing support by nurse

Focuses on desired behavior
change
Provide individual counseling

sessions

Develop a behavior change plan

Provide telephone, Internet

Reiterate benefits of change

Address facilitators and barriers to change
Determine time frame for implementation

counseling
Offer group support

Formalize commitment to behavior change plan

Implementation, continued

Evaluation

Facilitate social support

Assist client to assess, modify, and develop social
support
Provide health education

Ongoing

Enhance behavior change

Strategies at each stage of change
Advance client to next stage of changing
Provide modeling
Client, nurse together select models
Nurse can serve as model

Client may continue plan, reorder priorities, change

Physical Fitness and Exercise

Physical Activity and Exercise

Physical fitness
Improving mood and
overall mental health
Reducing risk for
cardiovascular disease
Strengthening bone and
muscle
Reducing risk of some
illnesses
Improving stability

Physical activity
Bodily movement produced by skeletal muscle
contraction
Increases energy expenditure

Exercise
Prevent, reverse chronic
diseases experienced in
aging

Activity-exercise pattern:
routine of exercise,
activity, leisure
Includes ADLs
Type, quantity, quality of
exercise

Monitoring short-term, long-term goals

Target date determined for attaining goals written

during planning
strategies, or revise plan
Collaborative effort between nurse and client

Exercise
Planned, structured, repetitive bodily movement
Performed to improve, maintain fitness

Physical Activity and Exercise, continued

Activity tolerance
Type and amount of exercise, ADLs individual can
perform without adverse effects
Functional strength
Body's ability to perform work

Types of Exercise
Isotonic
Dynamic exercises
Isometric
Static or setting
exercises
Isokinetic
Resistive exercises

Benefits of Exercise
Musculoskeletal System

Urinary System

Cardiovascular system

Immune System

Respiratory System

Psychoneurological

Gastrointestinal System

System
Cognitive Function
Spiritual Health

Metabolic/Endocrine

System

Aerobic
Amount of oxygen taken
into the body is greater
than amount used to
perform the activity
Anaerobic
Muscles cannot draw
out enough oxygen from
bloodstream, anaerobic
pathways used for
additional energy

Oral Health
Anatomy of the mouth
Oral cavity lined with mucous membranes
Enclosed by:

Lips
Cheeks
Palate
Tongue

Saliva
Teeth

Lifespan Considerations

Assessment

Appearance of teeth
Appear 58 months after birth
All 20 deciduous teeth usually by 2 years old

Health history
Oral hygiene practices
Dental visits
Self-care abilities
Physical assessment
Plaque
Tartar
Gingivitis
Pyorrhea

Risk of periodontal disease in pregnancy

Aging process
Teeth yellow
Tooth, gum problems
Periodontal disease

Assessment, continued
Physical assessment
Perform oral health assessment

Inspect, palpate lips

Inspect, palpate tongue
Inspect, palpate buccal mucosa
Inspect, palpate teeth
Inspect, palpate gums
Inspect throat, tonsils
Evaluate client's breath for unusual odor

Assessment, continued
Identifying clients at risk
Lack of knowledge
Inability to maintain
oral hygiene
Seriously ill clients
Confused clients
Comatose clients
Dry mouth

Depressed clients
Illiterate clients
Dehydrated clients
Clients with NG tubes
Clients receiving oxygen
Healthy-appearing

individuals ??

Diagnosis

Planning

Bathing Self-Care Deficit

Monitor for dryness of oral mucosa

Impaired Oral Mucous Membrane

Monitor for signs and symptoms of glossitis, stomatitis

Assist dependent clients with oral care
Provide special oral hygiene for debilitated or

unconscious clients or those with lesions of oral

tissues
Teach clients good oral hygiene practices
Educate clients about commercial products to decrease
mouth dryness
Reinforce oral hygiene regimen

Implementation
Good oral hygiene
Daily stimulation of gums
Mechanical brushing
Flossing
Flushing the mouth

Implementation: Promote Oral

Health Throughout the Life Span
Infants and toddlers
Begin dental hygiene when first tooth erupts
Beginning at 18 months: soft toothbrush
Fluoride supplement as recommended
Inspection visit at 18 months
Initial dental visit at 23 years
Seek professional dental attention for problems

Implementation: Promote Oral Health

Throughout the Life Span, continued
Preschoolers, school-age children
Dental care
Establish good dental habits early
Fluoride remains important
Adolescents and adults
Diet
Tooth and mouth care

Implementation: Promote Oral Health

Throughout the Life Span, continued
Clients with special oral hygiene needs
Debilitated, unconscious client

Oral mucosa, tongue in addition to teeth

Mouth tends to become dry

Tooth decay, infections

Predisposing client to tooth decay
Remove plaque, microorganisms
Soft-bristled toothbrush
Oral swab and water-soluble moisturizer

Normal Sleep-Rest Patterns

Sleep is a basic human need.
Universal biological process
Reasons we sleep

Cope with stress

Conserve energy
Restore mind and body
Vital for psychological, physiological functioning

Implementation: Promote Oral Health

Throughout the Life Span, continued
Older adults
At risk for cavities, periodontal disease
Increased risk because of self-care deficits
Brushing, flossing
Caring for artificial teeth: plate(s), bridge
Assisting with oral care
Wear gloves
Foam swabs often used
Privacy in cleaning artificial teeth

Evaluation
Determine whether:
Nurse overestimated client's
functional ability
Client's hand coordination impaired
Client's cognitive function impaired
Client's condition changed
Client's energy level or motivation
changed

Physiology of Sleep
Altered state of consciousness
Perception of/reaction to environment decreased
Minimal physical activity
Changes in physiological processes
Cyclical nature controlled in lower brain
Neurotransmitters affect sleepwake cycle
Melatonin and cortisol levels

Circadian Rhythms

Types of Sleep

Biological rhythms
Normal sleepwake cycle
Awake when body
temperature highest
Asleep when body
temperature lowest
Begins to develop by sixth
week of life

NREM sleep
Stage I: very light sleep, lasts a few minutes
Stage II: light sleep
Stages III and IV: deepest sleep
Physiological changes
REM sleep
Every 90 minutes, lasts 530 minutes
Brain highly active
Dreaming

Sleep Cycles

Functions of Sleep

90110 minutes/cycle in adults

Four to six cycles during 78 hours
Sleeper awakened during any stage must start anew at stage

I NREM
Duration of NREM/REM sleep varies throughout sleep

period
Deep sleep longer in early part of night
Later, less time in stages III, IV of NREM

Physiological effects
Restores normal levels of activity
Necessary for protein synthesis
Psychological effects
Inadequate sleep

Irritability
Poor concentration
Difficulty making decisions

REM sleep increases, longer dreams

Stages I, 11 NREM sleep, REM sleep predominate toward

end of sleep period

Alterations with sleep

Nursing Diagnoses for problems with sleep
Insomnia
Sleep Deprivation
Disturbed Sleep Pattern

Normal Sleep Patterns & Requirements

Newborns
1618 hours/day

Irregular schedule
Enter REM sleep
immediately
Put to bed on back when
sleepy but not asleep

Infants
1415 hours/day

Awaken every 34 hours

Eat, back to sleep
Sleep through the night,
daytime naps by 6 months
Half of time in light sleep
Active during light sleep
Put to bed when sleepy
but not asleep helps them
become self-soothers

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Normal Sleep Patterns & Requirements

Toddlers
1214 hours/night with
nap(s)

Preschoolers
1113 hours/night

Nighttime fears,
nightmares common
Security object can help
Consistent bedtime
routine, sleep schedule
help

Need fluctuates in relation

to activity, growth
Restless, irritable if not
enough sleep
Maintain consistent sleep
schedule
Wake frequently at night,
may fear dark or have
night terrors, nightmares

Normal Sleep Patterns & Requirements

Adults
79 hours/night

Individual variation
Signs of not enough sleep
Falling asleep or getting drowsy during nonfatiguing task
Inability to concentrate or remember information
Unreasonable irritability

Vulnerable to insufficient sleep

Normal Sleep Patterns & Requirements

School age
1011 hours/night

Most get less

Demands of homework,
sports, social activities
Spend more time at
computer, TV
Caffeinated beverages
Consistent sleep schedule,
routine help

Adolescents
910 hours/night

Most get less

Later sleepwake patterns
conflict with daily
schedule
Nocturnal emissions

Normal Sleep Patterns & Requirements

Adults
Children's sleep patterns affect caregivers
Parents of infants lose most sleep
Women have more difficulty than men falling, staying
asleep
Women have more disrupted sleep during pregnancy,
menses, perimenopause

Shift workers
Travelers
Individuals with stress, depression, or chronic pain
Adults working long hours or multiple jobs

Normal Sleep Patterns & Requirements

Older adults
Awaken earlier, go to bed earlier
Increase in disturbed sleep affects quality of life
Better health more likely to sleep well
Adults with more medical conditions sleep problems
Sleep disorder may be complicating other conditions
Older adult clients with dementia

Sundown syndrome: symptoms in late afternoon

Factors Affecting Sleep

Irregular morning or

nighttime schedule
Exercise
Moderate in morning or

early evening good

sleep
Late in day can delay
sleep

Diet
Weight gain reduces
total sleep time
Weight loss increases
total sleep time
Smoking
Difficulty falling asleep
Easily aroused

Emotional stress
Stimulants, alcohol

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Factors Affecting Sleep, continued

Motivation
Can increase alertness
in some situations
Won't overcome
sleepiness

Medications
Hypnotics
Beta-blockers
Narcotics
Antidepressants

Nutrition: Lifespan Considerations

Infants and children
Rapid physical, functional changes from growth,
development
In first year, body weight triples
AAP recommends

Breastfeed exclusively first 6 months

Continue as foods introduced in first year

Ready-to-feed formulas available

Nutrition: Lifespan Considerations

Nutrition for adolescents
Rapid physical, emotional, social growth
Increased need for protein, calcium, iron, overall caloric
intake

Calcium especially important

Adolescent bone density adult bone health

Growth spurts
Struggles about food intake, food choices

Nutrition: Lifespan Considerations

Nutrition for adolescents
Social pressure on females to be thin

Extreme dieting dangerous

Low nutrition levels, loss of estrogen
Eating disorders cardiac dysthymias, electrolyte
imbalances, death

Pressure on males to gain muscle mass

Puts pressure on bones
Overweight, obesity

Associated with depression, hypertension, type 2 diabetes,

poor self-esteem

Nutritional Variations, continued

Nutrition for adolescents
Healthy People 2020

School involvement in healthier eating in,

after school
Nutrition education
Community-based obesity intervention
programs
Reduce proportion of children, adolescents
considered obese
Bariatric surgery option for those
significantly overweight

Nutrition for adults

34% Americans classified as obese in 2008
Adult men require more calories than adult women
Calorie needs reduced with decrease in metabolic rate at
around age 50
Females of childbearing age

Eat foods with heme iron, vitamin C

Add folic acid supplements

Food choice similar to that of older adults

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Nutritional Variations, continued

Nutrition for older adults
Unique nutritional requirements

Need for some nutrients increases with age

Vitamins D, B6, B12, calcium

Risk factors for undernutrition

Risk factors for obesity
Help to improve nutritional intake

Congregate nutrition services

Home-delivered nutrition services
Family caregiver support

Immunizations
allowing immunity to develop
Active immunity
Vaccine
Passive immunity

Injection of antibodies produced

by another host

Immunizations, continued
Immunization schedule
Specific ages and intervals
Children
Transplacental immunity decreases

Adults

Prevention of immune disorders

Vaccines to prevent infections diseases
Healthy People 2020 goals
Adequately immunize 8090% of US children by 35
months old
Adequately immunize 95% of children in Kindergarten
Adequately immunize 8090% of adolescents
Have 95% of children younger than 6 years of age
participating in a fully operational, population-based
immunization registry

Immunizations, continued

Introduce antigen into body,

Immunizations: Health Promotion

May need boosters of childhood vaccines

Schedule updated annually

Types of vaccines
Killed virus
Toxoid
Live virus
Recombinant
Conjugated

Responses to vaccines
Local reaction
Systemic reaction
Local allergic reactions
Life-threatening allergic
reaction

Anaphylaxis

Immunizations, continued
Contraindications
Acute illness with high fever
Hypersensitivity reaction
Recent immunoglobulin therapy
Cancer treatments
Pregnancy

Assess immunization status at every visit

13

Immunizations, continued

Immunizations, continued

Parent education and informed consent

Concerns about overloading immune system at young
age
Doubts about efficacy
Lack of confidence in immunization recommendations,
vaccine testing
Belief in "herd immunity
Fear of side effects
Previous negative vaccine reactions in family members,
friends
Belief that vaccines compromise immune system

Parent education and informed consent

Healthcare providers' roles

Class Activity

Questions

1.

Consistent message about value of vaccines

Answer parents' questions
Give VISs to parents/guardians
Discuss risks, benefits of vaccines
Obtain written consent before administering vaccine
Document informed refusal
Parents have the right to refuse immunizations

Complete My Family Health Portrait activity

2. Identify the most prevalent condition in your family

3. Perform an internet search for patient education

related to this condition

4. Develop 5 teaching points related to promote health

and decrease risk associated with this condition

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