Oxidative stress: Implications in Nursing Practice

Ehsan Yahia

B.Sc., M.Sc., PhD

Medical Surgical Nursing

Outline: • Introduction • Definition of oxidative stress • Causes • Risk factors • Diagnosis • Free radicals • Impact of oxidative stress. • Disorders caused by oxidative stress • Management of oxidative stress • Benefits of antioxidants • Nano-vitm device • Implications for nursing practice.

Introduction

Oxygen

Oxidation Oxygenation

Oxygen

chemical is a Oxygenwith element

atomic and O symbola . It is 8 number

and nonmetal reactive highlythat readily oxidizing agentwith most oxides forms

elements as well as compounds other

Oxygenation

The delivery of oxygen to the body tissue and cells to

maintain life

Oxidation

• Oxidation is the loss of electrons o

r an increase in oxidation state by a molecule, atom,

or ion.

• Old definition: Combination of

oxygen with other substances.

Definition of oxidative stress

• Oxidative stress is a condition in which accumulation of free radicals (reactive oxygen species) or the inability of antioxidants to counter the accumulation of free radicals.

RISK FACTORS

• Air pollution

• Life style

• Smoking

• Radiation

• Excessive oxygen consumption

• Increased metabolic activity.

DIAGNOSIS

• 1. HRV (Heart Rate variability)

• 2. Oxymetry

• 3. Oxygen consumption

• 4. Thermography

• 5. Metabolic resting rate

Free Radicals

OXYGEN AS A FREE RADICAL.

• Probably the most well-known free radical, oxygen is the basis for development of most free radicals in the body. Inherently, oxygen is an unstable molecule.

IMPACT OF OXIDATIVE STRSS.

• Oxidative stress causes damage on three main

structures, DNA, Cellular protein and lipids. This changes causes injury and damage to cell. And directly affect to normal body system. The sources of oxidative stress during critical illness include;

• Activate of phagocytic cell of immune system (respiratory burst)

• Production of nitric oxide by the vascular endothelium.

• Release of iron and copper ions and metalloproteins.

• Vascular damage caused by ischemia reperfusion.

MANAGEMENT OF OXIDATIVE STRESS

• The body has a natural defense system that uses

antioxidants to neutralize, or inactivate, free radicals.

• Antioxidants, which are also called free radical

scavengers, are substances that inhibit Oxidation and disable free radicals. Antioxidants act in several ways They inhibit the initial generation of free radicals, limit the intensity of free radical chain reactions, and repair the cellular damage that occurs as a result of ROS formation

Sources of High Antioxidants Foods

BENEFITS OF ANTIOXIDANTS

• A diet high in antioxidants may reduce the risk of many diseases, including heart disease and certain cancers. Antioxidants scavenge the free radicals from the body cells, and prevent or reduce the damage caused by oxidation.

NANOVitm DEVICE

The NanoVitm device is designed to improve cellular activities, specifically by improving the body’s response to oxidative stress. Just some of the benefits include;

• Protection against and repair of free radical damage

• Stronger immunity

• Improved-utilization of oxygen and nutrients

• Improved cell energy production

• Improved cell metabolism

Implications for Nursing Practice

min3 Group Activity Think of nursing implications in your area

Free radicals are associated with many disease and complications.

Understanding free radicals at the cellular levels can help us focus our

care practices to potentially affect ROS production.

1.DRUGS

N -Acetycysteine(Mucomix)has been safely used

for treatment of acetaminophen over dose, sepsis or systemic inflammatory response syndrome and as mucolytic agent in acute respiratory distress syndrome, human immunodeficiency syndrome and chronic obstructive pulmonary disease. Also reduces the risk of contrast renal insuffiency.

• Probucol, another synthetic antioxidant reduces the incidence of restenosis after percutaneous coronary angioplasty and exerts its anti-restenotic effect by improving vascular remodeling after angioplasty.

• Allopurinol is effective at attenuating the damage from ischemia and reperfusion injury.

• Other common drugs such as beta - antagonists, angiotension converting enzyme(ACE) Inhibitors and statins have exhibited antioxidant properties.

2) DIET.

• Micronutrients like selenium,zinc, copper,vitamins C and E, and more recently also vitamin B group are essential not only as intermediaries in metabolism but also for their potential roles in cellular immunity, wound healing and antioxidant activity and improved LDL resistance to oxidative stress.

• Zinc plays a crucial role in wound healing, cellular immunity, and protection against oxidative stress.

• Copper is important for wound healing, hematopoiesis and as an antioxidant.

• Nurses taking care of critically ill patients to be aware that under certain circumstances, infusion of vitamin C in patients with sepsis result in rapid consumption, due to either the promotion of free radical of iron or as a result of antioxidants activity.

3) EXERCISE.

• A potential therapeutic option to reduce bed-redden acquired weakness is avoidance of bed rest via early mobilization in hospital setting. In additional to improved strength, mild exercise may decrease oxidative stress and inflammation.

• Nurses should keep one more thing on mind that exercise can lead to increase oxidative stress, hence more exercise should be avoided.

4) MISCELLANEOUS.

• One significant nursing implication is recognizing that oxygen administration has risks. Oxygen is a drug and should be treated as such. Oxygen has proven in cerebral hypoxia, myocardial ischemia and infarction, impaired left ventricular function, wound healing, and decompression sickness. But its overuse and abuse can cause production of free radicals and subsequent damage.

• Also remember that physiologic stress is a factor involved in free radical production. As Nurses ,how can we alter our care practices to decrease patient stress? Can such practices as suctioning, positioning, and resuscitation affect ROS production?

• Research that would help answer these questions is limited-but this provides a great opportunity for nursing research.

• Until evidence is available, we must use theory, knowledge, and critical thinking to guide our care for patients with potential imbalance of free radicals and antioxidants.

• Using the earlier example of free radical damage, theory-based care can guide us as we minimize physiologic stress and free radical damage. for example pediatric nurses can promote healthier outcomes in children with Down syndrome through effective nutritional education.

• Similarly, adult critical care nurses can take measures to ensure adequate perfusion for patients with ischemic injuries.

• As new medications, such as n-acetyl cysteine,

selenium, arginine, and other radical scavengers, are added to treatment regimens, nurses will need to:

• Become familiar with these therapies.

• Of course, all nurses can encourage, support, or participate in ongoing research on free radicals.