| Question | Answer |
| 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 |
