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Basic Nursing: Foundations of Skills & Concepts Chapter 16. STRESS, ADAPTATION AND ANXIETY. Stress is. A nonspecific response to any demand made on the body. Such demands are called stressors. Stress Management.

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Basic Nursing: Foundations of Skills & Concepts Chapter 16

STRESS, ADAPTATION AND ANXIETY


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Stress is...

  • A nonspecific response to any demand made on the body.

  • Such demands are called stressors.


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Stress Management

  • Successful stress management is necessary for wellness of both clients

    and nurses.


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Response to Stress

  • The inner force an individual uses to respond or adapt to stress is known as adaptive energy.

  • All persons have adaptive energy; the amount varies from individual to individual.


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Homeostasis

  • The balance or equilibrium among the physiologic, psychological, sociocultural, intellectual, and spiritual needs of the body.

  • Stress is an assault on the homeostasis.


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General Adaptation Syndrome

The body’s response to stressors:

  • Stage One: Crisis/alarm (paleness, shivering, sweating of palms, etc.)

  • Stage Two: Adaptation/Resistance (Flight-or-Fight response)

  • Stage Three: Exhaustion (if adaptive energy is inadequate to deal with prolonged or overwhelming stress)


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Local Adaptation Syndrome

  • Physiologic response to stress (e.g. trauma, illness) affecting a specific part of the body.

  • Classic symptoms include redness, warmth, swelling at the site.


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Manifestations of Stress (i)

  • Physiologic: increased pulse rate; rapid shallow breathing; dizziness; headaches; dilated pupils; nausea; diarrhea or constipation; polyuria; tension.

  • Psychological: irritability; increased sensitivity; sadness, depression; feeling “on edge”


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Manifestations of Stress (ii)

  • Cognitive: impaired memory; confusion; impaired judgment; delayed response time

  • Behavioral: pacing; sweaty palms; rapid speech; insomnia; withdrawal;exaggerated startle reflex

  • Spiritual: alienation; social isolation; emptiness


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Outcomes of Stress

  • Eustress - a type of stress that results in a positive outcome.

  • Distress - when stressors evoke an ineffective response.


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Adaptation

  • An ongoing process whereby individuals use various responses to stressors and change.


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Coping Measures

  • The ways an individual may react to stress.

  • One coping measure is conditioning, behavior that becomes an automatic response.


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Factors Influencing Coping

  • Degree of danger perceived by individual.

  • Immediate needs of individual.

  • Amount of support from others.

  • Individual’s belief in his own ability to handle a stressful situation.

  • Individual’s previous successes and failures in coping.

  • Number of concurrent or cumulative stresses being handled.


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Adaptive Measures

  • Use of support people.

  • Relaxation to relieve tension.

  • Behavioral change.

  • Development of more realistic goals.

  • Problem solving.

These measures for coping with stress that

require a minimum amount of energy include:


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Defense Mechanisms

  • Unconscious operations that protect the mind from anxiety.

  • They are universal and can be positive.

  • Defense mechanisms that prevent an individual from making progress towards resolving and accepting stress are called maladaptive measures.


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Crisis

  • An acute state of disorganization that occurs when the individual’s usual coping mechanisms are no longer effective.

  • Crises are:

    • Characterized by extreme anxiety.

    • Inability to function.

    • Disorganized behavior.

    • Limited as to how long they can last.


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Anxiety

  • A subjective response that occurs when a person experiences a real or perceived threat to well-being.

  • The most common emotional response to stress.


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Symptoms of Anxiety

Rapid pulse

Profuse Sweating

Selected focus of attention

Increased blood pressure

Severe Anxiety

Tense muscles

Dry mouth

Rigid posture

Shallow, rapid respiration

Tremors

Shivering

Interrupted speech


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Illness as Stressor

  • Illness and hospitalization are major stressors for individuals and their families.

  • To alleviate the stress of hospitalization, nursing interventions should reduce the client’s feelings of unfamiliarity and loss of control.


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Change

  • A dynamic process whereby an individual’s response to a stressor leads to an alteration in behavior

  • Change is an inherent part of life.

  • Change can be constructive or destructive.


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The Nurse as Change Agent

  • In bringing about change to effect positive adaptation, the nurse serves as change agent, a person who intentionally creates and implements change.


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Stress and The Nursing Process

  • Assessment.

  • Nursing Diagnosis.

  • Planning/Outcome Identification.

  • Nursing Interventions.

Nurses can help clients understand their anxiety and learn coping mechanisms through:


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Assessment

  • What are the patterns of stressors?

  • What are the typical responses to stressful situations?

  • What are the cause-and-effect relationships among stressors and thoughts, feelings, and behaviors?

  • What is the past history of successful coping mechanisms?


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Impaired adjustment

Altered role performance

Altered thought processes

Defensive coping

Sleep Pattern Disturbance

Post-trauma syndrome

Impaired Social Interaction

Spiritual Distress

Hopelessness

Fatigue

Fear

Nursing Diagnoses

Nursing diagnoses that may occur in

Response to stressors include:


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Planning/Outcome Identification

  • Identify situations that increase stress and anxiety.

  • Verbalize a plan to decrease the effect of common stressors.

  • Differentiate positive and negative stressors.

  • Categorize stressors.

  • Demonstrate stress-management exercises.

  • Verbalize a plan for stress management, including necessary lifestyle modifications.


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Nursing Interventions

  • Meeting basic needs.

  • Minimizing environmental stimuli.

  • Verbalizing feelings.

  • Involving family and significant others.

  • Using Stress-Management techniques.

  • Crisis intervention.


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Important Stress-Management Techniques

  • Exercise

  • Relaxation techniques (e.g. progressive muscle relaxation, guided imagery, meditation, hypnosis)

  • Cognitive Reframing or Thought Stopping


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Crisis Intervention

  • A specific technique used to help clients regain equilibrium.


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The Five Steps of Crisis Intervention

  • Identification of the Problem

  • Identification of the Alternatives

  • Selection of an Alternative

  • Implementation

  • Evaluation


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Stress & Nurses: Burnout

  • Burnout is a state of physical and emotional exhaustion that occurs when caregivers deplete their adaptive energy.


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Factors Leading to Burnout

  • Job-related stress.

  • Heavy workload.

  • Interpersonal conflict in the work environment.

  • Organizational barriers to autonomous decision making.


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Combating Burnout

  • Expect to be successful.

  • Remember the power of self-fulfilling prophecies and deliberately focus on the positive.

  • Let go of the need to be perfect.

  • Listen to self-talk.

  • Encourage the use of appropriate humor in the workplace.


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Achieving Stress Hardiness

  • Commitment: Becoming involved in what one is doing.

  • Challenge: Perceiving change as an opportunity for growth instead of as an obstacle or threat.

  • Control: Believing that one is influential in directing what happens to oneself.


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