GENERAL CONCEPTS

in Medical-Surgical Nursing

Andrew D. Beluso,RN
Erikson’s Psychosocial Development
and Havighurst’s Developmental
Tasks
• Adolescence (12-20) – Identity vs Role
Confusion
– Achieving new and more mature relations
with age-mates of both sexes
– Achieving a masculine or feminine social role
– Accepting physique and using body effectively
– Achieving emotional independence from
parents and other adults
Erikson’s Psychosocial Development
and Havighurst’s Developmental
Tasks
– Preparing for marriage and family life
– Preparing for an economic career
– Acquiring set of values and ethical system as
guide to behavior; developing ideology
– Desiring and achieving socially responsible
behavior
Erikson’s Psychosocial Development
and Havighurst’s Developmental
Tasks
• Early Adulthood (21-39) – Intimacy vs
Isolation
– Selecting a mate
– Learning to live with marriage partner
– Starting a family rearing children
– Managing a home
– Getting started in an occupation
– Taking on civic responsibility
Erikson’s Psychosocial Development
and Havighurst’s Developmental
Tasks
• Middle Age (40-60) – Generativituy vs
Stagnation
– Assisting teenage children to become
responsible and happy adults
– Achieving adult social and civic responsibility
– Reaching and maintaining satisfactory
performance in one’s occupational career
– Developing adult leisure-time activities
Erikson’s Psychosocial Development
and Havighurst’s Developmental
Tasks
– Relating oneself to one’s spouse as a person
– Accepting and adjusting to the physiologic
changes of middle age
– Adjusting to aging parents
Erikson’s Psychosocial Development
and Havighurst’s Developmental
Tasks
• Later Maturity (>65) – Ego Integrity vs
Despair
– Adjusting to decreasing physical strength and
health
– Adjusting to retirement and reduced income
– Adjusting to death of spouse
Erikson’s Psychosocial Development
and Havighurst’s Developmental
Tasks
– Establishing an explicit affiliation with one’s
age-group
– Adopting and adapting social roles in a flexible
way
– Establishing satisfactory physical living
arrangements
Terminologies

• Health
– (WHO) a state of complete physical, mental
and social well being and not merely the
absence of disease or infirmity
– Absence or presence of symptoms of illness or
their ability to carry out their normal activities
Terminologies

• Disease
– Presence of pathologic change in the structure
or function of the body or mind
• Illness
– Abnormal process in which the person’s level
of functioning is changed compared with a
previous level
Selye’s Types of Stress Responses

• Localized Adaptation Syndrome (LAS)

– Short-lived stressor, signs and symptoms seen
in a certain part of the body
• Generalized Adaptation Syndrome (GAS)
– Stressor present for a long period; signs and
symptoms manifested by the entire body
– Eg. Anorexia, body malaise, fever
Steps in the Inflammatory
Response
• Cell and tissue injury
• Vascular response
• Vasoconstriction – produces chemical
mediators (histamine, bradykinin, serotonin,
prostaglandins); produces blanching of skin
• Vasodilation – causes stasis of blood and
margination of leukocytes; produces redness
of skin
• Fibrin clot formation – histamine, kinins,
prostaglandins causes opening of venules
Steps in the Inflammatory
Response
• Fluid exudation - histamine, kinins,
protaglansdins causes opening of
venules
• Serous – clear and watery; protein or
albumin portion of the blood and from
serous membrane
• Sanguinous – large number of red blood
cells and looks like blood
Steps in the Inflammatory
Response
• Purulent – white blood cells, liquified dead
tissue debris and live or dead bacteria; thick
and foul smelling
• Edema – swelling of tissue from fluid in the
interstitial space
Steps in the Inflammatory
Response
• Cellular Exudation
• Leukocyte exudation – leukocytes passes from
blood to site of injury and accumulates there
• Attack and engulfment of foreign materials –
removal and digestion of bacteria, foreign
particles and damaged tissues
Steps in the Inflammatory
Response
• Healing
• Fibroblasts produce collagen fibers leading to
resolution of inflammation
• Regeneration – proliferation with same type
of cell;
• Labile cells – multiply constantly like the gastro-
intestinal tract
• Permanent cells – neurons
• Stable cells – latent regeneration: kidney, liver
Cardinal Symptoms of
Inflammation
• Rubor (redness)
• caused by hyperemia
• Calor (heat)
• caused by vasodilation
• Tumor (swelling)
• caused by fluid exudation
• Dolor (pain)
• caused by pressure of fluid exudates and chemical
irritation of nerve endings
• Loss of function
• caused by swelling and pain
Systemic Reactions in
Inflammation
• Fever
• release of endogenous pyrogens,
prostaglandins, endotoxins and leukotrienes;
defense mechanism and helps increase
production of antimicrobial agents like
interferon
• Leukocytosis
• Increase number of leukocytes released from
bone marrow and lymph nodes into blood
Systemic Reactions in
Inflammation
• Increased Erythrocyte Sedimentation Rate
• Increase in fibrinogen; indicates that the
body’s defense mechanisms for the repair of
damaged tissues are operating
 Classification of Inflammation

• According to characteristic type of

exudates:
• Serous – clear; easily reabsorbed without
damage
• Fibrinous – filled with large amount of
fibrinogen
• Sanguinous or hemorrhagic – large amount of
blood from vascular damage
Classification of Inflammation
• Purulent or suppurative – results from
bacterial infection
• Catarrhal – mucinous secretion and results
from viral infection of respiratory tract
Classification of Inflammation

• According to position that inflamed area

occupies within involved tissue:
• Abscess – localized collection of pus caused
by suppuration in tissue, organ and confined
space
• Sinus – infection forming abscess develops
suppurating channel and ruptures onto the
surface or into a body cavity
Classification of Inflammation
• Fistula – infection forms a tube-like passage
from an epithelium-lined organ or normal
body cavity to the surface of another organ or
cavity
• Cellulitis – inflammatory process poorly
defined and diffused with tendency to spread;
involves cellular or connective tissue
• Ulcer – superficial defect on surface of organ
or tissue caused by sloughing of necrotic
tissues
Classification of Inflammation

• According to location (with suffix itis –

depends upon organ affected)
Classification of Inflammation

• According to duration or length of time

• Acute
• Lasts less than 2 weeks; response is immediate;
healing takes place with return of normal structure
and function
Classification of Inflammation
• Chronic
• Lasts from several weeks to years; debilitating and
produces long lasting effect; proliferative cell
multiplication, cellular filtration, necrosis, fibrosis
or scarring; with periods of
• Remission – disease is present but the person
does not experience symptoms
• Exacerbation – acute phase, signs and symptoms
are back
Objectives and Principles of
Care
• Conserving energy
• Enhancing inflammatory process
• Increasing fluid intake
• Diminishing effects of inflammation
• Isolating patient
Physiologic Responses to Stress

• Neuroendocrine responses
• SAMR – Sympatho Adrenal Medullary
Response
• Fight or flight response
• Epinephrine
Physiologic Responses to
Increased Epinephrine
• Increased heart rate and blood pressure
• Better perfusion of vital organs
• Increased cardiac output and cardiac rate
• Increased myocardial contractility
• Increased venous return
• Peripheral vasoconstriction
• Increased blood glucose
• Increased energy
Physiologic Responses to
Increased Epinephrine
• Glycogenolysis or carboydrate breakdown
• Increased mental activity
• alertness, dilated pupils
• Increased tension of skeletal muscles
• Preparedness for activity, decreased fatigue
• Increased ventilation
• Provision of O2 for energy
Physiologic Responses to
Increased Epinephrine
• Increased coagulability of blood
• Prevents hemorrhage
• Increased perspiration
• Dissipation of heat
• Decreased urinary output
• Decreased gastrointestinal tract activity;
decreased urinary output; decreased
salivation
Physiologic Responses to Stress
• Adreno-cortical response
• Glucocorticoids
• cortisol
• Mineralocorticoids
• aldosterone
Physiologic Effects of
Glucocorticoids
• Maintains blood glucose
• Increases gluconeogenesis
• Decreases glucose uptake by cells
• Protein and fat catabolism
• Depresses immune response
• Inhibits inflammatory process
• Destroys lymphocytes and decreases antibody
production
Physiologic Effects of
Glucocorticoids
• Augments effects of other hormones and
catecholamines
• Maintains cardiac output and blood pressure
• Promotes Na and H2O water retention and K
excretion
• Maintains emotional stability
• Increases RBC and platelet formation
• Inhibits defensive acts (anti-inflammatory)
Physiologic Effects of
Mineralicorticoids
• Stimulate defensive acts (pro-
inflammatory)
• Acts on distal tubule of kidneys
• Reabsorption of Na and water
• Excretion of K and H ions
• Maintains vascular volume and BP
Physiologic Responses to Stress
• Neurohypophyseal response
• Vasopressin or ADH
• Promote Na and water retention
• Adaptive mechanism in bleeding
Physiologic Responses to Stress

• Antigen-antibody reaction
• Antigen/immunogens
• Substances which when introduced into an animal
causes formation of antibodies or sensitized cell
• Antibody/immunoglobulins
• Produced when exposed to antigen; produced in
lymphoid tissues
Antibody Types

• IgG – immunoglobulin G
• Crosses placental barrier
• Predominant class (75-85%); major antibody
in primary and secondary immune responses
• Present in blood plasma
• Plays major role in blood borne and tissue
infection
• Activates compliment system and enhances
phagocytosis
Antibody Types

• IgA – immunoglobulin A
• Present in all body fluids like tears, saliva, [
• Protects against respiratory, gastrointestinal
and genitourinary infection
• Prevents absorption of antigens from food
• Passed on breast milk to protect neonates
Antibody Types

• IgM – immunoglobulin M
• Confines in intravascular fluids; attached to B-
cells
• First produced in response to bacterial or viral
infection
• Mainstay or primary immune system
• Responsible for transfusion reactions in ABO
blood typing system
Antibody Types

• IgE – immunoglobulin E
• Produced by plasma cells in mucous
membranes and tonsils
• Mediate serum and hypersensitivity reaction
• Defense against parasitism
Antibody Types

• IgD – immunoglobulin D
• Attached to B cells
• Unknown biologic function
• Activation of and suppression of lymphocyte
function
Antigen-antibody Reactions
• Agglutination
• Agglutinins; clump
• Precipitation
• Precipitins; clusters
• Opsonization
• Opsosins; coats
• Lysis
• Lysozyme; dissolves or liquifies
• Neutralization
• Antitoxin; neutralizes
Physiologic Responses to Stress

• Immune Response
• Developed when the body recognized the
invading organism that cannot be identified as
part of itself
• Immunity – state of being resistant to injury
or disease
Functions of Immune System

• Defense – resisting infection

• Homeostasis – removing”worn out” self
component
• Surveillance – identification and
destruction of mutant cells
Types of Immunity

• Active
• Antibodies are synthesized by the body in
response to antigenic stimulation
• Natural
• Contact with antigen eg. chickenpox, measles
• Artificial
• Immunization with antigen (live or killed vaccine or
toxoid immunization)
Types of Immunity

• Passive
• Antibodies produced in one individual
transferred to another
• Natural
• Transplacental colostrum transfer from mom to
child
• Artificial
• Injection of serum from immune human or animal
• e.g. human globulin, hyperimmune sera
Interactive Divisions of the
Immune System
• Humoral (antigen antibody reaction)
• Provides immunity against:
• Bacteria that produce acute infection
• Bacterial exotoxins (diphtheria, tetanus)
• Viruses that must enter the bloodstream to reach
their target tissues
• Organisms that enter the body from mucosal
tissues
Interactive Divisions of the
Immune System
• Cellular (cell mediated; lymphocytes)
• Offers protection from:
• Chronic bacterial infection (syphilis, leprosy, TB)
• Many viral infections (measles, herpes,
chickenpox)
• Fungal infections (candidiasis)
• Parasitic infections (pneumocystis carinii)
• Transplanted or transformed cells
Comparison of Humoral and
Cellular Immunity
HUMORAL CELLULAR
Cells B-lymphocytes T-lymphocytes
Products Antibodies Sensitized T-cells

Reaction Immediate Delayed

e.g. Anaphylactic TB, contact
shock, transfusion dermatitis, AIDS
reaction
TH ANK Y OU!