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NPP Unit 5
Stress, Rest, Self-Concept, Tissue Integrity
| Term | Definition |
|---|---|
| Stress | The mental, emotional, or physical response and adaptation to real or perceived changes and challenges. Stress response: Initiated by the nervous and endocrine systems when a stressor is perceived as a serious threat. |
| Fight or Flight Response | When a stressful situation is perceived, the hypothalamus secretes corticotropin releasing factor (CRF), which activates the sympathetic nervous system and signals the anterior pituitary gland to secrete adrenocorticotropic hormone |
| General Adaptive Syndrome | The body's attempt to maintain equilibrium and homeostasis. Consists of three stages: alarm, resistance, and exhaustion. |
| General Adaptive Syndrome, Alarm: | Upon perceiving a stressor, the CNS becomes aroused, and body mechanisms are mobilized. Hormones released from the adrenal cortex place the body in a state of readiness known as the fight or flight response. |
| General Adaptive Syndrome, Resistance: | In the resistance stage of the GAS, the body resists and seeks to counter the stress. The parasympathetic nervous system attempts to return bodily functions back to a state of homeostasis. |
| General Adaptive Syndrome, Exhaustion: | In the exhaustion phase of the GAS, the body can no longer defend itself against the stressor. In this stage, when the body’s capacity to withstand or adapt to the stressor becomes depleted and the individual’s resources are exhausted. |
| Transactional Theory of Stress and Coping (TTSC) | Describes stress as a dynamic process and a transaction between a person and their environment. How an individual appraises a stressor determines how they will respond to the stressor. |
| Acute Stress | The most common type of stress. It is usually brief, and triggers the fight-or-flight response. |
| Episodic Acute Stress | Characterized by frequent bouts of acute stress, usually associated with taking on too much responsibility. |
| Chronic Stress | Occurs when stress is heightened, constant, and prolonged. Continuous activation of the nervous system can cause or exacerbate health problems. |
| Stress Related Disorders | Stress-related disorders include acute stress disorder (ASD), posttraumatic stress disorder (PTSD), and irritable bowel syndrome (IBS). |
| Acute Stress Disorder (ASD) | An intense and dysfunctional reaction to a traumatic event that lasts less than a month. |
| Post Traumatic Stress Disorder (PTSD) | A prolonged and heightened stress reaction to a traumatic event that lasts more than a month. |
| Irritable Bowel Syndrome (IBS) | A gastrointestinal condition characterized by abdominal pain and changes to bowel elimination patterns that can include diarrhea and/or constipation. |
| Crisis | A crisis is a threatening situation triggered by a precipitating event whereby an individual experiences a strong behavioral, emotional, or psychiatric response. Crises arise from various sources. |
| Situational Stressor | Stress that stems from personal, family, or work-related issues. |
| Development (Maturational) Stressors | Stress that occurs as an individual moves through the stages of life. |
| Adventitious Stressors | Stress that results from events of disaster; they are generally rare, unexpected, and can result from natural disasters. |
| Socioeconomic Stressors | Stress that occurs from factors such as poverty, socioeconomic status (SES), and homelessness. |
| Cultural Stressors | Stress that individuals may experience by living within a society in which they do not culturally fit and/or receiving care that ignores their cultural beliefs. |
| Seven Stage Model of Crisis Intervention | An action plan for nurses to help a client identify precipitating events leading up to a crisis, utilize skills, resources, and available support systems to effectively deal with the crises and to formulate a plan of care for critical events. |
| Seven Stage Model of Crisis Intervention Step 1: | Conduct a thorough biopsychosocial crisis assessment. Assess for suicidal and homicidal risk, drug and alcohol abuse, need for medical attention, and ineffective coping strategies. Assess resilience, protective factors, and support systems. |
| Seven Stage Model of Crisis Intervention Step 2: | Establish rapport and a therapeutic environment by conveying respect and acceptance. Display neutrality and a nonjudgmental attitude. |
| Seven Stage Model of Crisis Intervention Step 3: | Assess the dimensions of the problem or crisis. Identify client issues and challenges, including what precipitated the crisis, to glean insight into the presenting problem. |
| Seven Stage Model of Crisis Intervention Step 4: | Encourage the client to explore and express feelings and emotions. Use active listening, reflection, and paraphrasing, and respond with encouraging statements. |
| Seven Stage Model of Crisis Intervention Step 5: | Explore past positive coping strategies and alternatives. View the client as resourceful and resilient, and as possessing an array of potential resources and alternatives. |
| Seven Stage Model of Crisis Intervention Step 6: | Implement the action plan. Identify supportive individuals and contact referral sources. |
| Seven Stage Model of Crisis Intervention Step 7: | Establish a follow-up plan after the initial intervention to determine the client’s status and ensure that the crisis has been resolved. |
| Ego Defense Mechanism | Defense mechanisms are psychological strategies that help individuals separate from and put distance between themselves and unpleasant events, feelings, or thoughts. |
| Ways to Defend the Ego | Common ego defense mechanisms include denial, rationalization, projection, repression, regression, and compartmentalization. |
| Coping Strategies | The strategies that an individual adopts to deal with a stressor, which is highly influenced by psychological, sociological, and cultural factors. |
| Coping Strategies Examples | Adaptive coping strategies include maintaining a healthy diet and nutrition, exercise, time management techniques, building personal resilience, rest and relaxation, mindfulness activities, complementary and alternative therapies, and journaling. |
| Health Promotion | The process of enabling clients to increase control over and improvement of all aspects of their general health. |
| Circadian Rhythm | Natural internal process that regulates the sleep–wake cycle within a 24-hour period. |
| Sleep-Wake Homeostasis | Assists the body to remember to sleep after a given time. |
| Short-Term Memory | Ability to recall information for a short time. |
| Long-Term Memory | Ability to recall information for an indefinite time. |
| Melatonin | Hormone that regulates the sleep–wake cycle. |
| Rapid-Eye Movement | Rapid movement of the eyes accompanied by low muscle tone associated with the dream stage of sleep. |
| Electroencephalogram (EEG) | Measurement of the brain's electrical activity. |
| Alpha Waves | Electrical brain waves in the frequency range of 8 to 12 hertz. |
| Beta Waves | Electrical brain waves in the frequency range of 12.0 to 30 hertz. |
| Sleep Spindles | Sudden burst of oscillatory activity in a frequency range of 11 to 15 hertz lasting approximately 0.5 to 1.5 seconds. |
| K-Complex | Electrical waveform on an electroencephalogram seen mainly during stage 2 sleep cycle. |
| Delta Waves | High amplitude electrical brainwaves in the frequency range of 1.0 to 4 hertz. |
| The Four Stages of Sleep, Stage 1: | -Non-rapid eye movement (REM) sleep -Breathing remains regular and muscle tone is present -Body temperature starts to decrease -5% of a person’s total sleeping time |
| The Four Stages of Sleep, Stage 2: | -Non-REM sleep -50% of a person’s total sleeping time -No eye movements detected, heart rate and breathing decreases, and muscles relax |
| The Four Stages of Sleep, Stage 3: | -Non-REM sleep -The brain activity, through an EEG, shows the delta wave -Body’s short-term hibernation period -Immune system strengthens -Muscles and tissues relax -15% of a person’s total sleeping time |
| The Four Stages of Sleep, Stage 4: | -REM sleep -The heart rate and blood pressure increase -Muscle mobility and body temperature decrease further -Brain activity, as noted in an EEG, increases -20% to 25% of a person’s total sleeping time |
| National Sleep Foundation, recommended hours of sleep, Newborn: (birth to 28 days) | 14 to 17 hours |
| National Sleep Foundation, recommended hours of sleep, Infants: (1 month to 1 year) | 12 to 15 hours |
| National Sleep Foundation, recommended hours of sleep, Toddlers: (1 to 3 years) | 11 to 14 hours |
| National Sleep Foundation, recommended hours of sleep, Preschool: (3 to 6 years) | 10 to 13 hours |
| National Sleep Foundation, recommended hours of sleep, School-age children: (6 to 12 years) | 9 to 11 hours |
| National Sleep Foundation, recommended hours of sleep, Adolescents: (12 to 20 years) | 8 to 10 hours |
| National Sleep Foundation, recommended hours of sleep, Young adults: (20 to 35 years) | 7 to 9 hours |
| National Sleep Foundation, recommended hours of sleep, Middle adults: (35 to 65 years) | 7 to 9 hours |
| National Sleep Foundation, recommended hours of sleep, Older adults: (65 years or older) | 7 to 8 hours |
| Sleep Deprivation | When the body does not meet its biological sleep requirement, either chronically or acutely. |
| Promoting Sleep pt.1 | Avoid stimulants, such as caffeine, alcohol, and nicotine, at least 4 to 6 hours before bedtime. Remove any unnecessary light and noise; substitute calming white noise if necessary. |
| Promoting Sleep pt.2 | Establish a bedtime routine, such as taking a warm shower or bath before bedtime. Keep the room dark, quiet, and at a comfortable, cold temperature. |
| Promoting Sleep pt.3 | Only go to bed when tired. If the client feels restless while attempting to sleep, they should go to another room and do a simple activity like reading or listening to preferred music. |
| Promoting Sleep pt.4 | Keep a consistent sleep–wake cycle by going to bed and waking at the same time, which allows the body to fall into a biologic rhythm. Keep naps short, less than 30 minutes. |
| Promoting Sleep pt.5 | Engage in a regular exercise routine, along with healthy eating; complete exercising at least 3 hours before going to bed. |
| Promoting Sleep pt.6 | Remove all work items and televisions from the bedroom when possible. The bedroom should be associated with sleep and sexual activity only. |
| Sensory Overload | Receiving stimuli at a rate and intensity beyond the brain's ability to process the stimuli in a meaningful way. |
| Contributing Factors to Poor Sleep | The use of a cell phone after going to bed is associated with more sleep disturbances, resulting in shorter sleep duration, poor sleep quality, and daytime sleepiness. Sleep deprivation not only leads to tiredness, also can induce depression, anxiety. |
| Insomnia | Ongoing inability to sleep despite having the opportunity to sleep. |
| Central Sleep Apnea | The reduction of the brain's transmission to the respiratory muscles resulting in the cessation of breathing. |
| Obstructive Sleep Apnea (OSA) | Recurrent episodes of upper airway collapse and obstruction while sleeping combined with waking from sleep. |
| Polysomnography | A test that documents heart rate, blood pressure, breathing, oxyhemoglobin saturation, brain wave patterns, body movements, and snoring patterns. |
| Narcolepsy | Chronic sleep condition characterized by sudden sleepiness and sudden periods of sleep. |
| Hypersomnia | A disorder of excessive daytime fatigue without improvement after more sleep. |
| Comfort | Easement from the pain of suffering from negativity, emotional, and physical distress. Being comforted has one feel accepted, safe, stronger, and valued. |
| Self Concept | The beliefs one holds regarding their qualities and attributes. |
| Self-Image | Self-image refers to the way an individual views their unique qualities such as genetic and physical characteristics, social roles and responsibilities (e.g., student, brother, parent, musician), personality traits, and material effects. |
| Self-Esteem | An individual's generalized sense of self-worth measured by how much value a person places on themselves. |
| Ideal Self | What a person desires to be (e.g., strong, intelligent, respected, appreciated) |
| Self-Concept Congruence | Occurs when a person's ideal self is consistent with their actual life experiences. |
| Self-Concept Incongruence | Occurs when a person's ideal self is not consistent with their actual life experiences. |
| Emotional Intelligence | When an individual is able to perceive, understand, control, manage, and evaluate emotions. |
| Self-Awareness | The ability to see oneself clearly and objectively through reflection and introspection. |
| Body Image | A person's perceptions, feelings, and thoughts about their body, usually conceptualized by perceptions related to body shape, size, and physical attractiveness. |
| Self-Efficacy | Refers to a person's perceived ability and aptitude to successfully complete a task. |
| Culture | Shared beliefs, attitudes, values, traditions, and goals; a way of thinking or behaving; or societal characteristics common to a group or individual. |
| Role Performance | Taking relevant actions to effectively execute the tasks of a specific role. |
| Identity Information | A complex, lifelong process whereby an individual develops an understanding about themselves within the context of family, cultural, and social norms. |
| Identity Confusion | An unclear sense of self, individuality, and personality resulting from an inability to adapt to identity stressors. |
| Identity Stressors | Life events that can threaten self-concept |
| Identity Stressor Examples | Gender dysphoria, a feeling of incongruity between one's gender identity and assigned sex at birth; being laid off, downsized, or losing one's career; separation, divorce, or death of a spouse. |
| Body Image Stressors | Societal attitudes about physical attributes, appearance, and performance that can impact a client's self perception of their body image. |
| Self-Esteem Stressors | Life events such as disability, chronic illness, loss of career, change in financial status, feeling irrelevant due to retirement, and loss of social support when a spouse is deceased that can impact a client's self-esteem. |
| Role Conflict | Occurs when individuals are faced with two or more role expectations and find themselves unable to meet these expectations at the same time. |
| Role Ambiguity | Refers to the lack of clarity in understanding the actions that need to be taken to achieve proposed goals. |
| Role Overload | Occurs when the roles and responsibilities placed upon an individual are greater than their ability to effectively manage them or when they find themselves pressured to respond to the many roles they hold. |
| Role Strain | Occurs when an individual has difficulty meeting the responsibilities of a particular life role or when incompatible demands are placed upon an individual. |
| Epidermis | The outer most layer of the skin, made of squamous epithelial cells, which provides a barrier against the external environment. |
| Keratinocytes | Cells formed in the basal layer of the skin that function to protect the skin from the external environment. |
| Melanocytes | Cells that are produced in the epidermis and produce melanin. |
| Melanin | A pigment that determines the color of the hair and skin. |
| Merkel Cells | Receptors cells in the epidermis that are specialized for detection of light touch. |
| Langerhans Cells | Cells found in the epidermis that play a role in cutaneous immune system reactions. |
| Dermis | The layer under the epidermis that is composed mainly of connective tissue and provides strength and flexibility of the skin. |
| Maceration | An irritation of the epidermis caused by moisture. |
| Dermatitis | A red skin irritation that develops when the skin is exposed to irritants such as feces, urine, stoma effluent, and wound exudates. This type of dermatitis is called an irritant dermatitis. |
| Skin Tears | Loss of the top skin layer caused by mechanical forces. The severity of a skin tear is defined by the depth of the skin layer loss. |
| Skin Frailty | At-risk vulnerable skin. |
| Pressure Injuries | Localized damage to the skin and/or the soft underlying tissue, which can be caused by prolonged contact with a firm surface that interferes with circulation to the area. |
| Cellulitis | An infection of the superficial layers of skin. |
| Pressure Injuries | Localized damage to the skin and/or the soft underlying tissue, which can be caused from prolonged contact with a firm surface that interferes with circulation to the area. |
| Erythema | Redness of the skin due to dilation of blood vessels. |
| Blanchable Erythema | An area of a reddened skin that temporarily turns white or pale when light pressure is applied. the skin then reddens when pressure is relieved. |
| Nonblanchable Erythema | Redness of the skin that does not go away when pressure is applied and indicates structural damage has occurred in the small vessels supplying blood to the underlying skin and tissues. |
| Wound | A wound is a disruption in the normal composition and performance of the skin and it s underlying structures. |
| Laceration | Any tearing of the skin, usually caused by blunt or sharp objects. |
| Exudate | Fluid secreted by the body during the inflammatory stage of healing and is made of plasma. |
| Moisture-Associated Skin Damage (MASD) | A form of dermatitis; a skin irritation that forms when the skin is exposed to irritants like feces, urine, stoma content, and wound exudates. |
| Serous | Thin, watery wound drainage. |
| Serosanguinous | Thin, watery wound drainage mixed with blood. |
| Sanguineous | Bloody wound drainage. |
| Purulent | Green/yellow wound drainage. |
| Tunneling | A narrow channel or passage way extending in any direction from the base of the wound |
| Shearing | A force parallel to the surface of the skin. |
| Malnutrition | Imbalance in a client's intake, which can include deficiencies or excesses in nutrients, vitamins, or calories. |
| Friction | The force created when two objects rub together. |
| Hypoperfusion | Inadequate supply of blood circulation, which results in low oxygen levels in tissues. |
| Undermining | An open area extending under skin along the edge of the wound. |
| Benchmarking | Comparing results and outcomes to other sources of similarly retrieved data. |
| Pressure Injury, Stage 1: Non-blanchable Erythema | the skin is intact with a localized area of non-blanchable erythema. Sensation, temperature, and changes in consistency of the skin and tissues may precede color changes. |
| Pressure Injury, Stage 2: Partial-Thickness Skin Loss | present as a partial-thickness skin loss, with pink or red viable tissue in the wound bed. The tissue is moist, and deeper tissues are not visible. |
| Pressure Injury, Stage 3: Full-Thickness Skin Loss | Granulation tissue, or new skin tissue that forms on the surface of the wound, is often present, and wound edges may be rolled. Dead tissue may have formed. Undermining and tunneling may also be present. |
| Pressure Injury, Stage 4: Full-Thickness Skin and Tissue Loss | The fascia, muscles, tendons, ligaments, cartilage, and/or bone are visible. Edges are rolled, and undermining and tunneling may be present. Dead tissue may also be seen. |
| Pressure Injury, Unstageable Pressure Injury: Obscured Full-Thickness Skin and Tissue Loss | owing to the obscured full-thickness skin and tissue loss injury. Such a wound is covered with either slough, a yellow, stringy nonviable tissue found in the base of the wound, or eschar, a hard nonviable black/brown tissue. |
| Granulation Tissue | New skin tissue that forms on the surface of the wound. |
| Unstageable Pressure Injury | Obscured full-thickness skin and tissue loss injury. |
| Slough | Yellow, stringy nonviable tissue found in the base of the wound. |
| Eschar | Hard nonviable black/brown tissue found in the wound bed. |
| Deep Tissue Pressure Injury | Persistent nonblanchable tissue injury of the skin appearing deep red, maroon, or purple color. |
| Mucosal Membrane Pressure Injury | Injury to a mucous membrane caused by the pressure related to the insertion or placement of a foreign device. |
| Debridement | The process of surgically removing dead tissue and other debris that can cause infection. |
| Hematoma | Accumulation of blood in the body. |
| Seroma | Accumulation of serous fluid. |
| Necrosis | Death of body tissue as a result of diminished blood flow. |
| Hypoxia | Below the expected level of oxygen in body tissue. |
| Vasoconstriction | The narrowing of the blood vessels due to acute blood loss, pain, and/or low body temperature. |
| Dehiscence | The complete or partial separation of the suture line and underlying tissues that occurs when a wound fails to heal properly. |
| Evisceration | Protrusion of internal organs through a surgical wound which has dehisced or opened. |
| Hemorrhage | Bleeding (may be internal or external). |
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