Natural History of Disease

Referred to the course of the disease over time, unaffected by treatment. DISEASE IS AN EVOLVING PROCESS Stages 1. Stage of Susceptibility 2. Stage of Pre-Symptomatic Disease 3. Stage of Clinical Disease 4. Stage of Disability

- Disease has not developed -Risk factors promote development (poor diet, lack of exercise, stress, high cholestorol level,etc.)

Factors that will favor the disease's development Two types: Modifiable and Non-modifiable

Changeable factors Lifestyle: Centenarians (exercise, diet rich in fruits and vegetables, friends, purpose in life) Obesity: Weight Smoking: lung cancer: 2nd most common cancer

Factors that cannot be changed Premature babies: at risk for mental retardation disability, chronic lung disease and learning disabilities Age and genetics: Heart disease, Parkinson's disease, Alzheimer's disease Race: -Black Americans have higher incidence for HTN, diabetes and coronary heart disease: risk for stroke -Mexicans have high incidence of diabetes (higher mortality) -Native Americans have higher incidence of alcoholism, lower incidence of heart disease Genetics

- No manifestations (clinical signs and symptoms) of the disease -Pathological changes have started to occur Examples: -High Cholesterol: plaque formation -High Stress Level: develop pre-hypertension -Pre-cancerous mole: atypical cells -Pre-diabetes: chronic elevation of blood glucose levels

-Organ changes have occured (now there are recognizeable signs and symptoms of the disease) -Subdivided into 3 stages (Morphological, Functional or Therapeutic)

Involves the CELLULAR level -Most often used with CANCER -Measures extent of disease (Ex: tumor staging) -Allows for prognosis Tumors placed into categories Localized Regional Metastasis Metastasis

1 single lymph node or organ is involved

Group of lymph nodes near organ on SAME SIDE of diaphragm

Involves BOTH SIDES of diaphragm

Involves the stages or types of disease -Based on extent of disease Examples -Types of Diabetes (Insulin vs Non-Insulin dependent) -Stages of Alzheimers (7 stages) -Stages of Hypertension

Involves the TREATMENT -Based on restrictions Examples -Heart disease (Restriction of activity, dietary restrictions) -Diabetes (Dietary or caloric restriction)

Is for epidemiologic studies in research Reduces variability in -evaluation of the effect of treatments -clinical trials -management of clients

Any temporary or long term reduction of a person's activities, including his psychosocial role as parent, wage earner and member of his community Emphasis is on LOSS OF FUNCTION, not the structural defect Examples -Diabetes leads to blindness, amputation, renal failure or cardiac disease -Hypertension leads to stroke and paralysis -COPD and heart disease leads to impairment of activity

Leavell and Clark (1965) Disease EVOLVES over time. Pathological changes may or may not become fixed and irreversible. The aim of prevention is to DETECT and INTERVENE at the RISK FACTORS. Basis of all prevention programs

Primay Prevention Secondary Prevention Tertiary Prevention

-Focuses on health promotion and protection -Occurs in the stage of SUSCEPTIBILITY

-Identifying a health problem and its intervention -Occurs in the stage of PRE-CLINICAL and CLINICAL

-Focuses on restoration and rehabilitation -Occurs in the stage of DISABILITY

Health Promotion -AVOIDANCE of disease -Motivated by personal approach to wellness -WELLNESS focused Protection against specific health problems -Behaviors to actively avoid illness (immunizations, taking vitamins, handwashing) -Health promotion programs (exercise programs, nutrition programs, fire safety, D.A.R.E program)

-Early identification of health problems (Goal -> identify people in early stages of disease and limit disability -Interventions to alleviate health problems (ex: screenings, physical exam, dental checks, assessment of growth and development) Examples: -Annual pap smear -Mammogram -Self-breast exam -Self-testicular exam -Falls risk -ROM -Turn patients Q 2

-Begins after an illness or disability (is fixed and stabalized) -Helps rehabilitate or restore client to optimal level of health within the constraints of the disability Examples: -Physical therapy -Cardiac rehab -Support group after cholestomy -Teaching diabetic how to prevent complications

Pg 133

Needs Theory Developmental Theory Theoretical Frameworks

Maslow (See pg. 134)

-Adapted Maslow's theory (6 Levels) -Included category between physiological and safety needs (STIMULATION NEEDS)

-Describes characteristics of people in a certain group Usefulness in Nursing: -Describes a typical behavior within a certain group -Predicts behavior in a given circumstance -Used in clinical education

Provided framework for national health promotion, health protection and prevention

-Increase quality and years of life -Eliminate health disparities

The presense or abscense of disease

A state of complete physical, mental and social well-being and not merely the abscense of disease and infirmity

State of well-being

Clinical model Role Performance model Adaptive Model Eudemonistic model Agent-host envrironmental model

-PHYSIOLOGICAL aspect of health -absence of signs and symptoms -Disease is narrow model

Ability to fullfil societal's needs

-Disease is a failure in adaptation -Aim of treatment is to restore the ability to adapt

-Based on self-actualization (Maslow's Theory) -Health is seen as self-actualization -Illness prevents actualization (client potential)

-Considers multiple causes of disease -Used to predict illness -Identifies risk factors which result from agent, host and environment

Consists of grids or graduated scales -Used to measure a client's perceived level of health and illness are on opposite ends Dunn's High Level of Wellness Grid (See Pg. 137) Travis' Illness Wellness Continuum (See Pg. 138)