1. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning VOLUME TWO | SECOND EDITION Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Nursing: A Concept-Based Approach to Learning VOLUME TWO | SECOND EDITION MODULE 31 Stress and Coping

2. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Stress  Body's reaction to stimulus that Demands change Disrupts homeostasis

3. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Stressors Four categories Table 31-1  Acute, time limited  Sequential events after initial stressor  Chronic intermittent  Chronic permanent

4. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition 3 Types of Stressors, continued 1. Developmental stressors 2. Internal stressors  Physical, spiritual, cognitive, emotional, psychological  Daily hassles 3. External environmental stressors  Triggers outside the individual  Demand change or disrupt homeostasis  Eustress, distress

5. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Factors Affecting The Stress Response Table 31-2 Individual Factors  Past experiences  Culture  Coping mechanisms Environmental Factors  Support  Finances

6. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition The Coping Process Cognitive appraisal  Primary appraisal First impression  Secondary appraisal Attempt to predict impact, intensity, duration

7. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition The Coping Process, continued Maslow's hierarchy of needs  Explains how human beings prioritize needs

8. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition The Coping Process, continued Types of coping Table 31-3 1.Problem-focused coping 2. Emotion-focused coping

9. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition The Coping Process, continued Reappraisal and adaptation  Coping mechanism successful Adaptation OR  Coping mechanism unsuccessful Another response to stressor

10. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Theoretical Models of Stress and Coping Stimulus-based stress models  Stress defined as: Stressor: stimulus, life event, circumstances Arouses physiological, psychological reactions  Holmes, Rahe SRRS scale to numerically rate stress  Degree of stress very individual

11. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Theoretical Models of Stress and Coping, continued Response-based stress models  Stress considered response to a stressor  Hans Selye Chain of physiological events: GAS and LAS Three-stage response Alarm reaction Resistance Exhaustion

12. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Theoretical Models of Stress and Coping, continued Transactional model  Accounts for individual differences Perceptions, responses  Cognitive appraisal  Hildegard Peplau Nursing viewed as therapeutic interpersonal process

13. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Manifestations of Stress Individual variation in internal, external manifestations Physiological, psychological, cognitive domains Let’s examine the next few slides to see how stress affects the body…

14. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Physiological Indicators Pupils dilate Sweat production Heart rate, cardiac output increase Skin pallid Sodium, water retention

15. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Physiological Indicators, continued Rate, depth of respirations increase Urine output, peristalsis decreases Mouth may be dry Muscle tension, blood sugar, alertness increase Multisystem Effects of Stress Page 1903

16. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Psychological Indicators Fear Anxiety Anger Depression Variety of other responses

17. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Cognitive Indicators Problem solving Cognitive structuring Self-control Suppression Fantasizing

18. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Ego Defense Mechanisms Unconscious psychological adaptations Essential to psychological survival Table 31-6

19. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Concepts Related to Stress and Coping Page 1906-7 Perfusion Metabolism Caring Interventions Oxygenation Perioperative Care

20. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Integrating the Concepts Chronic exposure to stress  Increases susceptibility to illnesses  Affects caregivers, including nursing professionals

21. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Alterations From Normal Coping Responses DSM-5 cites three classifications of disorders Recognized as impairments in stress, coping  Anxiety disorders  Obsessive-compulsive and related disorders  Trauma- and stress-related disorders

22. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Genetic Considerations and Nonmodifiable Risk Factors Gender a significant factor Brain chemistry Genetic factors Certain life experiences  History of childhood sexual abuse  Rape victims

23. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Prevention Traumatic events Social factors  Limited, absent socialization Family wellness promotion  Childhood abuse still increases risk decades later Screenings  Identify many disorders

24. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Assessment Help clients identify stressors that trigger unhealthy coping responses, potential effects of coping responses

25. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Nursing Assessment Nursing history  Illnesses  Physical complaints  Health history  Stressors  Stress, coping patterns  Stress assessment checklist

26. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Nursing Assessment, continued Physical examination and observation  Clinical signs, symptoms May not occur when cognitive coping effective  Laboratory tests not routinely performed May be necessary to rule out medical condition

27. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Lifespan and Cultural Considerations Age, developmentally-specific assessment  PTSD in children  Older adults who may have existing physical illness, cognitive changes Take care not to inadvertently attribute normal, healthy cultural response as inappropriate

28. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Diagnostic Tests Medical testing  Rule out other causes  Many signs, symptoms similar to anxiety Evaluation for psychiatric disorder by trained mental health professional

29. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Nursing Diagnosis Nursing diagnoses for stress:  Ineffective coping  Anxiety  Caregiver role strain  Fear

30. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Planning Goals and outcomes  Desirable outcomes frequently include Effective coping, family coping, caregiver emotional health, and psychosocial adjustment Setting priorities

31. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Interventions and Therapies Use of therapeutic communication Education regarding nonpharmacologic relaxation techniques

32. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Independent Encourage client to maintain, achieve optimal health Assist client in identifying strategies to help meet goals Utilize therapeutic communication Reinforce positive coping efforts

33. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Independent, continued  Regular exercise  Support systems  Time management: should do vs must do  Guided imagery and visualization  Progressive muscle relaxation  Assertiveness training  Journal writing  Stress management in the workplace  Sleep

34. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Independent, continued  Using a supportive internal message  Lifestyle changes  Addressing perfection 34

35. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Collaborative Recognize own response to stress Psychotherapy  Preferred method of treatment Cognitive-behavioral therapy (CBT)  Role of client's thoughts, attitudes  Aimed at reappraisal process  Exposure-based (triggers)  Table 31-4 Thought stopping

36. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Collaborative, continued Pharmacologic therapy  Most successful when combined with psychotherapy Benzodiazepines Alprazolam Antidepressants SSRIs: Prozac Antipsychotics Risperadal Beta Blockers Inderal

37. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Evaluation Patient outcomes:  Measure outcomes for each diagnosis.  Continually assess needs for additional support.

38. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Stress and Coping Alterations Page 1908-9 GAD Phobias Panic disorder PTSD Acute stress disorder OCD