1. MS II 2012

2.  Stress – positive or negative, biological, psychological or social elicits the same physical response.  Immune response and repair is negatively affected by stress.  Prolonged stress depletes personal resources  Immune  Physiological response  Adrenal response  Neurotransmitter release  Hormonal balance

3.  Stressful beyond our resources Lack of control Inability to communicate Death is a possiblity Minimal contact with loved ones Pain and anxiety

4.  Varies based on the individual  Depends on the number of stressors  Timing of stressors  Degree of change  Constructive adaptation  Hardiness sense of belonging  Resilience social support  Hope  Positive self concept  Internal locus of control

5.  1.stabilization of the patient in crisis  2.providing symptomatic relief and assessment of the patient’s coping responses  3.reinforcing adaptative behaviors and improved patient functioning  4.implementing strategies for health promotion and optimal quality of life.

6. Pain Anxiety Pain intolerance

7.  Energy conservation  Inward focus to gain or maintain control  Signs of anxiety and patient responses  Startle easily  Irritable  Anger/rage  Vigilant  Wary of caregivers  confused  Indecisive

8.  Pain management needs to be addressed  Assess anxiety levels  Identify the potential causes of anxiety  Validate findings with the patient  Look at potential medication side effect of anxiety

9.  Severe anxiety  Frequent occurrences in the ICU dyspnea tachycardia tachypnea

10.  Perception of the individual that his/her actions will not significantly affect an outcome.  Manifestations  Delayed decision making  Refusal to make decisions  Expressions of self doubt  Dissatisfaction with care

11.  Increased risk in the critical care environment related to rapid onset of illness without having had the time to acquire the illness role.  With admission  Loss of independence occurs  Clothing choices are limited  Lack of decision making choices  Visitor restrictions

12.  Allow realistic control choices for our patients  If their clothes are comfortable and facilitate ability to care for the patient allow them  Assess what control issues are reasonable and individualize it to the patient

13.  Follows powerlessness in most cases  Person loses ability to mobilize energy on his/her own behalf.  Facilitating hope is important in maintaining coping in patient’s and family  It allows all involved to deal with the unimaginable  It also helps patient’s and family to move in directions that are not wanted such as DNR orders, with increased tolerance of the stress.

14.  Disruption in the life principle that pervades a person’s entire being.  Mortality becomes real  Spiritual care involves  Active listening  Offering support  Enlisting the support of a spiritual counselor.

15.  Cause: depression  High risk groups: youth (15-24), elderly >than 65 years of age  Individuals with psychiatric disorders  Described as a self-destructive response resulting from an undesirable, unacceptable, or overwhelming event;  Causes are many

16.  Primary focus  Protection from harm  Removal of harmful objects  One on one observation  Active listening  Contracting with the individual to cease from harmful activities  Administration of anxiolytics  Mobilizing social support  Mental health education

17.  Dynamic process involving cognitive and behavioral efforts to manage internal/external demands perceived to exceed the person’s resources.  Coping mechanisms  Effective coping often goes unnoticed  Patient appears comfortable  Exhibits non-problematic behavior

18.  Suppression  Dealing with it later  Denial  It isn’t happening  Often will not respond to tangible evidence of the problem  Nurse allows this coping mechanism but utilizes cues of patient readiness to accept the reality of the medical diagnosis.

19.  Extremely important  Trust in the staff that they will get the patient through the illness inspires hope  Allows care to be given even in the face of anxiety  Significant factor in recovery and survival  Supports the patient  Helps the patient endure physical and psychological insults  Central to resilience and spiritual strength

20.  Family support  The patient is a person to the family  Can be involved in patient care  Help support the patient in the things that he/she is unable to do  Sharing concerns  Active listening by family or staff  Doesn’t mean that a solution is available

21.  Allow visitation as able  Provide information on a timely basis  Explain treatment plans  Answer questions  Help family members know what to say to an ill loved one.