Regents College Nursing
Study Guide Expanded Notes
Health, Wellness, and Illness
I. Health, Wellness, and Illness
A. Theoretical framework: basis for care
1. Concept of a continuum from wellness to illness
(health to illness), including variation on the health
continuum (e.g., high-level wellness, health belief model,
acute illness, chronic illness)
The concept of health has changed. Viewed previously as the
absence of illness, health is now defined by the world health
organization as a 'state of complete mental, physical and social well-
being and not merely the absence of disease or infirmity." Health , or
wellness, and illness are viewed on a continuum.
This continuum varries from peak wellness, through high-level
wellness, good heath, normal health, down through poor health,
extreme poor health and eventually to death. The status of one's
health moves along this continuum, varring from year to year, month
to month, and even day to day or hour to hour.
High-level wellness is the state of health that most of us would
like to have, yet, although we view our own health as acceptable,
most are no where near that state. North America still compares
poorly with other developed countries populations. Here the belief
about the nature of one's health is important.
Judgement on the nature of health is based on three main
areas, presence or absence of symptoms, the way one feels, and
ability to undertake activities.
Acute illness is fairly easy to recognize. All areas are usually
disterbed, and the nature of one or all areas is severe. Sever pain
from a myocardial infarction may be the primary area the patient
notices to arrive at the decision that it represents an accute illness,
although there are numorous other elements involved.
Cronic illness results from a failure to return to previous health
after an accute illness, or through an ongoing deterioration of health
over a longer period of time. The cigarette smoker may notice the
daily cough, but often fails to recognize the slow decay in health
untill the poor health state of COPD is arrived at. Then the daily
activites are no longer able to be preformed without shortness of
breath (SOB).
2. Concepts related to stress and adaptation
a. Nature of stress: Selye's theory
Selye's Theory
The General Adaptation Syndrome (G.A.S.)is a theory of Hans
Selye, Professor of ??? at the University of Montreal. In ??? he
described the body's response to an event as this syndrome.
The body's response can be outlined in three stages that
compose the GAS theory:
a. Alarm Reaction (where the body's defense mechanisms are
put into action against the event)
b. Stage of Resistance (were the body mechanisms attempt to
return things to homeostasis), and
c. State of Exhaustion (where the stressor is severe enough t
deplete the body's adaption)
In addition ot he G.A.S., Selye also described the Local Adaption
Syndrome (L.A.S.), to describe smaller localized events. Here the
pattern follows the same three stages, generealized localized reaction
of imflamation, the action against the event and finally overcomming
the stressor.
b. Types of stressors
Stressors can be of two types, physiological and psycological.
Physiological stressors are the main ones considered in the
healthcare environment, however there is an equally great
overlooking of the psychological stressors associated with health
problems.
1) Physiological
2) Psychological
c. Factors affecting adaptation to stress (e.g., age, life experience,
support systems, health status)
d. Defining characteristics of increased stress
1) Physiological (e.g., increased heart rate, increased
respiratory rate, diaphoresis, patient reports a nervous
stomach)
2) Psychological (e.g., inability to focus, decreased
perception, patient reports feelings of anxiety)
e. Adaptation to stress
The very young and the aged are less able to withstand the
stresses of common illnesses. Simple flue and colds can progress into
major pneumonia. The young and old have bodies that are less able
to addapt in these situations. For both, fluid loss can occure quickly
from vomiting and diarrehea.
Those with stronger support systems and well grounded life
experiences may be better able to withstand the psycological stresses
of major illness or injury. Here the end result is an overall better
response to the illness or injury.
Physical fitness and appropriate nutritional intake is important
to overall general health status. Those with such health status are
better able to withstand major illnesses. Poor nutrition and the other
elements of the western life style contribute to health problems of
their own accord.
1) Physiological adaptations (e.g., the general adaptation
syndrome)
Varations in vital signs such as the pules, respiration,
temperature, and blood pressure along with skin colour and
conditions, and the individuals mental status, are the main method
for determining a condition of increased physiological stress. These
values have varriation between individuals and with the individual
there is also varriance from time to time. It is important to know the
standard values. Increased pulse, respiration and temperature are
often the first signs of a stressor, especially of an infectious process.
The individual's statement of the problem or the comlaint is
also a determining method for a stressor. This complaint may be
described in terms of pain such as in a myocardiainfarction. Other
complaints may be specific or of a very general nature.
2) Psychological adaptations (e.g., coping strategies, defense
mechanisms)
3) Stress management (e.g., relaxation techniques, exercise,
problem solving, humor, anticipatory guidance)
3. Principles related to health assessment
a. Health history (e.g., interviewing skills, questioning
techniques)
Interviewing is the primary method for determining
information about the patient. It is not only used for the initial
establishment of the problem, but also throughout patient care for
ongoing follow up and assessment of the results of therapy. The
communication itself my form a theraputic use.
Establishing an environment condusive to good communication
may be important to the interview. In open situations, the patient
may be garded about personal information and fail to disclose fully
the history. A situation of security and confidentiality, even if just
b. Physical examination (e.g., vital signs, auscultation1,
palpation2, inspection3, percussion4 5)
4. Principles related to health maintenance and promotion (e.g.,
health screening, principles of teaching and learning)
5. Factors affecting health, wellness and illness
a. Developing level: infancy through senescence6
b. Individual preferences and patterns (e.g., lifestyle, past
experiences, educational level)
c. Physical condition (e.g., presence of chronic disease,
weight, height, fatigue, risk factors)
d. Ethnic and cultural considerations (e.g., values,
perception of health, spiritual and religious beliefs, male-
female roles, language, communication patterns)
e. Socioeconomic factors (e.g., availability of health
resources, health insurance, family structure, support
system, employment status, peer pressure)
f. Environmental factors (e.g., temperature, housing
conditions, occupational hazards, light and sound levels)
g. Psychological factors (e.g., level of motivation;
orientation to time, place, and person; hopelessness;
helplessness)
B. Nursing Care Related to Theoretical Framework
1. Assessment: gather and synthesize data about the
patient's health status in relation to the patient's
functional health patterns
a. Obtain the patient's health history
b. Assess factors affecting adaptation to stress (see IA2c)
c. Assess factors affecting health, wellness and illness (see IA5)
d. Obtain objective data (e.g., temperature, pulse, respirations,
blood pressure, breath sounds, heart rate and rhythm, intake and
output, daily weight)
e. Review laboratory and other diagnostic data (e.g., vital signs,
complete blood count [CBC]7, blood glucose8)
2. Analysis: identify the nursing diagnoses (patient
problem) and determine the expected outcomes (goals) of
patient care
a. Identify nursing diagnoses (e.g., altered health maintenance
related to stress, fatigue related to excessive role demands,
health-seeking behavior [breast self-examination] related to
desire for highlevel wellness, ineffective individual coping related
to knowledge deficit regarding stress management)
Anxiety [Mils, Moderate, Sever, Panic]/Powerlessness (A vauge,
uneasy feeling whose source is often nonspecific or unkown to the
individual)
Caregiver Role Strain, and risk for(A caregiver's, and vulnerability
for, felt difficulty in performing the family caregiver fole)
Community Coping, enhanced, potential for (A pattern of community
activities for adaption and problem solving that is satisfactory for
meeting the demands or needs of the community but can be
improved for management of current and future
problems/stressors.)
Sleep Pattern disterbance
b. Set priorities and establish expected outcomes (patient-
centered goals) for care (e.g., patient will identify stressors and
effective health maintenance behaviors, patient will report an
increase in energy level, patient will correctly and regularly
perform breast self-examination, patient will use adaptive coping
methods to reduce anxiety)
3. Planning: formulate specific strategies to achieve the
expected outcomes
a. Plan nursing measures to help the patient achieve the expected
outcomes (e.g., encourage the patient to keep a log of incidents
that arouse anxiety and frustration, assist the patient to set
priorities and manage time effectively, demonstrate the procedure
for breast self-examination to the patient, provide information
about relaxation techniques and problem-solving skills)
b. Consider factors affecting adaptation to stress (see IA2c)
c. Incorporate factors affecting health, wellness, and illness in
planning the patient's care (e.g., consider patient's developmental
level, occupation, exercise routine, smoking habits, level of
anxiety, support systems, and stage of wellness-illness) (see IA5)
4. Implementation: carry out nursing plans designed to
move the patient toward the expected outcomes
a. Use nursing measures to structure an environment conductive
to health (e.g., eliminate annoying noise and odors, control
temperature)
b. Use nursing measures to maintain psychological comfort (e.g.,
involve the patient in decision making, respect the patient's needs,
encourage the expression of feelings)
c. Provide information and instruction regarding health
maintenance and promotion (e.g., advise the patient regarding the
use of health care services, provide information about self-
examination for early detection of disease, provide a list of
community screening agencies)
5. Evaluation: appraise the effectiveness of the nursing
intervention relative to the nursing diagnosis and the
expected outcomes
a. Record and report the patient's response to nursing actions (e.g.,
patient correctly performs relaxation techniques, patient
demonstrated ability to use the health care system, patient
reports less anxiety)
b. Reassess and revise the patient's plan of care as necessary (e.g.,
need for further instruction, provide written instruction to
reinforce the nurse's demonstration)
1 auscultation: listening to body sounds, esp. heart, lungs, bowel sounds, and fetal
heart; mainly using a stethoscope
2 palpation: manual examination of the body
3 inspection: visual examination of the body
4 percussion: tapping of a body area to determine resonance or dullness
5 should be preformed.. except for .. which is
6 senescence: changes of mind and body occuring normally with ageing
7 complete blood count [CBC]:
8 blood glucose: