ANP PPT BY ANITA PATTHOP.AND PSYCHDYNAMIC OF DISEASE CAUSATION.ppt

pathophysiology of disease causation

1. PATHOPHYSIOLOGY AND
PSYCHODYNAMICS OF
DISEASE CAUSATION
PRESENTER
ANITA
MSc.1
ST
YEAR
NURSING

2. INTRODUCTION
Definition's: health, disease, wellness,
Pathology, psychodynamics ,illness and sickness.
New philosophy of health
Changing concept of health
Dimensions of health
Determinants of health
Concept of disease causation
Risk factors ,risk group.
Spectrum of disease.
Psychodynamics
Psychosocial theories of disease causation.
Health promotion, wellness, and illness prevention.
Nursing care.
Conclusion.
Summary
References

4. "LIFE IS A DISEASE; AND THE ONLY DIFFERENCE
BETWEEN ONE ANOTHER IS THE STAGE OF THE
DISEASE AT WHICH HE LIVES"
“GOOD HEALTH IS NOT SOMETHING WE CAN BUY.
HOWEVER, IT CAN BE AN EXTREMELY VALUABLE
SAVINGS ACCOUNT.”-
ANNE WILSON S.
 

5. HEALTH

Health is a state of complete physical, mental and
social wellbeing and not merely an absence of
disease or infirmity.-by W.H.O.

BACK GROND OF HEALTH

The enjoyment of the highest attainable standard
of
 
health 
is one of the fundamental rights of every
human being without distinction of race, religion,
political belief, economic or social condition”. ...BY
WHO 1948

6. DISEASE:

The oxford English dictionary defines disease as
a condition of the body or some part or organ of
the body in which its functions are disrupted or
deranged .

Webster defines disease as a condition in which
body health is impaired, a departure from a state
of health, an alteration of the human body
interrupting the performance of vital functions.

7. Disease, Illness And Sickness
which are not wholly,
synonymous.
Disease is a physiological/psychological
dysfunction.
Illness is a subjective state of the person
who feels aware of not being well.
Sickness is a state of social dysfunction,
E.g. A role that the individual assumes
when ill.(sickness role)

8. CONTI…….

9. PATHOPHYSIOLOGY-

Two words -pathology and physiology

Pathology -Study of structural and functional changes in
cells, tissues and organ systems of the body that cause
or are caused by a disease.

Physiology - functions of the human body.

Pathophysiology -Pathophysiology is the branch which
deals with the physiological consequences of disease .

10. PSYCHODYNAMICS :
The term psychodynamics
implies that psychic , or mental,
processes are dynamic as
opposed to static: they involve
movement and force.
The interrelation of the
unconscious and conscious
mental and emotional forces
that determine personality and
motivation.

11. NEW PHILOSOPHY OF
HEALTH


A fundamental human right

The essence of productive life

Intersectoral

An integral part of development.

Central to the concept of quality of life.

Involves individuals, state and international responsibility.

Its maintenance- a major social investment.

World wide social goal.

12. CHANGING CONCEPTS OF CHANGING CONCEPTS OF
HEALTHHEALTH

BIOMEDICAL CONCEPT

Health- “an absence of disease”

If free from disease- considered healthy.

Had basis in the “germ theory” of disease.

Medical profession viewed:

Body- machine, Doctors’ task- repair the machine.

13. ECOLOGICAL CONCEPT

Health – a dynamic equilibrium between man and his
environment.

Disease – the maladjustment of human organism to environment.

“Health implies the relative absence of pain and discomfort and a
continuous adaptation and adjustment to the environment to
ensure optimal function”. [Dubos]

14. PSYCHOSOCIAL CONCEPT

Health- Influenced by social, psychological,
cultural, economic and political factors of the
people concerned.

Both a biological and social phenomenon.

Not only a biomedical phenomenon.

15. HOLISTIC CONCEPT

Synthesis of all the above
concepts

Health - a sound mind, in a
sound body, in a sound family,
in sound environment.

Emphasis - on the promotion
and protection of health.

16. DIMENSIONS OF HEALTH:

PHYSICAL DIMENSION:
oHealth - State in which every cell and every organ
is functioning at optimum capacity and in perfect
harmony with the rest of the body.
oSigns of physical health -“a good complexion, a
clean skin, bright eyes, lustrous hair with a body
well clothed with firm flesh, not too fat, a sweet
breath, a good appetite, sound sleep, etc.

17. MENTAL DIMENSION:
Good mental health is the ability to respond to
many varied experiences of life. It is not mere
an absence of mental illness.

3 CHARACTERISTICS OF MENTALLY
HEALTHY PERSON

1) free from internal conflicts and tension.

2) he is able to feel a part of others and has a
harmonious relation with others.

3) he is well adjusted to meet the demands of
life ;able to solve problems intelligently

18. SOCIAL DIMENSION:

Harmony and integration within and between
the individuals and Other members of the
society and the world in which they live.

Ability to see oneself as a member of a large
society.

Indirect measures of social health by:
sociometry, attitude scales , socioeconomic
status.

19. SPIRITUAL DIMENSION:
It pertains to the soul or spirit of man.
It is associated with religious beliefs of
an individual which provide philosophy
of life, directions, ethical values and
principles of integrated and high living ,
this gives strength and determination to
face realities of life and live gracefully
and meaningfully.

20. EMOTIONAL DIMENSION:

Relates to “feeling”.

Historically the mental and emotional dimensions
have been seen as one element or as two closely
related elements.

21. VOCATIONAL DIMENSION:

Work provides physical capacity, while goal
achievement and self realization in work are a
source of satisfaction and enhanced self esteem.

22. OTHERS:

Cultural dimension

Socio economic dimension

Environmental dimension

Educational dimension

Nutritional dimension

23. WHAT ARE THE
DETERMINANTS
OF HEALTH ?

24. Contd….

Environment

Biological

Economic

Socio cultural

Socio economic: education, occupation etc.

Health services

Gender

Aaging of the population

Others

25. THE HEALTH SICKNESS SPECTRUM

26. CONCEPT OF DISEASE
CAUSATION:
THEORIES
AND
MODELS
PATHOGENESIS
OF DISEASE
ICEBERG
PHENOMENON

27. OLD THEORIES

Supernatural theory of disease(an evil eye)

In Ayurveda: disease due to imbalance of the tridoshas.
these are vata (air),pitta (bile),kapha (mucus).

In Chinese: believes that disease is due to imbalance of
male principle (yang), and female principle (yin).

28. THE GERM THEORY
Discoveries in M.O. became a turning point in the etiological
concept of disease.
So the emphasis has shifted from empirical causes (like bad air
is cause of malaria) of the old theories to microbes of germ
theory .
Louis Pasteur proposed that a specific microorganism is
capable of causing an infectious disease
Disease agent Man Disease
* But now it is recognized that a disease is rarely caused by a
single agent alone ,but depends upon a number of
contributory factors.

29. THE BIOMEDICAL MODEL
This model explains disease as a result of malfunctioning
organs or cells. E.g. diabetes is caused by malfunctioning of
pancreas. But the drawback with it is that it focuses on cause
and effect relationships. Tends to ignore the psychosocial
component of the disease.

30. THEORY OF MULTIFACTORIAL
CAUSATION

De-emphasize the concept of disease
agent(single cause idea) and stress
multiplicity of interactions between host
and environment. E.g. T.B. Offers
multiple approaches for the prevention
or control of disease.

It Helps in prioritization, modification
and to prevention or control disease.

31. Risk factors:

modifiable
factors:
smoking,
hypertension,
elevated serum
cholesterol,
physical activity,
obesity, etc.

The unmodifiable
factors :
as age, sex, race,
family history and
genetic factors.

32. RESEARCH INPUT

Obesity in Patients Younger Than 60 Years Is a Risk
Factor for COVID-19 Hospital Admission

New York city hospital, Retrospective study.

RESULT: patients aged < 60 yrs. +BMI(30-34) ,2.0 to 1.8
times more likely to be admitted to acute and critical
care, respectively , compared to BMI<30:

Patients with a BMI >=35 AND Aged <60 yrs. Were 2.2
to 3.6 times more likely to be admitted to acute and
critical care than patients in the same category who
had BMI<30.

33. Contd….

Unfortunately ,obesity in people < 60
years is a newly identified
epidemiologic risk factor that may
contribute to increased morbidity
rates experienced in the United
states.

34. Risk groups:

at
­risk mothers

at-risk infants

at-risk families

chronically ill

handicapped

elderly in the population

35. WEB OF CAUSATION

Suggested by Mac Mohan and Pugh

Ideally suited in the study of chronic disease- outcome of
interaction of multiple factors.

Considers all the predisposing factors and their complex
interrelationship with each other. Removal or elimination of
causative factor is just only one link or chain -sufficient to control
disease (it is provided, that link is sufficiently important in the
pathogenic process).

36. WED CAUSATION OF CARDIO VASCULAR
DISEASE

37. Multifactorial aspects of
chronic disease today:

Role of hereditary in disease

Role of aging in disease

Role of nutrition-Cholesterol,
Chylomicrons, VLDL, LDL, Alcohol etc.

Obesity

Role of free radical

38. LAZARU'S THEORY OF
STRESS RESPONSE

LAZARUS AND FOLKMAN, 1984 . View stress as an individual perceptual response
rooted in the psychological and cognitive processes, which allows the individual to
be influenced by person-related factors such as belief’s, perception of control, and
uncertainty. Stress originates from the relationship between the person and the
environment.

According to him ,in the process of coping ,the individual shapes as well as responds
to a demand or stress ,which can have impact on the clients resistance to disease.


39. WOLFF" THEORY OF STRESS, ORGAN
MALADAPTATION AND DISEASE

He studied people's response to chronic stressor like
frustrating job or unhappy home life.

He believed that a person's total life situation
profoundly affects his susceptibility to disease.

40. HOLMES AND RAHE'S THEORY OF LIFE
CHANGE AND THE ONSET OF DISEASE

Explored the relationship between the change in a person's life
and the subsequent illness. They discovered that the higher a
person's life change score, the greater will be the likelihood of
developing illness.
Top Ten Stressful Life Event

Spouse's death , Divorce, Marriage separation, Jail term , Death
of a close relative, Injury or illness, Marriage, Fired from job,
Marriage reconciliation and Retirement.

41. NATURAL HISTORY OF
DISEASE:

Prepathogenesis phase

Pathogenesis phase

Agent factors

Host factors (intrinsic )

Environmental factors (extrinsic )

Risk factors

Risk groups

Spectrum of disease

Iceberg of disease

42. PATHOGENSIS OF DISEASE

43. EPIDEMIOLOGICAL TRAID

44. AGENT FACTORS:

Biological agent

Physical agent

Nutrient agent

Chemical agent
Endogenous
Exogenous

45. HOST FACTORS [INTRINSIC]

Human host -“soil”, disease agent -“seed”.

Play a major role in determining the outcome of
an individual’s exposure to infection.

Classified as:

Demographic characteristics: Age, sex, ethnicity.

46. HOST FACTORS [INTRINSIC]

Biological characteristics: Genetic factors, biochemical
levels of the blood ,blood groups and enzymes.

Social and economic characteristics: Socioeconomic
status, education, occupation.

Lifestyle factors: Living habits, nutrition, physical
exercise, alcohol, smoking.

47. ENVIRONMENTAL
FACTORS [EXTRINSIC]

External (macro-environment) -“all that which is external to the
individual human host, living and non-living, and with which he is
in constant interaction”.

Environment of man - divided into three components –
physical(non-living things: Air, water, soil. Etc.) biological (living
things: bacteria, viruses ,M.O. Etc.) and psycho social (cultural
values, customs, beliefs Etc.)

Closely related to each other and with host factors.

48. SPECTRUM OF DISEASE

The term "spectrum of disease" is a
graphic representation of variations in the
manifestations of disease.

At one end of the disease spectrum, are
subclinical infections which are not
ordinarily identified and at the other end
are fatal illnesses. In the middle of the
spectrum lie illnesses ranging in severity
from mild to severe

49. ICEBERG OF DISEASE

According to this concept, disease in a
community may be compared with an iceberg

The floating tip of the iceberg represents,
clinical cases.

The vast submerged portion of the iceberg
represents the hidden mass of disease.

The "waterline" represents the demarcation
between apparent and inapparent disease.

50. ICEBERG PHENOMENON

51. PSYCHODYNAMICS

Systematized study of theory of the psychological forces
that underlie human behavior.

Emphasize the interplay between unconscious and
conscious mind.

Analyzes and studies human thought process, response
patterns, and influences.

52. STRESS

Produced by a change in the environment(Challenging,
threatening, or damaging to the person's dynamic
balance or equilibrium).

There is an actual or perceived imbalance in the
person's ability to meet the demands of the new
situation.

53. STRESSOR

“Any physical, social, psychological event or condition that a person
perceives as challenging, threatening, or demanding".

INTERNAL:
Physiological, Psychological, Developmental.

EXTERNAL:

Sociological, Environmental, Spiritual and cultural.

About 75% of the bodily diseases are said to be related to stress.

Has immediate effects and long term behavioral, physiological, emotional,
psychological and cognitive effects.

54. PSYCHODYNAMIC
THEORIES

Concept was developed by ‘Sigmund Freud’

concerned with both genesis and development of
current mental process and behavior

ID

EGO

SUPEREGO

55. FREUD’S VIEW OF
DEVELOPMENT

The oral stage ( birth to 18 months)

The anal stage (18 months to 3 yrs.)

The phallic stage (3 to 6 yrs.)

The latency stage (6 to 12 yrs.)

The genital stage ( 12 yrs. And
beyond)

56. CURRENT THEORIES OF
PSYCHOPATHOLOGY

Genetics :-specific gene is for bipolar disorder,
Gene goes to expression and non expression.

Neurotransmitter :- increase and decreases causes
chemical imbalances.

Stress related factors :- inner stress –from previous
trauma

Outer stress-environmental issues ,family
problems.

57. RESPONSE-BASED MODEL
OF STRESS

Selye : identified 2 physiological responses to the stress.
1) LOCAL ADAPTATION SYNDROME:(LAS)

Response of the body tissue, organ, or part to the stress.

Body - localized ,responses to stress.

Include blood clotting, wound healing, Etc.

Response is localized.

Does not involve entire body systems.

58. CONTI……
2) GENERAL ADAPTATION SYNDROME [GAS]-

Defense response of the whole body ,to stress.

Involves the autonomic nervous system and the endocrine
system.

Three stages:

Alarm stage

Resistance stage

Exhaustion stage

59. STAGES OF GAS

60. CONTI……

61. ALARM STAGE

Sympathetic "fight or flight" response activated.

Release of catecholamines onset of
adrenocorticotropic hormone [ ACTH]-adrenal cortical
response.

Brings huge amount of oxygen and glucose to the organs
that are most active in warning off danger.

62. RESISTANCE STAGE

Hormones involved corticotrophin-releasing hormone, growth
hormone-releasing hormone and thyrotropin releasing hormone.

Increase blood sugar levels to sustain energy.

Body tries to return to normal.

If stressor remains, the person third stage.

63. EXHAUSTION STAGE

Resources of the body - depleted cannot sustain the
resistance stage exhaustion.

Prolonged exposure to high levels of cortisol and other
hormones wasting of muscles, suppression of the
immune system.

64. CURRENT THEORY –THE
BIOPSYCHOSOCIAL MODEL OF
MENTAL ILLNESS

3 DOMAINS

1 ) Biological factors :-causes disruption of neural
communication within specific circuits E.g.
Schizophrenia.

2 )Psychological factors :-poor relationship with
parents ,premature death of caregivers leads to
deprivation of maternal love and affection.

3) social factors :- 1) rapid urbanization.

2) rural life.

65. CRISIS

A sudden event in one's life that disturbs
homeostasis, during which usual coping mechanism
cannot resolve the problem. (Lagerquist, 2001)

Crisis intervention - requires problem solving skills -
preserves self esteem and promotes growth with
resolution.

66. CHARACTERISTICS OF
CRISIS

Occurs in all individuals at one time or another and is not
necessarily equated with psychopathology.

Precipitated by specific identifiable events.

They are personal by nature.

They are acute, and will be resolved in one or the another with
a brief period.

A crisis situation has the potential for psychological growth or
deterioration

67. HOMEOSTASIS

Homeostasis (homeo=sameness, stasis=standing still) -the condition of
equilibrium in the body's internal environment.

It occurs due to the causeless interplay of all the body's regulatory process.

CHARACTERISTICS OF HOMEOSTATIC MECHANISMS

Compensatory in nature.

Self regulatory.

Dynamic in nature.

Can follow a positive feedback system or a negative feedback system.

68. PROCESSES RELATED TO PROCESSES RELATED TO
HOMEOSTASIS HOMEOSTASIS

ACCLIMATIZATION-

Increased ability to respond and adapt to an environmental
stressor.

APOPTOSIS –

Orderly and genetically programmed death of cells.

Maintains the homeostasis by regulating the number of
cells and eliminating undesirable cells.

69. PATHOPHYSIOLOGICAL CHANGES
OF DISEASES CAUSATION

Cell Is a complex unit dynamically responding to
the changing demands and stressors of daily life.

They possess maintenance function and a
specialized function.

Maintenance function: cell must perform to
maintain itself.

Specialized function : cell perform in relation to
tissues and organs of which it is a part

70. CELLULAR ADAPTATIONS
AND INJURY

Cell can adapt to environmental stress
by structural and functional changes.

Hypertrophy

Atrophy

Hyperplasia

Metaplasia

Dysplasia

71. INJURY

It is a disorder in steady state regulation ,any
stressor that alters the ability of cell or system to
maintain optimal balance of its adjustment
processes will lead to injury.

Hypoxia - chemical injury

Infectious agents - nutritious agents

Physical agents - genetic disorders

72. ALTERATION IN FLUIDS AND
ELECTROLYTES

Edema

Dehydration

Alteration in electrolytes

Increased capillary permeability

Acid base disorders.

73. ALTERATION IN IMMUNE
RESPONSE
1.Allergic and hypersensitivity disorders
2.Autoimmune disorders
3.Immunodeficiency disorders,

BODY DEFENCE MECHANISMS

Immunity:
The body's specific protective response to an invading foreign
agent or organism.

Two types : natural (innate) and acquired (adaptive).

74. 1 ) INFLAMMATION

A defensive reaction to neutralize, control or eliminate the
offending agent and to prepare the site for repair.

Non specific response that is meant to serve a protective
function.

INFLAMMATORY RESPONSE

Produces in response to tissue injury or invading organisms.

Chemical mediators - minimize blood loss, wall off the invading
organism, activate phagocytes, and promote formation of
fibrous scar tissue and regeneration of injured tissue.

75. INFLAMMATORY
RESPONSE
INCLUDES THE FOLLOWING:

Vascular and cellular response.

Formation of inflammatory exudates.

Tissue repairs

76. RESPONSE TO INVASION
THREE MEANS OF DEFENSE RESPONSE

The phagocytic immune response

The humoral or antibody immune response

The cellular immune response

77. APOPTOSIS

Body's way of destroying unwanted cells such as cancer cells .

Involves the digestion of DNA by endonucleases, resulting in
the cells being targeted for phagocytosis .

On activation, eosinophils probably kill parasites by releasing
specific chemical mediators into the extracellular fluid.

Additionally, they secrete leukotrienes, prostaglandins, and
various cytokines

78. 2 ) AUTOIMMUNITY

Antibodies in immune system – lost the ability to
recognize self and non-self markers.

Immune system's recognition of one's own
tissues as "foreign“

Leads to the development of autoimmune
disease e.g. SLE, Rheumatoid Arthritis, etc.

79. 3) IMMUNODEFICIENCIES

Failure of mechanisms of self- defense to function in their
normal capacity.

Clinical hallmark-unusual or recurrent severe infections

SCID(rare genetic disorder),AIDS

80. HEALTH PROMOTION,
WELLNESS, AND ILLNESS
PREVENTION

Health promotion:

Routine exercises and good nutrition -to maintain or enhance
health.

motivates -act positively.

Wellness education:

Teaches people how to care for themselves in a healthy way -
physical awareness, stress management, and self responsibility.

81. HEALTH PROMOTION,
WELLNESS, AND ILLNESS
PREVENTION (Contd …)

Help them to achieve new understanding and control
of their lives.

Illness prevention-

Immunization -protects clients from actual or potential
threats.

Motivate people to avoid declines in health or
functional levels.

82. NURSING CARE

Oriented to health promotion, wellness, and illness
prevention

Primordial, Primary, Secondary , Tertiary level

Includes health education programs, immunization,
and physical and nutritional fitness activities.

83. 
Primordial prevention

Prevention of the emergence or development of risk
factors in population in which they have not yet appeared

Aims to stop the development of risk factors for a disease
in a population.

E.g. eliminating added salt from all foods ,which would ,if
achieved be quite effective in preventing hypertension.

Discouraging children from adopting harmful lifestyles
NURSING CARE(Contd…)

84. 
PRIMARY PREVENTION

Precedes disease or dysfunction

Applied to clients considered physically and emotionally healthy.

Also focus all individual at risk for developing specific diseases.

SECONDARY PREVENTION

Focus individuals - experiencing health problems and at risk for
developing complications or worsening conditions.

Directed at diagnosis and prompt intervention.
NURSING CARE(Contd…)

85. NURSING CARE(Contd…)

TERTIARY PREVENTION :

Defect or disability is permanent and
irreversible.

Minimize effects of long term disease or
disability

Directed at preventing complications and
deterioration.

Help them to achieve high level of functioning
as much as possible despite the limitations
caused by illness or impairment.

86. RESEARCH INPUT

Differences in Obesity Prevalence by Demographic
Characteristics and Urbanization Level Among
Adults in the United States, 2013- 2016

cross-sectional.

adults in the United States, the age- adjusted
prevalence of obesity and severe obesity in 2013-
2016 varied by level of urbanization, with significantly
greater prevalence of obesity and severe obesity
among adults living in nonmetropolitan statistical
areas compared with adults living in large
metropolitan statistical areas.

87. CONCLUSION

Health is multifactorial. The factors which affect and influence
health lie both within the individual and externally in the society.
The health of individuals and whole community considered to be
the result of many interactions. Present scenario is oriented to
health promotion, wellness education and illness prevention
through various levels of prevention which help achieve high
level of functioning, minimize disabilities and prevent
complications. A disease is a particular abnormal condition that
negatively affects the structure or function of all or part of an
organism, and that is not due to any immediate external injury.
Diseases are often known to be medical conditions that are
associated with specific symptoms and signs. 

88. SUMMARY:

HEALTH

DISEASE

PATHOPHYSIOLOGY

PSYCHODYNAMICS

CONCEPT OF DISEASE CAUSATION

CHANGING CONCEPT OF HEALTH

DIFFERENT THEORIES- Seley’s , bernand, Wolff's, Holmes & Rahe’s.

Natural history of disease.

CRISIS.

STRESS RESPONSE.

HOMEOSTASIS.

BODY’S DEFENCE MECHANISM.

COURSE OF INFECTION

89. SUMMARY

HEALTH PROMOTION,WELLNESS,ILLNESS
PREVENTION

NURSING CARE-
PRIMORDIAL,PRIMARY,SECONDARY AND
TERTIARY PREVENTION

90. REFERENCES:-

Navdeep Kaur Brar, Textbook of advanced nursing Practice Pg.
no.299- 316.

Vijay Kumar Gauttam ,a comprehensive textbook for advanced
practices in nursing first edition 2019,page no.280-290

K .Park ,Textbook of preventive and social medicine,25th
edition ,2019 pg. no.21-46.

K.K.Gulani,Community health nursing,2009 pg. no.10-16.

Brunner, Sidharth, "Text Book of Medical Surgical Nursing" 11th
edition, William Wilkins Lippincott

Mary c. Townsend psychiatry mental health nursing 1st Indian
edition 2007 pg33-39

Clinical Infectious Diseases, Volume 71, Issue 15, 1 August
2020, Pages 896– 897,

https://doi.org/10.1093/cid/ciaa415