III.

Man as a Biological Being

Maslow’s Heirarchy of Needs (Kozier p. 273)
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1. PHYSIOLOGIC NEEDS
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A. Oxygen( Kozier p. 1357)
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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.
*The body’s respiratory center is actually a number of groups of neurons located in the medulla
oblongata and pons of the brain.

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) in
response to stress.
- refer to the rate, volume, rhythm and relative ease and effort of respiration.
- Normal respiration is quiet, rhythmic and effortless (Eupnea).
– can be established by watching the movement of the chest.
Deep – large volume of air is inhaled and exhaled, inflating most of the lungs.
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).
Regular – evenly spaced breathing
4. Irregular
B. Water
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— the primary body fluid vital to health and normal cellular function.
— Total body water is approximately 60% of the average healthy adult’s weight.

1. a medium for metabolic reactions within cells.

2. a transporter of nutrients, waste products and other substances.
3. a lubricant
4. 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:

Intravascular fluid/plasma – found within the vascular system, 20% of ECF

Interstitial fluid – surrounds the cells, 75% of the ECF
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).

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 electrolyte
imbalances because of the inadequate intake or purging regimens (e.g. induced
vomiting). 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

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.

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.

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).

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.
C. Food (Kozier p. 1232)
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D. Rest and Sleep (Kozier P. 1164)
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.

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.
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

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 alert
at 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.

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

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).
(See 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
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 usually
not 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).

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.
normally composed of 75% water and 25% solid materials.

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 surgery
often suppress the urge to defecate to avoid the pain.
F. Vital signs (Kozier, p. 527)

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