Teaching Healthy Activities of Daily Living (ADLs)

Teaching Healthy Activities of Daily Living (ADLs)

1. exercise – relieve stress, increase tone

2. rest & sleep – restoration, repair, mental relaxation

3. nutrition – evaluate whether good or bad

4. use of support systems, provide emotional support

5. use of stress management techniques – discharge tension

Evaluating the Plan of Care

1. pt verbalizes causes & effects of stress & anxiety

2. pt. identifies and uses sources of support

3. pt uses problem solving to find solution to stressors

4. pt practices healthy lifestyle habits & anxiety-reducing techniques

5. pt verbalizes decrease in anxiety & increase in comfort

Stress Management Techniques

1. relaxation – music & humor

2. meditation – 4 components:

   A. quiet surroundings

   B. passive attitude

   C. comfortable position

   D. use word or mental image

3. anticipatory guidance – focus on psychologically preparing pt for unfamiliar / painful event

4. guided imagery – use 5 senses

5. Biofeedback – gain mental control over autonomic nervous system

6. Process intervention – specific technique that help pts regain equilibrium

Crisis Intervention

1. identify the problem – be specific

2. list alternatives

3. choose from alternatives

4. implement the plan – carry it out

5. evaluate the outcome

Crisis – definition:

disturbance caused by precipitating event that is perceived as threat to self

Factors Affecting Stress & Adaptation

Factors Affecting Stress & Adaptation

1. sources of stress – developmental, situational

2. types of stressors experienced – mind & body, physiologic, psychosocial

3. personal factors

Categories of Stress

1. developmental stress – occurs when person progresses through stages of growth & development

   A. infant – learning to trust

   B. toddler – toilet training

   C. school age – socializing, peer influence

   D. adolescent – independence

   E. middle age – accept physical signs of aging

   F. old age- adjust to death of spouse

2. situational stress – do not occur in predictable patterns, occur at different times: illness, marriage, divorce, new job, role change

Types of Stressors

1. physiologic – chemical agents, physical agents, infectious agents, nutritional imbalances, hypoxia, genetic or immune disorders

2. psychosocial – includes real and perceived threats

Stressful Activities in Nursing Profession

1. assuming responsibilities for which one is not prepared

2. working with unqualified personnel

3. working in environment in which supervisors are not supportive

4. caring for patient in cardiac arrest or dying person, emergency room, oncology

5. experiencing conflict with peers

   *know own limits, slow focused breathing, time-management skills

   burnout: inability to deal with physical emotional stress

Task-Oriented Reactions to Stress

Task-Oriented Reactions to Stress – consciously thing about stressful situation & act to solve

1. attack behavior – constructive: problem-solving or destructive:aggressive anger & hostility. Person overcomes obstacles to satisfy a need

2. withdrawal behavior – physically withdraw from threat, emotional reaction is guilt or isolation

3. compromise behavior – usually constructive, substitute goals or negotiate

Defense Mechanisms

1. compensation – excel in something else to make up for lack

2. denial – alcoholics – pt refuses to admit problem

3. displacement – kick dog instead of dealing with problem

4. introjection – adolescent who takes on values of favorite teacher

5. projection - "I'm not attracted to him, my best friend is."

6. rationalization – explain away - " I knew that teacher was out to get me."

Defense Mechanisms (continued)

1. reaction formation - pt who brings gifts to nurse that he is angry with

2. regression – child reverts to thumb sucking when admitted to hospital

3. repression - "Our family never had any problems." (said by an abused adolescent)

4. sublimation – deal with aggression by playing football

5. undoing – abusive husband who brings expensive gifts to wife the day after an argument

Adaptation to Acute and Chronic Illness

1. general tasks – ie. maintaining self-esteem & personal relationships (prepare for uncertain future)

2. illness-related tasks – ie. handling pain & disability (losing independence & control)

Effects of Stress on Basic Human Needs

1. physiologic – change in appetite, sleep, migraine, elimination

2. safety / security – threatened, nervous, inattentive

3. love / belonging – withdrawn, isolated, overly dependent on others

4. self-esteem – workaholic, compensate to deal with stress

5. self-actualization – accept or reject reality – center on own problems

Effects of Long-Term Stress

1. affects physical status

2. increases risk for disease or injury

3. compromises recovery & return to normal function

4. is associated with specific diseases (cardiovascular, gastrointestinal disorders, cancer)

Family Stressors

1. changes in family structure & role

2. anger & feelings of helplessness & guilt

3. loss of control over normal routines

4. concern for future financial stability

5. caregiver burden – stress response

The General Adaptation Syndrome

Homeostatic Regulators of the Body

1. Autonomic nervous system

   A. parasympathetic – normal conditions & at rest. ie. cranial, sacral nerves, heart rate slow

   steady, stimulate insulin secretion, stimulate digestive secretions, increase peristalsis,

   increase in glucose uptake by cells

B. Sympathetic – stress, fight or flight response, stimulate heart rate and force, dilate skeletal

blood vessels, dilate blood vessels to brain, stimulate glycogen breakdown pupils dilate,

peripheral circulation decrease, metabolism increase, bronchi dilate, alert,

1. Endocrine

   A. Pituitary – ACTH (adrenocorticotropic hormone) & TSH (thyroid stimulating hormone)

   B. Adrenals – effect is prepare for emergency, work with sympathetic nervous system

   a. medulla produces: norepinephrine & epinephrine

   b. cortex produces: mineral corticoids, glucocorticoids, androgens

   C. Thyroid – secretes thyroxin & calcitonin for regulating metabolic rate & growth

Homeostatic Regulators – other

1. cardiovascular – pumps blood, transport system, O₂ to cells, nutrients to cells, CO₂ out

2. renal – filters, excretes, reabsorbs metabolic products & H₂O

3. respiratory – intake of O₂ & output of CO₂ , metabolism, maintain acid-base balance

4. gastrointestinal – fluids, food intake, eliminate waste products, energy source, maintain fluid & electrolytes

Psychological Homeostasis - Maslow

1. love and belonging needs

2. safety and security needs

3. self-esteem

   defense mechanisms kick in when these are lacking

Emotional Responses to Stress

1. depression

2. anger

3. anxiety (most common) this is a emotional response to threat, whereas fear is a cognitive response to threat

   A. mild anxiety - ↑degree alertness, ↑vigilence. (good for test day, good for pt teaching)

   B. moderate anxiety – pt feeling subjective distress, ↓perception, ↓attention, less learning

   capable, help pt to determine cause & effect relationship between stressor & anxiety

   C. severe anxiety - ↑subjective distress, selective attention, distorted perception, encourage pt

   to talk, give specific motor activity, give specific directions

   D. panic – major perceptual distortion, immobilization, inability to function, impaired

   communication. provide limits & structure, maintain pt safety (physical & psychological)

Stress

1. Hormones of stress: ↑systemic fatigue & impaired immunologic surveilance, body tire & get ill

   A. epinephrine

   B. cortisol

2. Mind-body interaction

   psychosomatic disorder: diarrhea, headache, IBS (irritable bowel syndrome)

Coping Mechanisms

1. crying, laughing, sleeping, cursin

2. physical activity, exercise

3. eat, smoke, drinking

4. lack of eye contact, withdrawal

5. limiting relationships to those with similar values & interests

*adaptive coping ↓stress ie. exercise. maladaptive coping not promote adaptation- overeating, overwork, substance abuse*

What is stress?

What is stress? - unique to individual, body's physiological reaction to any stimulus that evokes change

1. Stress – any disturbance in person's normal balanced state (disturbs equilibrium)

2. Stressor – any situation, event, or agent that threatens a person's security

3. physical / emotional response to stress

4. adaptation – major components of health / illness – changes that take place as a result of

   stress / coping. Coping responses – when stress occurs, coping response is voluntary or involutary to restore equilibrium

Physiologic Homeostasis

1. Local Adaptation Syndrome (LAS) involves only one specific body part

   A. reflex pain response – response of CNS (central nervous system) to pain. It is rapid,

   automatic, serves as a protective mechanism to prevent injury. (ie. person steps on a nail,

   pulls foot back).

   B. inflammatory response – local response to injury – pain, swelling, heat, & redness

2. Generalized Adaptation Syndrome (GAS) pg 959– biochemical model of stress (Hans Selye) entire body affected. physiological response to stress. whether actual or imagined, present or potential.

   A. alarm reaction

   B. resistance

   C. exhaustion

A balance is achieved (homeostasis)

An imbalance occurs during a stressful event – not enough coping or support

Alarm reaction

1. person perceives stressor, defense mechanisms activated

2. fight / flight reaction (physiologic)

3. hormone levels rise, autonomic nervous system : body prepares to react, adrenalin & norepinephrine released, (involved in maintain homeostasis)

4. shock and counter shock phases

Resistance

1. body attempts to adapt to stressor

2. vital signs, hormone levels, and energy production return to normal

3. body regains homeostasis or adaptive mechanisms fail

Exhaustion

1. results when adaptive mechanisms are exhausted

2. body either rests and mobilizes its defenses to return to normal or dies