Ms.Vinay Kumari
Introduction
Prevent illness
Restore health
Facilitate coping
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Health
Traditionally health was defined in terms of
the presence or absence of disease.
Individually defined
Each person defines health in terms of
his or her own values and beliefs.
Acc. to WHO (World Health Organisation,
1946)
Health is a state of complete physical,
mental,and social well being, and not
merely the absence of disease or infirmity.
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Definitions of Health
American Nurses Association (1980)
’’A dynamic state of being in which
the developmental and behavioral
potential of an individual is
realized to the fullest extent
possible.’’
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Wellness and Well-Being
Wellness is a state of well being.
7 components of wellness (Anspaugh,
Hamrick, and Rosato, 2006)
Physical (ability to carry out daily tasks,
achieve fitness, maintain adequate
nutrition & proper body fat, and generally
positive lifestyle habits)
Social (ability to interact successfully with
people & within the environment)
Emotional (ability to manage stress & to
express emotions appropriately.)
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Wellness and Well-Being
7 components of wellness (Anspaugh, Hamrick,
and Rosato, 2006)
Intellectual (ability to learn & use information
effectively for development)
Spiritual ( belief in some force that serves to
unite human beings
Occupational (ability to achieve a balance
between work & leisure time)
Environmental (ability to promote health
measures that improve the standard of living &
quality of life in the community)
Wellness and Well-Being
Well being is a subjective perception
of vitality and feeling well. It is a
component of health.
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Models of health and illness
Agent- host- environment model
Health-illness continuum
High level wellness model
Health promotion model
Health belief model
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Agent- host- environment model
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Health-illness continuum
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Health illness continuum
People move back and forth within
this continuum day by day
A person with a chronic illness may
view himself or herself at different
points on the continuum at any
given time, depending upon how
well the patient believes he or she
is functioning with the illness.
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Factors/Variables affecting Health and Illness
People can usually control their health behavior
and choose healthy or unhealthy activities.
Internal variables
Biologic dimension
Psychologic dimension
Cognitive dimension
External variables
Physical environment
Standard of living
Family and cultural beliefs
Social support networks
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Internal Variables
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Internal Variables (Cont…)
Psychologic dimension
Mind body interaction can affect health status +vely or
–vely.Emotional responses to stress affect body
functions. E.g : student anxious before test may experience
diarrhea.
Self concept is how a person feels about self (self
esteem) and perceives the physical self (body image),
needs , roles and abilities. It affects how people view
and handle situationts. Such attitudes can affect health
practices, response to stress, illness etc.
E.g: Anorexia nervosa
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Internal Variables (Cont..)
Cognitive dimension
Life style refers to a person’s general way of living
( living conditions and individual patterns of behavior).
Lifestyle is often considered as behavior and activities
over which people have control.
E.g: Overeating, Insufficient exercises are related to incidence
of Heart disease ; Excessive tobacco use linked with lung
cancer
Spiritual and religious believes can significantly
affect health behaviour.
E.g: Some religious gp are strict vegetarian; serious illness as
God’s punishment
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External variables (Cont….)
Family and cultural beliefs
Family passes on patterns of daily living and lifestyle
to offspring. E.g A man who was abused as a child
may physically abuse his childern
Each culture has ideas about health, and these are often
transmitted to children. E.g Asians prefer herbal
remedies and acupunture than analgesics
Social support network ( family, friends) and
job satisfaction helps people avoids illness.
Support people help the person that illness exists
and provide stimulus to become well again.
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External variables
Environment
Geographic location determines climate and
climate effects health (malaria more in tropical
than temperate climate) : pollution;radiation
Standards of living (reflecting ocupation,
income, and education) is related to health,
morbidity and mortality. Hygiene, food habits,
propensity to seek health care advise vary
among high and low income gps.
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Illness And Disease
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Types Of Illness
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Causes and risk factors for developing
illness
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Causes and risk factors for developing
illness
2. Age
Age increase or decreases susceptibility to certain
illnesses.
3. Environment
The physical environment in which a person work or lives
can increase the likelihood that certain illnesses will occur.
4. Lifestyle
Lifestyle practices with potential negative effects are risk
factors; these include sedentary lifestyle, overeating or
poor nutrition, insufficient rest and sleep, and poor
personal hygiene etc.
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Illness Behaviours
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Illness behaviour (cont…)
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Impact of illness on the client
Ill clients may experience behavioral and
emotional changes, changes in self concept
and body image and life style changes.
Behavioral and emotional changes associated with
short term illness are generally mild and short
lived
Certain illnesses can also change the clients body
image
Clients self esteem and self concept may also be
affected
Ill individuals are also vulnerable to loss of
autonomy
Illness also often necessitates change in life style
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Impact on the family
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Types of health care services
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Types of health care services ( Cont..)
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Types of health care services ( Cont..)
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Health Promotion, Wellness, & Illness
Prevention
Wellness education teaches people how to
care for themselves in a healthy way and
includes topics such as physical
awareness, stress management, and self
responsibility. Help persons achieve new
understanding and control of their lives.
Illness prevention activities such as
immunization prog protect clients from
actual or potential threats to health.
Illness prevention motivates people to
avoid declines in health or functional
levels.
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Health Promotion
Science and art of helping people change
their lifestyles to move toward a state of
optimal health.
Health promotion activities: Active and
Passive
Passive (individuals gain from activities
of others without acting themselves e.g
fluoridation of municipal water)
Active ( individuals are motivated to
adopt specific health prog e.g weight
reduction)
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Levels of preventive care
Nursing care oriented to health promotion,
wellness, and illness prevention can be
understood in terms of health activities on
primary, secondary and tertiary level.
Primary prevention
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Levels of preventive care
Secondary Prevention
Focuses on individuals who are experiencing health
problems or illnesses and who are at risk for
developing complications or worsening conditions.
Activities are directed at diagnosis and
prompt intervention, thereby reducing
severity and enabling the client to return
to normal level of health as early as
possible.
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Levels of preventive care
Tertiary Prevention
Occurs when a defect or disability is permanent
and irreversible. Involves minimizing the effects
of long term disease or disability by interventions
directed at preventing complications and
deterioration
Activities are directed at rehabilitation rather than
diagnosis and treatment.
Care at this level aims to help clients achieve as
high a level of functioning as possible, despite
the limitations caused by illness.
Prevents further disability or reduced functioning.
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Health Care Agencies
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Health Care Agencies
Classification (Cont..)
Acc to population served
Age gp: (pediatric, adult health or geriatric
client)
Stage of illness: ( primary, secondary,
tertiary)
Specific health problems : ( communicable
diseases, drug addiction etc)
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Health Care Agencies
Classification (Cont..)
Acc to type of services
Specific
services (diagnostic studies,
counseling, formal instruction, surgery,
non surgical treatment)
General services (hospitals provide a
more comprehensive array of services)
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Health Care Agencies
Classification (Cont..)
Acc to source of fund
Profit
institutions (proprietary): (receive
payment from those who use their services)
Nonprofit (not-for-profit):
voluntary agencies (financed by private
charitable or religious org.)
public( govt. operated) agencies (funding from
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Hospital
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Definition of Hospital
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Hospital (Cont..)
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Hospital (Cont..)
Functions
Primary function: provision of medical care
to community
INTRA-MURAL FUNCTIONS
These functions are within the hospital,
namely:
A)Therapeutic
Diagnostic : diagnosis of illness
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Hospital (Cont..)
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Hospital (Cont..)
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Hospital (Cont..)
EXTRA MURAL FUNCTIONS
Those functions which are outside the
hospital, namely:
1) Outpatient services
2) Home care/ out reach/ domiciliary services
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Classification of Hospitals
Can be classified in many ways
B) According to ownership/ Control
Public hospitals
Run by central/ state Govt or Municipal bodies on non commercial
basis. May be general or specialized hospitals or both. General
hospitals are those which provide treatment for common diseases,
whereas specialized hospitals provide treatment for specific diseases,
specific group of people like infectious diseases, cancer, eye, ENT,
cardiac diseases
Voluntary ( Charitable ) hospitals
Established and incorporated under the Societies Registration Act. A
board of trustees usually manages such hospitals. The main source of
revenue are publics and private donations and grants aid from the
Central govt./ State govt. and from philanthropic organizations, both
national and international
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Classification of Hospitals
A) According to ownership/ Control
Private hospitals
Generally owned by individuals or groups of
people and are run on a commercial basis
Corporate hospitals
Run by limited companies, formed under
the companies Act.They can be general,
specialized or both.
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Classification of Hospitals ( Cont..)
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Classification of Hospitals ( Cont..)
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Physical Plan of the hospital
PROVISION OF
Safe drinking water
Adequate lighting and ventilation
Control of noise
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Physical Plan of the hospital
Important points to be considered
while constructing a hospital
Walls and floor should be, as far as
possible, non absorbent, non porous,
shock absorbing, attractive, fire
resistant, durable, easy to clean, and
damp proof, free of cracks (prevent
breeding of insects)
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Physical Plan of the hospital (Cont..)
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Organization of hospital
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Organization of hospital (Cont..)
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Organization of hospital (Cont..)
MAJOR DEPARTMENTS
Medical department (Medical superintendent is a
doctor who has control over all the medical dept.)
Nursing department
Paramedical department
Pathology dept ( Bacteriology lab, biochemistry lab,
Radiology dept
Dietary dept
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Organization of hospital (Cont..)
MAJOR DEPARTMENTS
NON PROFESSIONAL SERVICES (BUSINESS MX)
Admitting dept
Administration
Personnel dept ( recruitment, interview, promotion, transfer, inservice
training, safety, health prog, recreation)
Purchasing dept
Medical records
Accounts (Business office)
Housekeeping (to keep hospital clean)
Laundry
Mechanical dept (electricity, water supply,heat.)
Maintenance dept (carpenter, painters, welders, gardners
Central supply dept
Social services
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Primary Health care
Originally conceptualized in 1978 by the WHO and
the United Nations International Children’s
Emergency Relief Fund (UNICEF)
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Primary Health care
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Primary Health care (Cont…)
Principles of primary health care
1.Equitable distribution
Health services must be shared equally by all people
irrespective of their ability to pay and all (rich or
poor, urban or rural) must have access to health
services. Primary health care aims to address the
current imbalance in health care by shifting the
centre of gravity from cities where a majority of the
health budget is spent to rural areas where a
majority of people live in most countries.
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Primary Health care (Cont…)
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Primary Health care (Cont…)
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Primary Health care (Cont…)
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Primary Health care (Cont…)
Role of Nurse
Assessing the health status of individuals and
community.
Promoting community involvement
Providing integrated health care including the
treatment of emergencies and making referrals.
Making epidemiological surveillance.
Training and supervising health workers.
Collaborating with other developmental sectors
Monitoring progress in primary health care
Body defenses: Immunity and
Immunization
Introduction
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Non Specific Defenses
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Non Specific Defenses (Cont…)
Inflammatory Responses
Inflammation is a local and nonspecific
defensive response of tissues to an
injurious or infectious agent.
It is an adaptive mechanism that
destroys or dilutes the injurious agent,
prevents further spread of injury, and
promotes the repair of damaged tissue.
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Non Specific Defenses (Cont…)
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Non Specific Defenses (Cont…)
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Non Specific Defenses (Cont…)
Inflammatory Responses (Cont..)
2) Third Stage : Reparative Phase
Involves the repair of injured tissues by
regeneration or replacement with fibrous
tissue( scar) formation.
Regeneration is the replacement of destroyed
tissue cells by cells that are identical in structure
and function.
When regeneration is not possible, repair occurs
by fibrous (scar) tissue formation. Damaged
tissues are replaced with the connective tissue
elements of collagen, blood capillaries,
lymphatics.
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Non Specific Defenses (Cont…)
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Immunity
Immunity is a material term that
describes a state of having sufficient
biological defenses to avoid infection,
disease, or other unwanted biological
invasion.
An antigen is a substance that
induces a state of sensitivity or
immune responsiveness (immunity).
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Types of Immunity
IMMUNITY
NATURAL ACQUIRED
PASSIVE
ACTIVE PASSIVE ACTIVE
(INFECTION) (MATERNAL) (IMMUNISATION)(ANTIBODY TRANSFER)
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Active and passive immunity
Passive immunity is acquired
through transfer of antibody or
activated T-cells from an immune
host, and is short lived, usually lasts
only a few months, whereas active
immunity is induced in the host
itself by antigen, and lasts much
longer, sometimes life-long.
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Components of immune response
Immune response has two
components: Antibody mediated
defenses and cell mediated
defenses. These two systems
provide distinct but overlapping
protection.
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Components of immune response
(Cont…)
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Components of immune response
(Cont…)
Antibody mediated defenses ( Humoral or circulating
immunity)
Active immunity (host produces antibodies in response
to natural antigens (e.g infectious microorganisms) or
artificial antigens (e.g. vaccines). B cells are activated
when they recognize antigen. Bcells may produce
antibody molecules of 5 classes of immunoglobulins
(IgM, IgG, IgA, IgD, and IgE.)
Passive immunity the host receives natural (e.g from
nursing mother) or artificial(from an injection of
immune serum) antibodies produced by another
source.
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Components of immune response
(Cont…)
Cell mediated defenses ( Cellular immunity)
The cell mediated defenses or cellular immunity, occur
through the T cell system. On exposure to an antigen,
the lymphoid tissues release large numbers of
activated T cells into the lymph system. These T cells
pass into general circulation. There are 3 main gps of T
cells
helper T cells, which help in the functions of immune system
cytotoxic T cells, which attack and kill microorganisms and
sometimes the body's own cells
suppressor Tcells which can suppress the functions of the helper T
cells and cytotoxic T cells
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Immunisation
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Immunisation
Immunization, or immunisation,
is the process by which an
individual's immune system
becomes fortified against an agent
(known as the immunogen).
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Passive and active immunization
Immunisation can be achieved in an
active or passive fashion:
vaccination is an active form of
immunization.
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Active immunization
Active immunisation entails the introduction of a foreign molecule
into the body, which causes the body itself to generate immunity
against the target. This immunity comes from the T cells and the
B cells with their antibodies.
ACTIVE IMMUNISATION
NATURAL ARTIFICIAL
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Active immunization
Active immunization can occur naturally when a
person comes in contact with, for example, a
microbe. If the person has not yet come into
contact with the microbe and has no pre-made
antibodies for defense (like in passive
immunization), the person can become
immunized. The immune system will eventually
create antibodies and other defenses against the
microbe. The next time, the immune response
against this microbe can be very efficient; this is
the case in many of the childhood infections that
a person only contracts once, but then is immune
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Active immunization
Artificial active immunization is where the microbe,
or parts of it, are injected into the person before
they are able to take it in naturally. If whole
microbes are used, they are pre-treated, so that
they will not harm the injected person as the
naturally occurring microbe would. Depending on
the type of disease, this technique also works with
dead microbes, parts of the microbe, or treated
toxins from the microbe.
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Passive immunization
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Passive immunization
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Passive immunization
Artificial passive immunization is
normally given by injection and is
used if there has been a recent
outbreak of a particular disease or
as an emergency treatment to
poisons (for example, for tetanus).
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National Immunization Schedule
AGE VACCINE DOSE ROUTE
BIRTH BCG 1 ID
OPV 0 ORAL
6 WEEKS OPV 1 ORAL
DPT 1 IM
10 WEEKS OPV 2 ORAL
DPT 2 IM
14 WEEKS OPV 3 ORAL
DPT 3 IM
National Immunization Schedule
AGE
VACCINE DOSE ROUTE
9 MONTHS MEASLES 1 SC
18 MONTHS DPT 1 BOOSTER IM
OPV 1 BOOSTER ORAL
5 YEARS DT 1 IM
10 YEARS TT 1 IM
16 YEARS TT 1 IM
Optional Vaccines
AGE AGE DOSE ROUTE
HEPATITIS B BIRTH 1 IM
10 WEEKS 2 IM
9 MONTHS 3 IM
HEPATITIS A 1 YEAR 1 IM
1 AND ½ YEAR 2 IM
H. INFLUENZA-B 06 MONTHS 1 IM
(HIB) 14 MONTHS 2 IM
18 MONTHS 3 IM
MMR 15 MONTHS 1 IM
CHIKENPOX 24 MONTHS 1 IM
TYPHOID 5 YEARS 2 IM
UNIT TEST ON THIS UNIT
COMPULSORY FOR ALL
DURATION : 1 HR
MM: 35
(28/11/08 : FRIDAY)
Time: 1.45 to 2.30 PM