III. Man as a Biological Being

The Nature of Man as a Biologic Being:1. Man as a living organism Man is a living organism who from birth is destined to die. While alive he has to struggle continually with the forces in his environment; some of them friendly, others hostile e.g. music, illness, pollution. In the micro and macro forms of life, man responds to environmental stimuli as a particular unit-be it a solitary cell, a component organism or a member of conglomerate individuals.

SUBORDINATE SYSTEM –refers to the cell, organs and organ system found within the individual. The subordinate system of man is necessary in carrying out daily activities which are vital to survival. Man’s feeling of well-being each day depends on the condition of the various organs of the systems in his body.

SUPERDIATE SYSTEM –refers to the family, community and society which consist of the bigger unit of man. Provides man with the necessary framework of relationships which links him to the family, community and society. Together with others in the family and community, he copes with elements in his environment; his behavior which is greatly influenced by his relationships, therefore as are just as important as the form and function of the different organ systems which comprise the biologic nature of man.

ORGANISMIC BEHAVIOR –based on the two beliefs:1. Man normally responds as a unified whole, not as a series of integrated parts. His mind and body structures conform to the purpose for each part which was made. Since the mind operates in conjunction with the body, what affects one stands alone. e.g the body changes when terrified. 2. Man as a whole is different from and more than the sum of his component parts. Man as a human organism composed of various system is something more than the addition of his part. Given any set of stimuli, he responds as predicted or becomes unpredictable because of other extraneous variables. Example: water composed of hydrogen and oxygen.

Therefore, organismic behavior refers to those observable features and actions that reflect man’s functioning as a unified whole within the environment in which he exists.

2. Man is a system Buckey’s definition of a system: a whole which function as a whole by virtue of the interdependence of its parts. A system may be composed of subsystems. Each is designed to carry out an activity which in turn is necessary for achieving the general purpose of the system.

4. Man has biologic needsa. A need is that which is necessary, useful or desirable to maintain well- being and lifeb. A need is something that is essential to the emotional and physiologic health and survival of

humansc. A need can be met, partially met or unmet.

Characteristics of Basic Human Needs (Kozier, p 274)1. People meet their own needs relative to their own priorities.2. Although basic needs must be met, some needs can be deferred.3. Failure to meet needs results in one or more homeostatic imbalances, which can eventually result

in illness.4. A need can make itself felt by either external or internal stimuli. 5. A person who perceives a need can respond in several ways to meet it. 6. Needs are interrelated.

Maslow’s Heirarchy of Needs (Kozier p. 273)Abraham Maslow’s (1968) framework of basic needs is based on the theory that something is a basic need if:

● its absence results in illness● its presence signals health● once met restores health● it is preferred over other satisfactions when met● one feels something is missing if need is unmet● one feels satisfaction when need is met

Maslow arranges basic human health needs in a hierarchy, in which certain needs are more basic than others. Although all the needs are present, the individual strives to meet certain needs at least to a minimal level before attending to the others.

1. PHYSIOLOGIC NEEDS Such as air, food, water, shelter, rest, sleep, activity, and temperature maintenance are crucial for

survival.

A. Oxygen( Kozier p. 1357) – is the most essential of all the basic needs because all body cellsrequire oxygen for survival. Oxygenation of the body cells is carried out primarily by the respiratory and cardiovascular systems.- comprises 21% of the athmosphere, (78% nitrogen and 1% as combination of other gases)

RESPIRATION – the act of breathing includes the exchange of oxygen (intake) and carbon dioxide (output) exchange of gases, oxygen and carbon dioxide between an organism and its environment

Inhalation/Inspiration -intake of air into the lungsExhalation/Expiration – breathing out or the movement of gases from the lungs to the atmosphereVentilation – refer to the movement of air in and out of the lungs.External respiration – refers to the interchange of oxygen and carbon dioxide between the alveoli of the lungs and the pulmonary blood. Internal respiration –takes place throughout the body. It is the interchange of these same gases between the circulating blood and the cells of the body tissues.

3 Components of Respiration

1. Pulmonary ventilation or breathing - the movement of air between the atmosphere and the alveoli of the lungs as we inhale and exhale.

2. Gas exchange - involves diffusion of oxygen between the alveoli and the pulmonary capillaries.

3. Transport of oxygen from lungs to tissues and carbon dioxide from tissues to lungs.

Two types of breathing:1. Costal (thoracic) breathing – involves the external intercostals muscles and other accessory

muscles (sternocleidomastoid). It can be observed by the movement of the chest upward and outward.

2. Diaphragmatic (abdominal) breathing – involves the contraction and relaxation of the diaphragm, and is observed by the movement of the abdomen, which occurs as a result of the diaphragm’s contraction and downward movement.

*The body’s respiratory center is actually a number of groups of neurons located in the medulla oblongata and pons of the brain.

Factors affecting Respirations: (Kozier, p. 548)

1. Age - (See Kozier, page 1362 for normal respiratory rates)

2. Environment - Attitude, heat, cold and air pollution affect oxygenation. -People at high altitudes have increased respiration and cardiac rates and increases respiratory depth. -Increased environmental temperature increases respiration while decreased environmental temperature decreases respiration. -People, esp. those with lung diseases may experience varying degrees of respiratory difficulty in a polluted environment.

3. Lifestyle – Physical activity and exercise increase rate and depth of respirations as well as certain occupations which can predispose an individual to lung disease/s.

4. Health status – Diseases of respiratory system can adversely affect oxygenation of the blood.

5. Medications – Sedative-hypnotics, anti-anxiety drugs and narcotics can decrease the rate and depth of respirations.

6. Stress – readies the body for “fight or flight.” Some people hyperventilate (Rate and depth of respirations increase and more carbon dioxide is eliminated than is produced) inresponse to stress.

Assessing RespirationsBreathing patterns

- refer to the rate, volume, rhythm and relative ease and effort of respiration. - Normal respiration is quiet, rhythmic and effortless (Eupnea).

1. Respiratory Rate (refer to Kozier, table 29-2, p. 538)Eupnea – breathing that is normal in rate and depthBradypnea – abnormally slow respirationsTachypnea/ Polypnea – abnormally fast respirations.Apnea – is the absence of breathing.

2. Depth – can be established by watching the movement of the chest.1. Deep – large volume of air is inhaled and exhaled, inflating most of the lungs.2. Shallow – involves the exchange of a small volume of air and often minimal use of lung

tissue (An adult takes in about 500 ml of air during a normal inspiration and expiration, Tidal Volume).

3. Respiratory rhythm – refers to the regularity of the expirations and the inspirations. It can either be described as regular or irregular.

3. Regular – evenly spaced breathing4. Irregular

4. Respiratory character/quality – refers to those aspects of breathing that are different from normal, effortless breathing. Two of these aspects are the amount of effort a client must exert to breathe and the sound of breathing. Labored breathing are seen in clients who can breathe only with substantial effort. Sound of breathing is also significant. Normal breathing is silent.

Measures to Promote Respiratory Functions (Kozier, p.1368)1. deep breathing and coughing2. hydration3. medication4. percussion, vibration and postural drainage5. oxygen therapy

Altered Breathing Patterns and Respiratory sounds *refer to Kozier, box 29-5 p. 549

B. Water — total body water is 50% to 60% of body weight.— the primary body fluid vital to health and normal cellular function.— Total body water is approximately 60% of the average healthy adult’s weight.

Functions of Water in the Body

1. a medium for metabolic reactions within cells.2. a transporter of nutrients, waste products and other substances.3. a lubricant4. an insulator and shock absorber.5. a means of regulating and maintaining body temperature.

Two Compartments of Fluids in the Body 1. Intracellular Fluid (ICF) – fluid within the cells of the body, constitutes approximately

two-thirds of the total body fluid in adults.- fluid within cells (70%)- vital to normal cell functioning because it contains solutes (oxygen, electrolytes and glucose) and provides a medium in which metabolic processes of the cell take place.

2. Extracellular fluid (ECF) - fluid outside the cells, accounts for one-third of the total body fluid. - fluid outside cells (30%); Includes intravascular and interstitial fluids

- the transport system that carries nutrients to and waste products form the cells:

1. Intravascular fluid/plasma – found within the vascular system, 20% of ECF2. Interstitial fluid – surrounds the cells, 75% of the ECF3. Lymph and Transcellular fluid (include cerebrospinal, pericardial, pancreatic, pleural, intra-

ocular, biliary, peritoneal and synovial fluids).

* Extracellular and intracellular fluids contain oxygen from the lungs, dissolved nutrients from the gastrointestinal tract, excretory products of metabolism such as carbon dioxide and charged particles called ions.

* The composition of intracellular fluid differs significantly from that of the ECF.e.g. ICF - K+, Mg, PO4, ECF – Na, Ca, Cl

* Maintaining a balance of fluid volumes and electrolyte compositions in the fluid compartments of the body is essential to health. Normal and unusual fluid losses must be maintained if homeostasis is to be maintained.

e.g. fluid intake – average adult drinks 1,500 ml per day fluid output – 1,400-1,500 ml/day (See pp. 1428-1429 for average daily fluid intake and fluid output for adults)

* To maintain a state of homeostasis, body fluids and electrolytes move through different mechanisms of osmosis, diffusion, filtration and active transport (See pp. 1426-1428). Factors Affecting Body Fluids and Electrolytes Balance 1. Age - Infants and children have much greater fluid turnover than adults because

their higher metabolic rate increases fluid loss.-The normal aging process in the elderly may affect fluid balance and increases their likelihood of dehydration.

2. Gender and Body Size – Since fat cells contain little or no water, and lean tissue has a higher water content, people with a higher percentage of body fat have less body fluid.

3. Environmental Temperature - People with illness and those participating in strenuous activities (athletes and laborers) are at risk for fluid and electrolyte imbalances when the environmental temperature is high.

4. Lifestyle – Diet, exercise and stress affect fluid and electrolyte balance.- People with anorexia nervosa or bulimia are at risk for severe fluid and electrolyteimbalances because of the inadequate intake or purging regimens (e.g. inducedvomiting). Severely malnourished people may develop edema because the osmotic draw of fluid into the vascular compartment is reduced.- Regular weight-bearing physical exercise has a beneficial effect on calcium balance and can even prevent osteoporosis later in life.– Stress increases cellular metabolism, blood glucose concentration and even increases the

production of ADH which in turn, increases urine production.

Fluid Imbalances

1. Fluid volume deficit (FVD) – occurs when the body loses both water and electrolytes from the ECF in similar proportions. Fluid is initially lost from the intravascular compartment (e.g. through bleeding, decreased intake of fluids)

- often called Hypovolemia

* Third Space Syndrome – fluid shifts from the vascular space into an area (e.g. in the bowel, in the interstitial space as edema, in inflamed tissue or in potential spaces like the pleural cavities) where it is not readily accessible as extracellular fluid.

2. Fluid volume excess (FVE) – occurs when the body retains both water and sodium in similar proportions to normal ECF (Both intravascular and interstitial spaces have an increased water and sodium content).- commonly referred to as Hypervolemia (increased blood volume).- always secondary to an increase in the total body sodium content, which leads to an increase in total body water (e.g. in heart failure, renal failure)

* Edema – excess interstitial fluid (FVE increases capillary hydrostatic pressure, pushing the fluid into the interstitial tissues)

a. Dependent edema - typically most apparent in areas where the tissue pressure is low (around the eyes), and in the dependent tissues where hydrostatic capillary pressure is high (feet, ankles, sacrum).

b. Pitting edema – is edema that leaves a small depression or pit after finger pressure is applied to the swollen area, which is caused by movement of fluid to adjacent tissue, away from the point of pressure.

3. Dehydration (Hyperosmolar imbalance) – occurs when water is lost from the body leaving the client with excess sodium. Water is drawn into the vascular compartment from the interstitial space and cells, and results in cellular dehydration (common in older adults).

4. Overhydration (Hypo-osmolar imbalance/Water excess) – occurs when water is gained in excess of electrolytes. Water is drawn into the cells, causing them to swell.

Average Daily Fluid Intake for an Adult (Kozier Table 52-1, p.1428)

C. Food (Kozier p. 1232)Nutrients –are the organic and inorganic substances found in foods and required for body functioning. People require the essential nutrients in food for the growth and maintenance of all body tissues and normal functioning of all body processes. Nutrition –is the sum of all interactions between an organism and the food it consumes. In other words, nutrition is what a person eats and how the body uses it. Calorie –is a unit of heat energyDiet – is a combination of related behaviors, which are often culture specific. (PHN, p.200)

Essential Nutrients1) Macronutrients

a. Carbohydrates1. Sugars2. Starches3. Fibers

b. Fats/Lipidsc. Protein

2) Micronutrientsa. Vitamins

Water-Soluble Vitamins1. Vitamin C2. Vitamin B1, B2, B3, B6, B9, B12, Panthotenic acid, Biotin

Fat-soluble Vitamins1. Vitamin A2. Vitamin D3. Vitamin E4. Vitamin K

b. Minerals1. Macrominerals

Daily amounts are over 100 mg. Includes calcium, phosphorus, sodium, potassium, magnesium, chloride, and sulfur.

2. Microminerals. Daily amounts are less than 100 mg. Includes iron, zinc, manganese,

iodine, fluoride, copper, cobalt, chromium, selenium

Note: Show a sample of A Food Pyramid preferably the FILIPINO FOOD PYRAMID

Ideal Body weight (Kozier, p.1236) Is the optimal weight recommended for optimal health.

Rule of 5 for females:100 lb for 5 ft of height+ 5 lb for each inch over 5 ft- 10% for body-frame size (Filipinos)

Rule of 6 for males:106 lb for 5 ft of height+ 6 lb for each inch over 5 ft- 10% for body-frame size (Filipinos)

Kinds of Comprehensive nutritional assessment (PHN, p. 215)1) Direct

BMI (PHN, p. 201) (for adults 10 years old and above)o Correlates closely with total body fat in relation to height and weight. However,

this does not compensate for frame size, does not indicate fat distribution, and cannot be adjusted for age.

o Formula: BMI = weight in kgs / (height in meters)2

Height-for-age/ weight-for-age and weight-for-height measurement (for children below 10 years old) (PHN, p.93) (FNRI)

o Offers the most acceptable parameter and is the simplest way to determine the nutritional status of school children.

Guideline (Based on Asia-Pacific Obesity Guidelines):

BMI INTERPRETATION< 18.5 Underweight18.6 – 22.9 Healthy weight>23.0 Overweight23.0 – 24.9 At risk25.0 – 29.9 Obese I> 30.0 Obese II

Waist Circumferenceo An accurate measure of the amount of visceral fat. (central obesity) o Assessing degree of risk of co-morbid conditions based on BMI and WCo Procedure: Subject should be unclothed at the waist, and standing with abdomen

relaxed, arms are at the sides, feet together. Use nonstretchable tape measure and do not compress the skin.

o Clinical thresholds: Men <90 cm (35 inches)Female <80 cm (31.5 inches)

o Greater than these value is not normal and person is at risk even if BMI is normal.

Degree of Risk Based on Body Mass and Waist Circumference

CLASSIFICATION BMI WAIST CIRCUMFERENCEMEN <90 cmWOMEN <90 cm

MEN > 90 cmWOMEN > 80 cm

Underweight < 18.5 Low but increased risk of other clinical problems

Average

Normal 18.6 – 22.9 Average IncreasedOverweight: > 23 Increased ModerateAt risk 23.0 – 24.9 Moderate SevereObese I 25.0 – 29.9 Severe Very SevereObese II > 30.0

Waist-Hip Ratioo A measurement for upper body obesity. It is obtained by dividing the wasit

circumference at the narrowest ppoint by the hip circumference at the widest point.

o WHR = Waist circumference (cm) Hip circumference (cm)o WHR interpretation:

Less than 1.0 (men); less than 0.85 (women) = normal WHREqual to or greater than 1.0 (men) and 0.85 (women) = android or central obesity

2) Indirect

24 hour/3 days/One week diet recall or diaryo This method involves asking the client the type and specific amount of food eaten

in a specified amount of time (24 hours/3 days/One week).o When asking about a diet recall the following should be ask:

Vegetables – number of servings per day? Usual types of vegetables eaten? Fruits – number of servings od fruits per day? Fat – number of servings of meat and poultry? Which part (e.g. skin of

chicken)? How often fried foods are eaten? How often fast foods/restaurants are visited?

Sodium/Salt – how often preserved, canned and instant foods are eaten per week? How much salt is added when cooking food.

Factors affecting Nutrition (Kozier, page 1237)

1. Development – people in rapid growth (infancy, adolescence, pregnancy) have increased needs for nutrients. Elders on the other hand, need fewer calories and dietary changes in view of risk of coronary heart disease, osteoporosis and hypertension.

2. Gender – the larger muscle mass of men translates into a greater need for calories and proteins. Beacause of menstruation, women require more iron than men do prior to menopause. Pregnant and lactating women have increased caloric and fluid needs.

3. Ethnicity and Culture – Ethnicity determines food preferences. Nurses should not use a “good food, bad food” approach, but should realize that variations of intake are acceptable under different circumstances. The only “universally” accepted guidelines are (a) to eat a wide variety of foods to furnish adequate nutrients and (b) to eat moderately to maintain correct body weight.

4. Beliefs about food – Many people acquire their beliefs about food from television, magazines, and other media. Food fads that involve nontraditional food practices food practices are relatively common.

5. Personal Preferences – people develops like and dislikes based on associations with a typical food. Individual likes and dislikes can also be related to familiarity. Preferences in taste, smell, flavors, temperatures, colors, shapes, and sizes of food influence a person’s food choices. Textures plays a great role in food preferences.

6. Religious practices – Some Roman Catholics avoid meat on certain days, and some Protestant faiths prohibits meat, tea, coffee, or alcohol. Both Orthodox Judaism and Islam prohibit pork. Orthodox Jews observe kosher customs.

7. Lifestyle – Certain lifestyles are linked to food-related behaviors. Busy people buy ready cooked, fast food or restaurant meals. Some people work at different times, such as evening or night shifts. Muscular activity affects metabolic rate more than any other factor; the more strenuous the activity, the greater the stimulation of the metabolism. Mental activity, which requires only 4 Kcal per hour, provides very little metabolic stimulation.

8. Economics – What, how much, and how often a person eats are frequently affected by socioeconomic status. Not all people have the financial resources for extensive food preparation and storage facilities.

9. Medications and Therapy – Drugs may alter appetite, disturb taste perception, or interfere with nutrient absorption or excretion. Some nutrients can decrease drug absorption other enhances absorption. Therapy (chemotherapy and radiation) may also adversely affect eating patterns and nutrition. Oral ulcers, intestinal bleeding or diarrhea can diminish nutritional status. Radiotherapy may cause decreased salivation, taste distortions, and swallowing difficulties, malabsorption, nausea, vomiting, diarrhea, fatigue and anorexia.

10. Health and Illness – any problem with the gastrointestinal system can affect intake, digestion, & absorption of food and nutrients. Illness also causes increase energy requirements because of stress and increased metabolic rate.

11. Alcohol – Alcohol adds additional calories. It can also depresses appetite, decrease absorption of nutrients, and increase nutrient catabolism and excretion.

12. Advertising – it influences people’s food choices and eating patterns 13. Psychologic factors – people many overeat or loss appetite when stressed, depressed, or lonely.

Anorexia nervosa nd bulimia are severe psychophysiologic conditions affecting nutrition of female adolescents.

14. Climate –climate affects heat production. Generally, people in cold climates have about 20% higher metabolic rate than people in hot climates. This fact may be due to adaptation of the thyroid gland (increases thyroxine levels) in people who live in cold climates. 15. Sleep –people need less energy during sleep, when the muscles are relaxed and physiologic processes are slowed.

Nutritional Guidelines for Filipinos (Public Health Nursing in the Philippines, p. 214)1. Eat a variety of foods everyday.2. Breast-feed infants exclusively from birth to 4-6 months, and then, give appropriate foods while

continuing breast-feeding.3. Maintain children’s normal growth through proper diet and monitor their growth regularly.4. Consume fish, lean meat, poultry or dried beans.5. Eat more vegetables, fruits and root crops.

Guideline for adequate vegetable and fruit intake (PHN, p. 201)o Eat 2-3 servings of vegetables each day, one serving of which is green or yellow leafy

vegetables. One serving means:Raw vegetables: 1 cupCooked vegetables: ½ cup

o Eat at least 2 servings of fruit per day, 1 serving is a Vitamin C rich fruit. One serving of fruit depends on type of fruit.

6. Eat foods cooked in edible/cooking oil daily.7. Consume milk, milk products and other calcium-rich foods such as small fish and dark leafy

vegetables everyday.8. Use iodized salt but avoid excessive intake of salty foods.

Excessive salt may cause an elevation in blod volume, increase the sensitivity of cardiovascular or renal mechanics to adrenergic influences, or exerts its effects through some other mechanisms such as the rennin-angiotensin-aldosterone mechanism (PHN, p. 185)

9. Eat clean and safe food. 10. For a healthy lifestyle and good nutrition, exercise regularly, do not smoke, and avoid drinking

alcoholic beverages.

D. Rest and Sleep (Kozier P. 1164)

REST- a period of quiet activity that promotes a sense of feeling refreshed and able to perform.- an altered state of consciousness in which the individual’s perception of and reaction to the

environment are decreased. - is characterized by minimal physical activity, variable levels of consciousness, changes in the body’s physiologic processes, and decreased responsiveness to external stimuli.

– Humans spend about one-third of their lives asleep.

SLEEP- a time of reduced consciousness that restores physical and mental well-being and occurs at periodic intervals.

Functions of Sleep

1. Sleep restores normal levels of activity and normal balance among the parts of the nervous system.2. It is necessary for protein synthesis, which allows repair processes to occur.3. It plays a role in the psychological well-being of the person. Persons with inadequate amounts of sleep tend to become emotionally irritable, have poor concentration and experience difficulty in making decisions.

CONCEPTS/ PRINCIPLES:1. The body requires periods of decreased activity to refresh itself.2. Rest and sleep are more likely to occur under the conditions of reduced stress.3. Periodicity and duration of rest and sleep vary among individuals.4. Quality of sleep is sleep also important to the well-being.

Normal Sleep Requirements (see pp. 1166-1169)* Newborns- sleep 16-18 hrs a day, on an irregular schedule with periods of 1-3 hrs spent awake.* Infants –should get about 14-15 hrs of sleep a day esp. after reaching first year.* Toddlers (1-3 y/o) - 12-14 hrs of sleep is recommended * Preschoolers (3-5 y/o) – 11-13 hrs of sleep* School-age (5-12 y/o) – 10-11 hrs. of sleep* Adolescents (12-18 y/o) – 9-10 hrs of sleep* Adults – 7-9 hrs (However, there is an individual variation as some adults may be able to function well with 6 hrs of sleep and others may need 10 hrs to function optimally). Elders (65-75 y/o)- 7-9 hrs of sleep

Factors affecting sleep (Kozier, p. 1169)

Sleep quality – is a subjective characteristic and is often determined by whether a person wakes up feeling energetic or not.Quantity of sleep – is the total time the individual sleeps.

1. Illness - Illness that causes pain or physical distress (arthritis, back pain) as well as respiratory conditions or shortness of breath can result in sleep problems.

2. Environment- Environment can promote or hinder sleep. Any change like noise, can inhibit sleep as well as discomforts from environmental temperature and lack of ventilation affect the person’s sleep.

3. Lifestyle - Moderate exercise in the morning or early afternoon usually is conducive to sleep, but exercise late in the day can delay sleep. Night shift workers frequently obtain less sleep than other workers and have difficulty falling asleep after getting off work.

4. Emotional Stress - Stress is considered to be the no. one cause of short-term sleeping difficulties. A person preoccupied with personal problems maybe unable to relax sufficiently to get to sleep.

5. Stimulants and Alcohol - People who drink an excessive amount of alcohol often find their sleep disturbed.

6. Diet - Weight gain has been associated with reduced total sleep time as well as broken sleep and earlier awakening. Weight loss, on the other hand, seems to be associated with an increase in total sleep time and less broken sleep.

7. Smoking - Nicotine has a stimulating effect on the body, and smokers often have more difficulty falling asleep than nonsmokers do.

8. Motivation - Motivation can increase alertness in some situations which makes a tired person stay alertat night.

9. Medications - Some medications affect the quality of sleep. Most hypnotics can interfere with deep sleep and suppress REM sleep. Betablockers cause insomnia and nightmares. Narcotics suppress REM sleep and cause frequent awakenings and drowsiness.

Pattern of Sleep*refer to Taylor Table 40-2, p. 1173

Sleep Diary (Kozier, p. 1175)

E. Elimination (Kozier p. 1285 and p. 1323)

Urination/Voiding/Micturition - all refer to the process of emptying the urinary bladder. Urine collects in the bladder until pressure stimulates special sensory nerve endings in the bladder wall (Bladder can hold 250-450 ml of urine).Urine -is the amber colored fluid which is excreted from the kidneys at a rate of about 1500 ml every 24 hours in an adult.

Characteristics of Normal Urine (See p. 1293)*refer to Kozier Table 48-4 p. 1293*normal urine output by age Kozier Table 48-2 p. 1290 *amount per day – 1,200-1,500 ml

*color, clarity – straw, amber, transparent *odor – faint aromatic *sterility – no microorganisms *pH – 4.5 to 8 *specific gravity – 1.010-1.025 *glucose – not present *ketone bodies/acetone – not present *blood – not present

Factors affecting voiding (Kozier, page 1288)

1. Developmental Factors – Urine output varies according to fluid intake but gradually increases to 250-500 ml a day during the first year. Infants are also born without urinary control.-Preschoolers are able to take responsibility for independent toileting.-School-age children’s elimination reaches maturity during this period. Enuresis (involuntary passing of urine when control should be established) can be common for some school-age children.

-Elders – The excretory function of the kidneys diminishes with age, but usuallynot significantly below normal levels unless a disease process intervenes. Nocturnal frequency due to enlarged prostate gland is common among older men.

2. Psychosocial Factors- For some people, a set of conditions like privacy, normal position, sufficient time and occasionally running water, help stimulate their micturition reflex. Anxiety and muscle tension can happen and voiding becomes inhibited if some of these accustomed conditions are not allowed.

3. Fluid and Food Intake – Certain fluids (e.g. alcohol and caffeinated drinks) can increase urine production while some foods can change the color of urine. Other foods high in sodium can cause fluid retention.

4. Medications – Medications affecting the autonomic nervous system interfere with the normal urination process and may cause retention while some can alter the color of urine.

5. Muscle Tone – Good muscle tone is important to maintain the stretch and contractility of the detrusor muscle so the bladder can fill adequately and empty completely.

6. Pathologic Conditions – Diseases of the kidneys may affect the ability of the nephrons to produce urine. Heart and circulatory disorders such as heart failure, shock or hypertension can affect blood flow to the kidneys, interfering with urine production.

7. Surgical and Diagnostic Procedures – The urethra may swell following a cystoscopy while surgery on structures adjacent to urinary tract can also affect voiding because of swelling in the lower abdomen.

Characteristics of Normal Feces (See p. 1325) *color – adult: brown; infant: yellow *consistency – formed, soft, semi-solid, moist *shape – cylindrical (contour of the rectum), about 2.5 cm or 1 inch in diameter (adult) *amount – varies with diet (about 100-400 g per day) *odor – aromatic (affected by ingested food and person’s own bacterial flora) *constituents – small amounts of undigested roughage, sloughed dead bacteria and

epithelial cells, fat, protein, dried constituents of digestive juices (bile pigments, inorganic matter).

Defecation –is the expulsion of feces from anus and rectum. Also called bowel movement. The frequency of defecation is highly individual, several times a day to 2-3 times per week. The amount also varies from person to person.

Stool/Feces – wastes products in or excreted from the large intestine. - normally composed of 75% water and 25% solid materials.

Factors affecting defecation

1. Developmental Factors- Meconium (black, tarry, odorless and sticky stool) is the first fecal material passed by the newborn, normally up to 24 hrs. after birth, followed by transitional stools for about a week. Infants frequently pass soft, liquid stool because the intestine is still immature and water is not well absorbed. Infant feeding practices can also affect the color and consistency of stool.

- Bowel control/toilet training is achieved at 1 ½ to 2 yrs of age. - School-age children and adolescents have bowel habits similar to those of adults where patterns vary in frequency, quantity and consistency. -Elders commonly experience constipation due, in part, to reduced activity levels, inadequate amounts of fluid and fiber intake and muscle weakness.

2. Diet-Sufficient bulk in the diet is necessary to provide fecal volume. Other foods that may influence bowel elimination include: Gas-producing foods- cabbage, onions, cauliflowers, bananas, apples Laxative-producing foods- prunes, chocolate, alcohol Constipation-producing foods- cheese, pasta, eggs, lean meat

3. Fluid-Healthy fecal elimination usually requires a daily fluid intake of 2,000 to 3,000 ml.

4. Activity-Activity stimulates peristalsis, thus facilitating the movement of chime along the colon. Clients with neurologic impairment, immobile or bedridden are often constipated.

5. Psychological Factors- Some people who are anxious or angry experience increased peristaltic activity and subsequent diarrhea. People who are depressed may experience slowed intestinal motility, resulting in constipation.

6. Defecation Habits -Early bowel training may establish the habit of defecating at a regular time. If a person ignores the urge to defecate, he can develop constipation over time. When normal defecation reflexes are ignored, these conditioned reflexes tend to progressively weaken. 7. Medications

-Some drugs have side effects that can interfere with normal elimination. Some cause diarrhea and others in large doses and repeated administration (morphine and codeine) cause constipation because they decrease gastrointestinal activity. Other medications can affect the appearance of the feces.

8. Diagnostic Procedures-Clients who underwent other diagnostic procedures like colonoscopy usually have their defecation back only after they have resumed eating.

9. Anesthesia and Surgery -General anesthetics (regional/spinal anesthesia) cause the normal colonic movements to cease or slow by blocking parasympathetic stimulation to the muscles of the colon.

10. Pathologic Conditions-Spinal cord injuries and head injuries can decrease the sensory stimulation for defecation. Fecal incontinence or constipation is most likely to occur.

11. Pain-Clients who experience discomfort n defecating following hemorrhoid surgeryoften suppress the urge to defecate to avoid the pain.

Characteristic of Normal Stool*refer to Kozier Table 49-1 p.1325

F. Vital signs (Kozier, p. 527)

1. BODY TEMPERATURE –is the balanced between the heat produced by the body and the heat loss from the body. In other words, it is the heat of the body measured in heat units called degrees.

Two Kinds of Body Temperature:1. Core Temperature – the temperature of the deep tissues of the body, such as abdominal and pelvic

cavity. It remains relatively constant. 2. Surface Temperature – the temperature of the skin, the subcutaneous tissues, and fat. It, by

contrast, rises and falls in response to the environment.

Heat Balance – the process wherein the heat produced by the body equals the amount of heat loss.

Mechanism of heat production and Heat loss1. Heat is produced through the metabolism of foods.2. Heat is increased by the body’s secretions3. Heat is being produced during exercise4. Heat is produced physically from the environment

Heat is lost from the body through the 4 processes: (Kozier p. 528)a. Radiation –transfer of heat between objects that are not in contactb. Conduction – the transfer of heat from one molecule to a molecule of lower temperature. The

amount of heat transferred depends on the temperature difference and the amount and duration of the contact.

c. Convection – the dispersion of heat by air currents. The body usually has a small amount of warm air adjacent to it. This warm air rises and is replaced by cooler air, and so people always lose a small amount of heat through convection.

d. Vaporization – is the continuous evaporation of moisture from the respiratory tract and from the mucosa of the mouth and from the skin. The continuous and unnoticed water loss is called insensible water loss, and the accompanying heat loss is called insensible heat loss.

Maintenance of Body Temperature1. Thermoregulatory center in the hypothalamus regulates temperature2. Center receives messages from cold and warm thermal receptors in the body3. Center initiates responses to produce or conserve body heat or increase heat loss

Sites for Assessing Body Temperature and their Advantage and Disadvantages (Kozier, p. 532)1. Tympanic membrane2. Oral3. Rectal4. Axillary

Average Normal Temperatures for Healthy Adults at Various Sites*refer to Taylor Table 24-3, p. 526

Pyrexia/Hyperthermia/fever – a body temperature above the usual range.Hyperpyrexia – a very high fever such as 41 C (105.8 F) and above

Four common types of fever (Kozier, p. 529)5. Intermittent Fever – the body temperature alternates at regular intervals between periods of fever

and periods of normal or subnormal temperatures.6. Remittent Fever – a wide range of temperature fluctations (more than 2 C (3.6 F) occurs over the

24 hour period, all of which are above normal.7. Relapsing fever – short febrile periods of a few days are interspersed with periods of 1 or 2 days of

normal temperature.8. Constant fever – the body temperature fluctuates minimally but always remains above normal. *Spike fever – a temperature that rises to fever level rapidly following a normal temperature and then returns to normal within a few hours.

2. Pulse – is a wave of blood created by contraction of the left ventricle of the heart. Generally the pulse wave represents the stroke volume output or the amount of blood that enters the arteries with each ventricular contraction.

- In a healthy adult, it reflects the heartbeat.

Compliance – the ability of the arteries to contract and expand. Cardiac Output – is the volume of blood pumped into the arteries by the heart and equals the result of the stroke volume times the heart rate per minute

Pulse Physioloy Regulated by the autonomic nervous system through cardiac sinoatrial node Parasympathetic stimulation — decrease heart rate Sympathetic stimulation — increases heart rate Pulse rate = number of contractions over a peripheral artery in 1 minute

Pulse Site*refer to Kozier p. 538Peripheral Pulse – is a pulse located away from the heart.Apical pulse – is a central pulse, that is located at the apex of the heart.

Pulse Rhythm, Volume/Strength/Amplitude, Quality, *refer to Kozier p. 540Tachycardia – an excessively fast heart rate (over 100 BPM in an adult)

Bradycardia - a heart rate in adult of less than 60 BPMPulse Rhythm – is the pattern of the beats and the intervals between the beats

Normal should be equal time lapses between beats Abnormal (Dysrhythmia/Arrhythmia), maybe random, irregular

Pulse Volume – also called the pulse strength or amplitude, refers to the force of blood with each beat.

Scale Description rate0 Absent, not discernible1 Thready or weak, difficult to feel2 Normal, detected readily, obliterated by strong pressure3 Bounding, difficult to obliterate

3. Respiration

*Refer to notes on Oxygenation

4. Blood Pressure

Arterial Blood Pressure Is a measure of the pressure exerted by the blood as it flows through the arteries.

Systolic Blood Pressure – is the pressure of the blood as a result of contraction of the ventricles, that is, the pressure of the

height of the blood wave.Diastolic Blood Pressure

– is the pressure when the ventricles are at rest. It is the lower pressure, present at all time within the arteries. Pulse Pressure

– the difference between the diastolic and systolic pressures. Normally is about 40 mmHg.

Physiology of Blood Pressure

Force of the blood against arterial walls Controlled by a variety of mechanism to maintain adequate tissue perfusion Pressure rises as ventricle contracts and falls as heart relaxes Highest pressure is systolic Lowest pressure is diastolic

Determinants of Blood Pressure (Kozier, p. 551)1. Pumping Action of the Heart2. Peripheral Vascular Resistance3. Blood Volume4. Blood Viscosity

Equipment in Taking the Blood Pressure6. Sphygmomanometer7. Doppler Ultrasound8. Direct Electronic 9. Noninvasive Blood Pressure Monitor

Factors Affecting Blood Pressure*refer to Kozier p. 552

Categories of Blood Pressure in Adults*refer to Kozier Table 29-4 p. 552

Korotkoff Sound*refer to Kozier Box 29-6, p. 555

G. Physical Activity

Physical Activity Is something done inside or outside the home Examples includes washing the dishes, sweeping the

floor, cleaning the house, sweeping or raking leaves in yard or gardening, or walking to the neighborhood, using the stairs.

Is bodily movement produced by skeletal muscle contraction that increases energy expenditure (USDHHS)

Exercise Is a planned, structured and repetitive movement done to improve or remain one or more

components of physical fitness. It involves energy expenditure and planning. Examples are walking or jogging 3 kilometers each day before or after work and regular aerobics class 3 times a week.

Is a type of physical activity defined as a planned, structured, and repetitive bodily movement performed to improve or maintain one or more components of physical fitness. (USDHHS)

The minimum amount of physical activity required for health benefits can be achieved through: At least 30 minutes, cumulative, of moderate intensity, most days of the week, or At least 30 minutes, cumulative, of vigorous intensity, 3 or more days of the week

Factors Affecting Body Alignment and Activity (Kozier, p. 1116)• Growth and Development• Nutrition• Personal Values and Attitudes• External Factors • Prescribed Limitations

Types of Exercises (Kozier p. 1107)• Isotonic• Isometric• Isokinetic• Aerobic• Anaerobic

Benefits of Exercise *refer to Kozier, p. 1113

1. Safety and Security Needs (Kozier p. 273) Being protected form potential and actual harm. Are both physical and psychologic aspects. The person needs to feel safe, both in the physical

environment and in relationships. Emotional safety and security involves trusting others and being free from fear, anxiety, and

apprehension

2. Love and Belongingness (Kozier p. 274)

Understanding and acceptance of others in both giving and receiving love and affection, the feeling of belonging to family, peer, friends, neighbor, and community and maintaining the feeling of belonging.

3. Self Esteem Needs (Kozier p. 274) The need for a person to feel self–esteem (feelings of independence, competence, and self-respect)

and esteem from others (believe that others also respect, recognize and appreciate those accomplishments).

4. Self Actualization (Kozier p. 274) Highest level in the hierarchy Include the need for individuals to reach their full potential through the realization and development

of their unique abilities, capabilities and qualities. Characteristics of a Self-Actualized Person ( Kozier Box 16-1, p. 274)