A unity who can be viewed as functioning biologically, symbolically, and socially and who initiates and performs self-care activities on own behalf in maintaining life, health and well-being; self-care activities deal with air, water, food elimination, activity and rest, solitude and social interaction, prevention of hazards to life and well-being, and promotion of human functioning.
Environment:
The environment is linked to the individual, forming an integrated and interactive system.
Health:
Health is a state that is characterized by soundness or wholeness of developed human structures and of bodily and mental functioning. It includes physical, psychologic, interpersonal, and social aspects. Well-being is used in the sense of individual’s perceived condition of existence. Well-being is a state characterized by experiences of contentment, pleasure and certain kinds of happiness; by spiritual experiences; by movement toward fulfillment of one’s ideal; and by continuing personalization. Well-being is associated with health, with success in personal endeavors, and with sufficiency of resources.
Nursing:
A helping or assisting service to persons who are wholly or partly dependent-infants, children and adults – when they, their parents, guardians, or other adults responsible for their care are no longer able to give or supervise their care. A creative effort of one human being to help another human being. Nursing is deliberate action, a function of the practical intelligence of nurses, and action to bring about humanely desirable conditions in persons and their environments. It is distinguished from other human services and other forms of care by its focus on human beings.
Orem’s Self-Care Deficit Theory
Dorothy Orem’s self-care deficit theory, published first in 1971, has been widely accepted by the nursing community. It includes three related theories of self-care, self-care deficit, and nursing system. Self-care theory postulates that self-care and the self-care of dependents are learned behaviors that individuals initiate and perform on theri own behalf to maintian life, health, and well-being. The individual’s ability to perform self care is called self-care agency. Adults care for themselves, whereas infants, the aged, the ill, and the disabled require assistance with self-care activities.
These are three kinds of self-care requisites:
1. Universal requisites, common to all people, include the maintenance of air, water, food, elimination, activity and rest, solitude and social interaction; prevention of hazards to life and well-being; and the promotion of human functioning.
2. Developmental requisites are those associated with conditions that promote known developmental processes throughout the life cycle.
3. Health deviation requisites relates to defects and deviations from normal structure and integrity that impair an individual’s ability to perform self-care.
Self-care deficit theory asserts that people benefit from nursing because they have health-related limitations in providing self-care. Limitations may result from illness, injury, of form the effects of medical tests or treatments.Two variables affect these deficits: self-care agency (ability) and therapeutic self-care demands (the measures of care required to meet existing requisites). Self-care deficit results when self-care agency is not adequate to meet he known self-care demand.
Nursing system theory postulates that nursing systems form when nurses prescribe, design, and provide nursing that regulates the individual’s self-care capabilities and meets therapeutic self-care requirements. Three types of nursing systems are identified:
1. Wholly compensatory systems are required for individuals unable to control and monitor their environment and process information.
2. Partially compensatory systems are designed for individuals who are unable to perform some (but not all) self-care activities.
3. Supportive-educative (developmental) systems are designed for persons who need to learn to perform self-care measures ans need assistance to do so.
Reference:
Kozier, Barbara et.al Fundamentals of Nursing 5th edition
A behavioral system composed of seven subsystems: affiliative, achievement, dependence, aggressive, eliminative, ingestive, and sexual.
Environment:
Consists of all factors that are not part of the individual’s behavioral system but that influence the system and some of which can be manipulated by the nurse to achieve the health goal of the client. The individual links to and interacts with the environment.
Health:
Health is an elusive, dynamic state of influenced by biologic, psychologic, and social factors. Health is reflected by the organization, interdependence, and integration of the subsystem. Human attempt to achieve a balance in this system; this balance leads to functional behavior. A lack of balance in the structural or functional requirements of the subsystem leads to a poor health.
Nursing:
An external regulatory force that acts to preserve the organization and integration of the client’s behavior at an optimal level under those conditions in which the behavior constitutes a threat to physical or social health or in which illness is found.
Johnson’s Behavioral System Model
Dorothy Johnson used her observations of behavior over many years to formulate a general theory of man as a behavioral system. The theory was originally presented orally in 1968 but was not published until 1980. Johnson defines a system as a whole that functions as a whole by virtue of the interdependence of its parts. Individuals strive to maintian stability and balance in these parts through adjustments and adaptations to the forces that impinge on them. A behavioral system is patterned, repetitive, and purposeful.
Johnson’s key concepts describe the individual as a behavioral system composed of seven subsystems:
1. The attachment-affiliative subsystem provides survival and security. Its consequences are social inclusion, intimacy, and the formation and maintenance of a strong social bond.
2. The dependency subsystem promotes helping behavior that calls for a nurturing response. Its consequences are approval, attention or recognition, and p[physical assistance.
3. The ingestive subsystem satisfies appetite. It is governed by social and psychologic considerations as well as biologic.
4. The eliminative subsystem excrete body wastes.
5. The sexual subsystem functions dually for procreation and gratification.
6. The achievement subsystem attempts to manipulate the environment. It controls or masters an aspect of the self or environment to some standard of excellence.
7. The aggressive subsystem protects and preserves the self and society within the limits imposed by society.
Each of the above subsystem has the same functional requirements: protection, nurturance, and stimulation. The subsystems’ responses are developed through motivation, experience, and learning and are influenced by biopsychosocial factors.
Other concepts associated with Johnson’s model are equilibrium, a stabilized more or less transitory resting state in which the individual is in harmony with the self and the environment; tension, a state of being stretched or strained; and stressors, internal or external stimuli that produce tension ans result in a degree of instability.
Reference:
Kozier, Barbara Fundamental of Nursing 5th edition
Open system consisting of a basic structure or central core of survival factors surrounded by concentric rings that are bounded by lines of resistance , a normal line of defense, and a flexible line of defense. The total person is a composite of physiologic, psychologic, sociocultural, and developmental variables.
Environment:
Both internal and external environments exists and a person maintains varying degrees of harmony and balance between them. It is all factors affecting and affected by the system.
Health:
Wellness is the condition in which all parts and sub-parts of an individual are in harmony with the whole system. Wholeness is based on interrelationships of variables that determine the resistance of an individual to any stressor. Illness indicates lack of harmony among the parts and sub-parts of the system of the individual. Health is viewed as a point along a continuum from wellness to illness; health is dynamic. Optimal wellness or stability indicates that all a person’s needs are being met. A reduced state of wellness is the result of unmet systemic needs. The individual is in a dynamic state of wellness-illness, in varying degrees, at any given time.
Neuman’s Health Care Systems Model
Betty Neuman’s systems model, first published in 1972, is based on the individuals relationship to stress, the reaction to it, and reconstitution factors that are dynamic in nature. Reconstitution is the state of adaptation to stressors.
Neuman views the client as an open system consisting of a basic structure or central core of energy sources surrounded by two concentric boundaries or rings referred to as lines of resistance. The two lines of resistance represent internal factors that help the client defend against a stressor. The inner or normal line of defense represents the person’s state of equilibrium of the state of adaptation developed and maintained over time and considered normal for that person. The flexible line of defense is dynamic and can be rapidly altered over a short period of time. It is a protective buffer that prevents stressors from penetrating the normal line of defense.
The nurse’s focus is all the variables affecting an individual’s response to stressors. Nursing interventions are carried out on three preventive levels:
1. Primary prevention identifies risk factors, attempts to eliminate the stressor, and focuses on protecting the normal line of defense and strengthening the flexible line of defense. A reaction has not yet occurred, but the degree of risk is known.
2. Secondary prevention relates to interventions or active treatment initiated after symptoms have occurred. The focus is to strengthen internal lines of resistance, reduce the reaction, and increase resistance factors.
3. Tertiary prevention refers to intervention following that in the secondary stage. It focuses on readaptation and stability and protects reconstitution or return to wellness follwing treatment. The nurse emphasizes educating the client in strengthening resistance to stressors and ways to help prevent recurrence of reaction or regression.
Betty Neuman’s model of nursing has been widely accepted by the nursing community, nationally and internationally. it is applicable to a variety of nursing practice settings involving individuals, families, groups, and communities.
Reference:
Kozier, Barbara et.al Fundamentals of Nursing 5th edition
Three interacting systems; individuals (personal system), groups (interpersonal system), and society (social system); the personal system is a unified, complex, whole self who perceives, thinks, desires, imagines, decides, identifies goals, and selects means to achieve them.
Environment:
Adjustments to life and health are influenced by an individual;s interactions with environment. The environment is constantly changing.
Health:
A dynamic state in the life cycle; illness is an interference in the life cycle. Health implies continuous adaptation to stress in the internal and external environment through the use of one’s resources to achieve a maximum potential for daily living.
Nursing:
A helping profession that assists individuals and groups in society to attain, maintain, and restore health. If this is not possible, nurses help individuals die with dignity. Nursing is perceiving, thinking, relating, judging and acting a vis-avis the behavior of individuals who come to a nursing situation. A nursing situation is the immediate environment, spatial and temporal reality, in which nurse and client establish a relationship to cope with health state and adjust to changes in activities of daily living if the situation demands adjustment. It is an interpersonal process of action, reaction, interaction, and transaction whereby nurse and client share information about their perceptions in the nursing situation.
King’s Goal Attainment Theory
Imogene King’s theory of goal attainment, first published in 1971, was derived from conceptual framework of three dynamic interacting systems; (a) personal systems (individuals), (b) interpersonal systems (groups), and social systems (society). Key concepts are identified for each system as follows:
1. Personal system concepts: perception, self, body image, growth and development, space and time
2. Interpersonal system concepts: interaction, communication, transaction, role and stress
3. Social system concepts: organization, authority, power, status, and decision making.
The client ans nurse are personal systems subsystems within interpersonal and social systems. To identify problems and to establish goals, the nurse and client perceive one another, act and react, interact, and transact. Transactions are defined as purposeful interactions that lead to goal attainment. Transactions have the following characteristics:
1. They are basic to goal attainment and include social exchange, bargaining and negotiating, and sharing a frame of reference toward mutual goal setting.
2. They require perceptual accuracy in nurse-client interactions and congruence between role performance and role expectation for nurse and client.
3. They lead to goal attainment, satisfaction, effective care, and enhanced growth and development.
King postulates seven hypothesis in goal attainment theory:
1. Perceptual congruence in nurse-client interactions increases mutual goal setting.
2. Communication increases mutual goal setting between nurses and clients and leads to satisfactions.
3. Satisfaction in nurses and clients increase goal attainment.
4. goal attainment decreases stress and anxiety in nursing situations.
5. Goal attainment increases client learning and coping ability in nursing situations.
6. Role conflict experienced by clients, nurses, or both decreases transactions in nurse-client interactions.
7. Congruence in role expectations and role performance in creases transactions in nurse-client interactions.
King’s theory highlights the importance of the participation of all individuals in decision making and deals with the choices, alternatives, and outcomes of nursing care. The theory offers insight into nurses’ interactions with individuals and groups within the environment t.
Reference:
Kozier, Barbara et.al Fundamentals of Nursing 5th edition
Classic signs of inflammation (redness, swelling, heat, and pain)
Goal of Antibiotic Therapy
Decrease the population of the invading bacteria to a point where the human immune system can effectively deal with the invaders
Selecting Treatment
Identification of the causative organism
Based on the culture report, an antibiotic is chosen that is known to be effective at treating the invading organism
Bacteria Classification
Gram-positive
The cell wall retains a stain or resists decolorization with alcohol
Gram-negative
The cell wall loses a stain or is decolorized by alcohol
Aerobic
Depend on oxygen for survival
Anaerobic
Do not use oxygen
Aminoglycosides
A group of powerful antibiotics used to treat serious infections caused by gram-negative aerobic bacilli
Common medications:
Amikacin (Amikin)
Gentamicin (Garamycin)
Kanamycin (Kantrex)
Neomycin (Mycifradin)
Streptomycin
Tobramycin (Nebcin, Tobrex)
Bactericidal
Indications: treatment of serious infections caused by susceptible bacteria
Action: inhibit protein synthesis in susceptible strains of gram-negative bacteria causing cell death
Pharmacokinetics
Poorly absorbed from the GI tract but rapidly absorbed after IM injection, reaching peak levels within 1 hour
Widely distributed throughout the body, crossing the placenta and entering breast milk
Excreted unchanged in the urine and have an average half-life of 2 to 3 hours
Depend on the kidney for excretion and are toxic to the kidney
Contraindications
Known allergies, renal or hepatic disease, and hearing loss
Adverse effects
Ototoxicity and nephrotoxicity are the most significant
Drug-to-drug interactions
Diuretics and neuromuscular blockers
Cephalosporins
Similar to penicillin in structure and activity
Action
Interfere with the cell-wall–building ability of bacteria when they divide
Indication
Treatment of infection caused by susceptible bacteria
Pharmacokinetics
Well absorbed from the GI tract
Metabolized in the liver, excreted in the urine
Contraindications
Allergies to cephalosporins or penicillin
Adverse effect
GI tract
Drug-to-drug interactions
Aminoglycosides, oral anticoagulants, and ETOH
Fluoroquinolones
Relatively new class of antibiotics with a broad spectrum of activity
Indications: treat infections caused by susceptible strains of gram-negative bacteria, including urinary tract, respiratory tract, and skin infections
Actions: interferes with DNA replication in susceptible gram-negative bacteria, preventing cell reproduction
Pharmacokinetics
Absorbed in the GI tract
Metabolized in the liver
Excreted in the urine and feces
Contraindications
Known allergy, pregnancy, and lactation
Adverse effects
Headache, dizziness, and GI upset
Drug-to-drug interactions
Antacids, quinidine, and theophylline
Macrolides
Antibiotics that interfere with protein synthesis in susceptible bacteria
Indications: treatment of respiratory, dermatologic, urinary tract, and GI infections caused by susceptible strains of bacteria
Actions: bind to cell membranes causing a change in protein function and cell death; can be bacteriostatic or bactericidal
Pharmacokinetics
Absorbed from the GI tract
Metabolized in the liver, excreted in the bile to feces
Contraindications
Allergy and hepatic dysfunction
Adverse effects
GI symptoms
Drug-to-drug interactions
Digoxin, oral anticoagulants, theophylline, and corticosteroids
Lincosamides
Similar to macrolides but more toxic
Action
Similar to macrolides
Indications
Severe infections
Pharmacokinetics
Well absorbed from the GI tract or IM
Metabolized in the liver and excreted in the urine and feces
Contraindications
Hepatic or renal impairment
Adverse effects
GI reactions
Monobactams
Unique structure with little cross-resistance
Action
Disrupts bacteria cell wall synthesis, which promotes the leakage of cellular content and cell death
Indications
Treatment of infections caused by susceptible bacteria; UTI, skin, intra-abdominal, and gynecologic infections
Pharmacokinetics
Well absorbed from the IM injection
Excreted unchanged in the urine
Contraindications
Allergy
Adverse effects
GI and hepatic enzyme elevation
Penicillins
First antibiotics introduced for clinical use
Action
Inhibit synthesis of the cell wall in susceptible bacteria, causing cell death
Indications
Treatment of infections caused by streptococcal, pneumococcal, staphylococcal, and other susceptible bacteria
Pharmacokinetics
Well absorbed from the GI tract
Excreted unchanged in the urine
Contraindications
Allergy
Caution in patients with renal disease
Adverse effects
GI effects
Drug-to-drug interactions
Tetracyclines and aminoglycosides
Sulfonamides
Drugs that inhibit folic acid synthesis
Action
Interfere with the cell-wall–building ability of dividing bacteria
Indications
Treatment of infections caused by gram-negative and gram positive-bacteria
Pharmacokinetics
Well absorbed from the GI tract
Metabolized in the liver and excreted in the urine
Contraindications
Allergy and pregnancy
Adverse effects
GI symptoms and renal effects related to the filtration of the drug
Drug-to-drug interactions
Cross sensitivity with thiazide diuretics
Sulfonylureas
Tetracyclines
Developed as semisynthetic antibiotics based on the structure of a common soil mold
Action
Inhibit protein synthesis in susceptible bacteria, preventing cell replication
Indications
Treatment of various infections caused by susceptible strains of bacteria and acne, and when penicillin is contraindicated for eradication of susceptible organisms
Pharmacokinetics
Adequately absorbed from the GI tract
Concentrated in the liver and excreted unchanged in the urine
Contraindications
Allergy, pregnancy, and lactation
Adverse effects
GI, skeletal: damage to bones and teeth
Drug-to-drug interactions
Penicillin G, oral contraceptive therapy, methoxyflurane, and digoxin
Antimycobacterials
Contain pathogens causing tuberculosis and leprosy
Action
Act on the DNA of the bacteria, leading to lack of growth and eventual bacterial death
Indication
Treatment of acid-fast bacteria
Pharmacokinetics
Well absorbed from the GI tract
Metabolized in the liver and excreted in the urine
Contraindications
Allergy and renal or hepatic failure
Adverse effects
CNS effects and GI irritation
Drug-to-drug interactions
Rifampin and INH can cause liver toxicity
Antibiotic Use Across the Lifespan
Pediatric population
Adult population
Geriatric population
Comparison of Prototype Antibiotics
Drug/ Classification
Indication
Action
Route
Onset
Peak
Pharmacokinetics
Adverse Effects
Gentamicin/ Aminoglycosides
Treatment of serious infections caused by susceptible bacteria
Inhibits protein synthesis in susceptible strains of gram negative bacteria
IM
Rapid
30-90 min
T½ – 2-3 h
Sinusitis, dizziness, rash, fever, risk of nephrotoxicity
IV
Metabolized in the liver,
excreted in the urine
Cefaclor/ Cephalosporins
Treatment of respiratory, dermatological, urinary tract, and middle ear infections
Inhibits synthesis of bacteria cell wall
Oral
30-60 min
8-10 h
T ½ 30-60 min
Nausea, vomiting, diarrhea, rash, superinfections, bone marrow suppression, risk for pseudomembranous colitis
Excreted unchanged in the urine
Ciprofloxacin/ Fluoroquinolones
Treatment of respiratory, dermatological, urinary tract, ear, eye, bone, and joint infections
Interferes with DNA replication in susceptible gram negative bacteria
Oral
Varies
4-5 h
T ½ – 3.5-4 h
Headache, dizziness, hypotension, nausea, vomiting, diarrhea, fever, and rash
IV
10 min
4-5 h
Metabolized in the liver,
excreted in bile and urine
Erythromycin/ Macrolides
Treatment of respiratory, dermatological, urinary tract, and GI infections
Binds to cell membrane causing change in protein function and cell death
Oral
1-2 h
1-4 h
T ½ – 3-5 h
Abdominal cramping, vomiting, diarrhea, rash, superinfections, liver toxicity, potential for hearing loss
IV
Rapid
1h
Metabolized in the liver,
CONTINUED ON NEXT SLIDE
excreted in bile and urine
Treatment of serious infections caused by susceptible strains of bacteria
Inhibits protein synthesis in susceptible bacteria
Paul Ehrlich worked on developing a synthetic chemical effective against infection-causing cells only
Scientists discovered penicillin in a mold sample
1935
The sulfonamides were introduced
Mechanisms of Action
Interfere with biosynthesis of the bacterial cell wall
Prevent the cells of the invading organism from using substances essential to their growth and development
Interfere with steps involved in protein synthesis
Interfere with DNA synthesis
Alter the permeability of the cell membrane to allow essential cellular components to leak out
Mechanism of Anti-infective Agents
Mechanism of Anti infective Agents
Anti-infective Activity
Anti-infectives vary in their effectiveness against invading organisms
Some are selective: they are effective only for a small number of organisms
Bactericidal: kill the cell
Bacteriostatic: prevent reproduction of the cell
Narrow Spectrum vs Broad Spectrum
Narrow spectrum of activity
Effective against only a few microorganisms with a very specific metabolic pathway or enzyme
Broad spectrum of activity
Useful in treating a wide variety of infections
Human Immune Response
Goal of anti-infective therapy is reduction of the population of the invading organism
Drugs that eliminate all traces of any invading pathogen might be toxic to the host as well
Immune response is a complex process involving chemical mediators, leukocytes, lymphocytes, antibodies, and locally released enzymes and chemicals
Problems With Treating Infections in Immunosuppressed Patients
Anti-infective drugs cannot totally eliminate the pathogen without causing severe toxicity in the host
These patients do not have the immune response in place to deal with even a few invading organisms
Resistance
Anti-infectives act on a specific enzyme system or biological process; many microorganisms that do not act on a specific system are not affected by the particular drug
This is considered natural or intrinsic resistance to that drug
Acquired Resistance
Microorganisms that were once sensitive to the particular drug have begun to develop acquired resistance
This results in serious clinical problems
Ways Resistance Develops
Producing an enzyme that deactivates the antimicrobial drug
Changing cellular permeability to prevent the drug from entering the cell
Altering transport systems to exclude the drug from active transport into the cell
Altering binding sites on the membranes or ribosomes, which then no longer accept the drug
Producing a chemical that acts as an antagonist to the drug
Preventing Resistance
Limit the use of antimicrobial agents to the treatment of specific pathogens sensitive to the drug being used
Make sure doses are high enough, and the duration of drug therapy long enough
Be cautious about the indiscriminate use of anti-infectives
Identification of the Pathogen
Identification of the infecting pathogen is done by culture
A culture of a tissue sample from the infected area is done
A swab of infected tissue is allowed to grow on an agar plate
Staining techniques and microscopic examination identify the bacterium
Stool can be examined for ova and parasites
Sensitivity of Pathogen
Shows which drugs are capable of controlling the particular microorganism
Important to be done for microorganisms that have known resistant strains
Along with a culture, identifies the pathogen and appropriate drug for treatment
