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Stress and Anxiety

Stress and Anxiety for NU112

Homeostasis - is the process where the physiological mechanisms in the body respond to internal changes to maintain balance - when internal and external influences occur homeostasis is broken and the person is unable to meet self-care needs.
Internal Influence - Endocrine system controls it. - responses controlled by autonomic nervous system both the sympathetic and parasympathetic. - also controlled by endocrine system
External Influences - Occur from surrounding environment.
Stress - is a condition in which the human system responds to changes inits normal balanced state. - Can be positive or negative - is produced by a change in environment perceived as a challenge, threat or danger. - has a holistic effect - individualized
Stressor - Internal(illness) - external(environment) - Highly individualized - Neither positive or negative but can have a positive or negative effect.
Types of stressors - Chemical agents - physical trauma - infectious agents - Family immune system deficits - Genetic disorders - Nutritional imbalances - Hypoxia
Psychosocial stressors - any threat that is actual or perceived by a person - you have to know the person to know if it is a stress.
Developmental Stress - Occurs with growth and development - Within each stage a task must be completed - When stress of a task is adapted person moves on to next task. - Eg. walking,trusting others,independence, aging
Situational Stress - is unpredictable - can be positive or negative - Can be anything that a person perceives as stress and is influenced by developmental tasks.
Adaptation - Is the change that takes place as a result of a response to a stressor.
Parts of Local Adapatation Syndrome - LAS - Reflex PainResponse - Inflammatory Response
LAS and Reflex Pain Response - Originates in the CNS - Is Automatic - Designed to protect body from injury(hot stove or bath)
LAS and Inflammatory Response - Localized in the body - Prevents spread of infection - Promotes healing. - Symptoms(Pain,redness,heat and swelling
General Adaptation Syndrome Stages - G.A.S. - Stage I - Alarm Reaction - Stage II - Resistance - Stage III - Exhaustion
Alarm Reaction Stage - Stressor perceived initiated fight or flight response - Body experiences shock - increased O2, energy, cardiac output, BP, mental alertness - Counter Shock - reversal of body responses fatigue
Resistance Stage - Body attempts to adapt to re-establish homeostasis - small area - LAS homeostasis is re-established - Large area - GAS attempted if adaptive mechanisms fail it then results in exhaustion.
Exhaustion Stage - Body rests and mobilizes ifs defenses and returns to normal. - injuries too great to overcome exhaustion sets in body either responds and recuperates or death results.
Mind-Body Interaction - there is a strong correlation between physiological and psychological stress. - Threat is perceived initiates fight or flight response regulated by the sympathetic nervous system which releases epinephrine that increases BP, heart rate, and O2 consump
Psychosomatic Illness - Illness can be worsened by the state of mind or illness can be brought on by a person's state of mind.
Illness and Life changes - the more changes in a person's life the higher the incidence for illness to occur.
Psychosocial responses to Stress - Fear - actual - real - Anxiety - vague sense of doom or apprehension - unknown
Levels of Anxiety - Mild - Moderate - Severe - Panic
Mild Anxiety - 85% of time it is good - Increased alertness, motivates, may stimulate learning - may experience restlessness or irritability
Moderate Anxiety - Focus begins to narrow to immediate concern - May involve lack of attention to detail - Problem solving is helped by others - Symptoms: tension, pounding heart, headache, increase pulse and resp., upset stomach, and sweating.
Severe Anxiety - Very narrow focus, specific details and problem solving not possible. - Person appears daze and confused - Symptoms: severe headache, nausea, dizziness, insomnia, hyperventilation
Panic - Total Loss of control, disturbed behavior, loss of touch with reality - symptoms: hallucinations, false sensory perceptions, impending doom. - Continuation in this state may lead to mental and physical exhaustion and death. - NEEDS MEDICAL TREATMEN
Physical Assessment for Anxiety - Cardiac arrythmias - Chest Pain - Headache - Hyperventilation - Diarrhea - Tense Muscles - Skin lesions - Disheveled appearance, slouching, poor eye contact, restlessness, pacing, wringing of hands
Mild Anxiety Coping Mechanism - crying - laughing - sleeping - smoking - drinking - physical activity - exercise
Other Anxieties Coping Mechanism - people can suggest from moderate to semi-severe - Task Orientated - Attack Behavior - Withdrawal Behavior - Compromise Behavior
Task Orientated - action is taken after thinking a problem through
Attack Behavior - Constructive - Person is assertive and solves problem - Destructive - person harbors anger and hostility
Withdrawal Behavior - Physical and/or emotional withdrawal - feelings of isolation are experienced
Compromise Behavior - Always constructive - Substitutes one goal for another or negotiates to meet needs.
Defense Mechanism - are unconscious psychiatric processes used to ward off anxiety by preventing conscious awareness of threatening feelings. - Can be adaptive or maladaptive
Compensation - person makes up for deficits in one area by excelling in another
Denial - ignoring the existence of unpleasant realities
Displacement - transfer of emotions associated with a particular person, object or situation to another person, object or situation
Projection - unconsciously rejects emotionally unacceptable features and attributes to other people. - eg. marital discord is blamed on finances or child
Rationalization - justifying illogical or unreasonable ideas, actions or feelings by developing acceptable explanations. - This is a form of self-deception
Reaction-Formation - Overcompensation - unacceptable feelings of behaviors are kept subconscious by developing the opposite behavior or emotion. - eg. wife likes friend she treats him with anger.
Regression - ego returns to a more comforting, less mature way of behaving
Repression - exclusion of unpleasant or unwanted experiences, emotions or ideas from conscious awareness. - eg. Forgetting dr. appointment
Sublimation - ALWAYS CONSTRUCTIVE - substituting constructive and socially acceptable activity for strong impulses that are not acceptable in their original form. - eg. negative feelings person goes and works out
Supression - ONLY CONSCIOUS DEFENSE MECHANISM - denial of a disturbing situation or feeling. - eg. I know I have blood in my urine, I will just not think about it.
Crisis - is a temporary state of disequilibrium in which a persons usual coping mechanisms or problem solving methods fail - moderate to sever ends in 2 to 6 weeks.
Phases of Crisis - Anxiety is experienced - Coping mechanisms fail - anxiety becomes more intense - Trial and error attempts fail to solve problems - anxiety may reach panic level - Anxiety overwhelms - leads to serious maladaptive personality degeneration
Crisis Intervention - 1)Identify the Problem - 2)List alternative ways of problems solving - 3)Choose between alternatives - 4)Implement a plan to solve problem - 5)Evaluate the outcome
Crisis Resolution - Can result in a lower level of functioning - It is desirable to return to previous level of functioning - Format for resolution depends on action of person and interventions of others. - Patient must set goals with interventions centered on present
People in Crisis - are more open to outside intervention - are assumed to be mentally healthy just in a state of disequilibrium
Crisis Interventions - Nurse must take and active role - only deal with present problem and its resolution - early interventions increase the chances for a better prognosis
Effect of Stress on Ill patient - Usually Negative
Adaptive Tasks of Ill patient - attempts are made to maintain self-esteem. relations. and uncertain future - person feels loss of indep. and control - adjust to pain and symptoms - help body recover - strangers in hosp. - family and econ. problems
Stress and Family - roles and structure change - separated from loves ones - routine lost - anger, guilt, helplessness - how to care for them - economic instability - overprotective, deny illness, blame hospital for illness.
Nursing Interventions Family - Give emotional support to patient and family - Include family in problem solving and teach-learning activities and actual physical care of patient
General effects of Prolonged Stress - Homeostasis is disrupted - Adaptive mechanisms fail - Return to normal functioning becomes more and more difficult - Mental health status becomes seriously threatened.
Interventions in Stress Reduction - Promote regular exercise - Promote adequate sleep rest - Maint nutrition - family/group support - stress management
Created by: saraken2007
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