Pathophysiological mechanism of disease
a). Stress Adaptation, Stressors, Management and Nursing Management. (Stress Adaptation Stressors, Management, and Nursing Management).
Stress arises due to physical, chemical and emotional factors. Due to this, physical and mental restlessness is seen.
Stress arises when the individual cannot adequately cope with the demands. A stressful event occurs when a person perceives it as a stressor.
Common Sources of Stress. (Common Source of Stress)
Sensory Input
When stress arises due to pain, bright light, noise, temperature, any environmental factors like lack of control over some environmental circumstances like food, air, water quality, housing, health, freedom, mobility etc.
Social Factors (Social Factors).
Stress can be seen due to social factors like breakup, relationship conflict, any social defect, birth, death, divorce, marriage etc.
Various Life Experience.
Life experiences such as poverty, unemployment, clinical depression, OCD (mental illness), heavy drinking, insufficient sleep, exams etc. cause stress.
Other Factors (Other Factors).
Allergies, menstrual disorders, thyroid disorders, adrenal hypo function etc. cause stress.
Physiological Response Of body to Stress (Physiological response of body to stress).
Reproductive System (Reproductive System).
Infertility, premature ejaculation, impotence (unable to perform sexual activity due to physical and mental causes) etc. are seen in the reproductive system due to stress.
Skin.
Eczema, psoriasis, dermatitis, rashes etc. are seen on the skin due to stress.
Central Nervous System (Central Nervous System).
Stress affects the central nervous system. Because of this, problems like poor concentration, memory problem, sleep disturbance, and not being capable of taking decisions, migraine, headache, anxiety, depression etc. are seen.
Cardio Vascular System.
Due to stress, hypertension, atherosclerosis, tachycardia, palpitation etc. are seen in the vascular system.
Respiratory System (Respiratory System).
Asthma, breathlessness, etc. are seen in the respiratory system due to stress.
Digestive System (Digestive System).
Stomach upset, ulcer, diarrhea, gastritis, irritable bowel syndrome, colon cancer, shore in mouth etc. are seen in the digestive system.
Masculo Skeletal System (Musculo Skeletal System).
In which tension is seen in muscles and joints. Symptoms such as backache, multiple sclerosis, body pain, etc. are seen.
Endocrine System (Endocrine System).
Muscular pain is seen in the endocrine system due to stress. Degenerative diseases such as rheumatoid arthritis are seen. Apart from this, due to long-term hormonal disturbances, diabetes and thyroid related disorders can also be seen.
Immune System (Immune System).
Due to stress, immunity in the immune system decreases and the resistance against any infection decreases. There is a possibility of getting any type of infection.
Body response during stress has been shown in three stages by Doctor Hans. It is called General Adaptation Syndrome. These stages are as follows.
(1) Alarm Stage.
Fight or flight reaction is present in this stage. The body reacts to stress by physically releasing adrenaline and other hormones. Other physical responses such as butterflies in the stomach, elevation of blood pressure, dilation of the pupil in the eye, dry mouth, difficulty in concentration etc. are body responses which are temporary.
All the above symptoms are found in the early alarm stage of any stressful situation.
. Resistance or Adaptation Stage (Resistance or Adaptation Stage).
Resistance is the second stage. If stressors are continuous, coping with stress is necessary. The body tries to cope with the demands and stress of that environment, but if the body cannot cope, there is a decrease in resistance substances. Due to which the immune system is compromised. So the susceptibility to illness increases.
Some days the body provides it for resistance and adaptation to stress. Meanwhile, if the body can cope with the stress, then the stress is minimized and adjustment occurs, but if the stressors continue, the body cannot resist for a long time and the next stage is seen.
(3) Exhaustion Stage.
Exosan is the final stage. In this stage the resistance factor of the body decreases. Due to which the body becomes unable to perform its normal function. Initially autonomic nervous system symptoms such as sweating, increased heart rate are seen. If this stage is extended, it causes long-term damage so that the immune system of the body is weakened and the function of the body is impeded. So biological and psychological diseases are seen.
Measures for Stress Adaptation (Stress Adaptation Measures).
Constructive
In Constructive Major the person takes the challenge to resolve it.
Destructive
In which a person uses alcohol and drugs to relieve stress
Stress can be relieved by solving problems through psychological behavioral coping mechanisms such as problem solving techniques.
Management can be done according to 4 A’s to deal with stressful situations viz
Avoid the stressors (including avoiding stressful events)
Adaptation to the Stressors
Alter the stressors (which can be modified in other directions)
Accept the Stressors
Healthy ways for stress management
Walking every day
Spending time with nature
Communicating with a good friend to relieve stress and feel good
Exercising daily
Relieving stress by writing in your journal book.
Take a long bath
Use light or candle so that good feeling comes
Avoid alcohol, cigarettes and drugs
If needed, take a warm cup of coffee or tea
Play with pets or small children to refresh the mind
Reading a good book
Listening to music
Watching comedy in free time
Eat a healthy diet
Do deep breathing exercises
Do meditation
Stress can be relieved through a family support system.
Nursing Intervention in Stress
Discussing the person’s problem
Identifying the cause of the problem and treating it If it is not treatable, teaching how to cope
Provide psychological support
Do not give false reassurances
Clarifying about fantasy and fact
Linking to community resources
Helping to reestablish the network
Treat it psycho pharmacologically
If the person is overworking, ask him to take an in-between work break
Getting enough sleep after work
Have a good diet
Do deep bridging exercises
Helping a Stressful Person Find a Good Friend
A peaceful place to go for a walk when the person is free
Asking the person to work with good environment
Solving the problem through problem solving method
How to spend time with family and friends
Preventing alcohol and drug addiction.
Definition (Definition).
The local response given by the living cells due to injury of the body caused by any agent (microorganism) is called inflammation.
Inflammation is the body’s response to an ingested antigen.
Due to the inflammation process, mal function is seen in the immune system of the body.
Inflammation is a process in which the body’s white blood cells and chemicals protect the body from foreign substances or infectious agents.
which is a protective reaction of localized tissue causing localized pain, redness, swelling and sometimes loss of function
Tissues damaged by injury stimulate the entire process of inflammation. Which is a local response given by the skin and other tissues. Due to which redness, heat, swelling are seen. Due to increased blood supply, it is also seen as aria hot.
All these elements are caused by the activity of immune cells
Types of Inflammation (Type of Inflammation).
Acute Inflammation (Acute Inflammation).
Acute inflammation is characterized by rapid onset. In which local vascular and exudative changes are seen. Its duration is less than two weeks. An immediate response is seen in acute inflammation. When the injurious agent (microorganism) is removed, inflammation subsides and healing begins with return to normal function. Finally the structure is normalized.
Chronic Inflammation (Chronic Inflammation).
Chronic inflammation occurs when the agent causes continuous injury. It has long duration of symptoms. Which is up to month or year.
In chronic inflammation, proliferative changes are seen at the injury site. This cycle results in cellular infiltration, necrosis and fibrosis leading to permanent tissue damage.
Sub Acute Inflammation (Sub Acute Inflammation).
Sub acute inflammation is between acute inflammation and chronic inflammation. In which the element is activated as in the acute phase and repair occurs as in the chronic phase.
Etiology.
Exogenous factors
(1) Physical factors
A mechanical agent
In which inflammation occurs due to fracture, foreign substance
Thermal agent
Inflammation occurs due to burns, freezing
Chemical agent
Inflammation is caused by chemicals like toxic gases, acid bases, drugs and venoms.
(2) Biological factors
Bacteria
virus
Parasites and fungi cause inflammation
Endogenous factors.
Circulation Dis Order
Thrombosis
Infarction
Hemorrhage
All the above causes inflammation.
Process of Inflammation (Process of Inflammation).
Vasodilatation
When any part of the body gets injured, due to the chemical reaction, the small artery located there dilates and the blood supply to it increases.
Vascular permeability
Blood flow to that area is increased due to which vasoactive substances increase the permeability of those arterioles.
exudation
Fluid, red blood cells, white blood cells accumulate in the injured area. Due to which swelling is seen. which compresses the nerve receptors. Due to which pain is seen. Due to which extra vascular osmotic pressure increases.
Vascular stasis
Due to vasodilatation, increased balus supply leads to fluid accumulation. which collect chemical mediators and inflammatory cells and respond to stimuli.
Stages of the Inflammatory Reaction (Stages of the Inflammatory Reaction).
Inflammatory reaction is a combination of many reactions given by the body. It has the following reactions.
(1) Tissue injury
Tissue injury occurs due to pathogens, trauma or impact, fall, during cutting etc.
(2) Release of chemical
When tissue cells are injured, certain chemicals initiate that inflammatory response. Tissue injury causes the release of several chemical mediators such as histamine, bradykinin, prostaglandin, lymphokinase that activate the inflammatory process. This chemical collects causing vasodilation and increased capillary permeability.
Due to which blood flow increases towards the injury site. which acts as a chemical messenger and attracts other natural defense cells of the body called chemotaxis.
Redness and warmth are seen due to increased blood flow towards the injured side. Leakage of plasma is observed along with increased capillary permeability. This causes non-pitting edema (swelling) due to the collection of fluid outside the capillaries.
(3) Leukocyte migration
Leukocytes migrate to the area of damage due to chemotaxis. which infiltrates the damaged tissue and engulfs the bacteria.
There are two types of leukocytes that respond to the inflammatory process.
Macrophages
Neutrophils
Neutrophils arrive at the site of injury and act to neutralize harmful bacteria.
Macrophages fasten the healing process by engulfing those bacteria and dead cells.
which arrives within 72 hours of injury and persists for weeks after injury.
Destroyed cells are replaced with identical and simular structure and function. Promotes tissue healing and the formation of fibrous tissue that reduces the tissue’s capacity to function.
Tissue Healing.
Healing is the body’s response to injury that restores normal function and structure. Healing happens in two ways.
regeneration
Repair
Regeneration
Proliferation of parenchymal cells occurs due to which the original tissue is completely restored.
Some parenchymal cells have a short life span while other cells have a long life span. Which keeps the structure of the tissue properly maintained.
The growth factor helps in the regeneration of that tissue
Which includes the following growth factors
Epidermal growth factor
Fiber Blast Growth Factor
Platelet derived growth factor
Endothelium growth factor
Transforming growth factor
The period between two successive cell divisions is called the cell cycle. Which is divided into four equal parts
There are three types of cells in the body
(1) Liable sale
This cell undergoes continuous multiplication under normal physiological conditions. Cell division starts in them during the thru out life.
Epidermis cells, hematopoietic cells of bone marrow, cells of lymph nodes etc. have such characteristics.
(2) Stable cell
These cells lose their ability to proliferate after adolescence but have the capacity to multiply in adult life in response to stimuli. These types of cells are found in liver, pancreas, kidney.
(3) Permanent sale
This cell only proliferates at birth. Nervous system, skeletal muscle, muscles contain these types of cells. Regeneration takes place in this cell to a minimum extent. So these cells do not have the characteristics of multiplying.
Repair
Connective tissue is eliminated in the repair, leading to fibrosis and scarring. In which four phases are seen.
Collegiation
The healing process takes place at the end of the inflammatory process. Macrophages clear damaged tissue, and provide space for new tissue to regenerate. Fibroblasts produce a collagen matrix, which acts as the frame work of a new tissue cell.
Angiogenesis
Due to the cleansing of the damaged tissue in the damaged area, new capillaries are formed there. This is called angiogenesis or revascularization. Reintroduced blood vessels cause cell growth.
Proliferation
This phase is over four wicks. When the injury is more severe, there is a mixture between specific tissue like muscle tissue and other tissue called granulation tissue. This stage of remodeling involves the remodeling of new tissue which is converted to function. The process of remodeling takes months and even years.
Systemic and Local Signs of Inflammation
Redness _ Due to vasodilatation, the blood pooled there due to which redness is observed.
Warm _ Vasodilatation increases the blood flow due to which the local area is warm.
Edema (swelling). Edema occurs due to the entry of leukocytes and fluid into the circulatory system. Swelling is also seen due to increased blood supply to the site of inflammation and limited venous return from that site.
Purulent exudate
Pain. _ Due to compression on its nerve endings due to swelling in the local area.
Loss of function
Fever
Wickness
Increase respiration
Increase pulse
Increase in WBC count
Treatment of Inflammation (Treatment of Inflammation).
Inflammation is the body’s short-term or long-term response to a stimulus. Treatment is necessary to minimize the changes and discomfort that develop in the body during this response. Following are the treatments given during inflammation.
Non-Steroidal Anti-Inflammatory Drug (NSAID)
This drug inhibits the production of prostaglandin from that cell
Medicines like paracetamol, ibuprofen etc. can be given.
Corticosteroids
Steroids block the formation of prostaglandins and inhibit the function of white blood cells that play an important role in the inflammatory process. It also suppresses the body’s temporary immunity so as to minimize the body’s resistance.
Antihistamine
Histamine is a chemical. Which is produced by WBC and connective tissue cells. such as basophils and mast cells that secrete histamine in an allergic response. Antihistamines can relieve symptoms of local inflammation and block the production of basophils and mast cells.
Hot and cold therapy
Cold therapy causes narrowing of the blood vessels, which inhibits inflammation and numbs the area, reducing pain.
Hot application increases the symptoms of inflammation but it helps if there are spasms or cramps in the muscles.
assessment
Asking the client about risk factors, nutrition, medicine use, location, duration, redness, pain, swallowing.
To check the movement and circulation of the injured part and to check whether there is any discharge or not.
Nursing Management
Pain
To know the level of pain by using pain scale
Comfort majors such as back rubs, providing a comfortable position and engaging in mind diversional activities.
Administering analgesic and anti-inflammatory drugs as per doctor’s order.
Anchoring for a rest.
Giving hot and cold application to relieve pain.
Elevate the inflamed part if possible.
Tissue integrity
Providing nutritional food for the healing process
Check the circulation in the affected part and the skin of the surrounding area.
Use sterile water or normal saline to clean the inflamed part.
Clean and dry the inflamed area. Keep it open to air for better healing.
Prevent infection
Check the wound for signs of infection like oozing, slow healing, bad smell etc. If pus is found, send it for culture.
Checking vital signs like temperature, pulse, BP, respiration
Do a WBC count test and do a complete blood examination.
Give fluids and give nutritional diet
If there is a wound then dressing with aseptic technique.
Hand washing before touching the inflamed area and hand washing after touching
Giving foods rich in vitamin C speeds up the healing process.
Florence Nightingale understood the importance of nutrition.
The nurse has an important role in feeding the patient.
Nutrition plays an important role in the control of some diseases like diabetes, hypertension, inflammatory bowel disease.
Nutrition is required for the function of the body. The body gets energy from carbohydrates, proteins, vitamins, minerals, fats.
Water works as a solvent in those metabolic processes.
Vitamins and minerals are essential for metabolic processes that maintain acid-base balance and do not provide energy to the body.
The body needs energy in the form of kilo calories from the ingested food.
If one consumes more kilo calories than the energy demand then weight is gained and if one consumes less kilo calories than the energy demand then weight is lost.
Pregnancy, illness, lactation, and activity levels affect the body’s metabolic processes.
Nitrogen balance is an important factor that affects the health and growth of the body.
Nitrogen balance is maintained when nitrogen intake and output are equal. If nitrogen intake exceeds output, a positive nitrogen balance is produced in the body. Positive balance is required for body growth, normal pregnancy, maintenance of body mass, vital organs and wood healing. Stored nutrition is used in body building, repair and tissue replacement.
A negative nitrogen balance occurs if the body loses too much nitrogen. Which is seen when there is infection, sepsis, buns buns, fever, starvation, head injury and trauma.
If the loss of nitrogen in the body increases, it causes tissue destruction and the level of nitrogen in the body fluid decreases.
This shows how much nutrition is required in the body.
Protein has an essential role in growth and repair of the body.
So every person should take the required calories and balance diet to maintain the body.
Factors Affecting Nutrition
Religion, culture, background, age, economic status, life style, biological factors, personal preferences like their interest, food habit, physical status, availability of food, psychological factors, environment factors etc. affect nutrition.
The nurse has an important role in maintaining the nutritional level of the patient and plays a part in maintaining the body’s functions.
Supplies energy to the body through food. It is required for performing various functions of the body. Dietary management has an important role as we can provide all the nutritional supply of the body through an effective dietary plant. For the health and well-being of the body, it also prevents various diseases.
Defense against Injury.
There are many defense mechanisms in the human body that prevent infection and disease.
Non-specific defense mechanism It defends against a wide range of pathogens.
While specific defense mechanism it defends only against some particular pathogen.
Non-specific defense mechanism
In a non-specific mechanism
Anatomical barrier
Anatomical barriers include nasal opening to respiratory system, skull and vertebral column, skin which is the major anatomical barrier. Which prevents the micro organism from entering the body. Mucous membrane also secretes mucus that fights against micro-organisms.
Physiological barrier
As a physiological barrier, tears continuously flush the eye, vaginal secretions are acidic, preventing bacteria from passing through.
The hostile environment in the stomach inhibits the growth of many pathogens.
Tears, saliva, and nasal secretions from the eyes, mouth, and nose contain enzymes called lysozymes that break down bacterial cells. Also, blood, sweat, and some tissue fluids contain lysozyme. which acts as a physiological barrier.
Blood that contains white blood cells. It contains several types of phagocytic cells that detect bacteria and viruses, track them down, digest and kill them, and also protect against infected host cells and other debris.
Inflammatory response is a non-specific defense mechanism to prevent infection from spreading in the body. Inflammation that causes swelling, redness, elevated body temperature, and pain. Repeated inflammation causes tissue damage and in severe cases can lead to death.
Normal flora is that protective layer. Located in the skin, mouth, gastrointestinal tract, and other body areas where the microorganism is present. which protects against pathogens if the normal flora is disturbed, the agent will have an opportunity to grow and cause disease.
Specific Defense Mechanisms
When non-specific mechanisms fail, the body initiates another specific defense mechanism.
A specific immune response that destroys target pathogens and infected cells.
That response depends on WBC of special type, which includes lymphocytes, T cells, B cells.
T cells mature in the thymus gland. Produced by lymphocytes.
B cell bone marrow matures and is produced by lymphocytes.
Specific immuno responses are cell mediated response and antibody mediated response.
Cell mediated responses include T cells. It directly destroys body cells that are cancerous or infected and activates other immune cells.
The antibody mediated response includes T cells, B cells that disturb the entered pathogen and eliminate the toxin.
Macrophages engulf the pathogen and elicit cell mediated and antibody mediated responses.
Immunity
When the host encounters that antigen, it triggers a specific immune response so that the second the pathogen enters the body, memory lymphoside recognizes it and produces lipokinase and antibodies.
By making a second encounter quickly and by giving an immune response, the pathogen does not get enough time to reproduce, so that we can stop it before the disease occurs in the body. A memory response can also be produced by vaccination that prevents disease from occurring in the first place.
Vaccination
Vaccines are either killed or attenuated. The content of the pathogen in the solution is relative to the particular pathogen. The body responds to the antigen in the vaccine but the antigen is not capable enough to cause disease. Specific diseases can be prevented by giving vaccines.
Inflammation
When an injury occurs, the micro organism enters the body, causing inflammation in the affected area.
Many conditions can cause inflammation. Inflammation is a body’s defense against an antigen.
Inflammation causes tissue damage. An increase in body temperature is a protective response against injury. Which is a defense mechanism. This causes discomfort.
Thus the above mechanism helps to protect the body as a defense mechanism.