The Stuart Stress Adaptation Model of Psychiatric Nursing Care.
Stress & Adaptation
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Transcript of Stress & Adaptation
Homeostasis Medulla oblongata: respiration &
circulation Pituitary gland: regulates other glands-
growth, maturation, reproduction Reticular formation: nerve cells help
control vital reflexes such as cardiovascular function & respiration
Homeostasis: Feedback Mechanisms Sensor mechanism: senses disruptions
in homeostasis
Control center: regulates body’s response to disruptions in homeostasis
Effector mechanism acts to restore homeostasis
Feedback mechanisms An endocrine gland usually controls the
sensor sensor mechanism. Signal sent to the control center in the
CNS, which initiates the effector mechanism
Feedback mechanismnegative feedback and positive feedback
Feedback MechanismsNegative Works to restore homeostasis by
correcting a deficit within the systemPositive Hormone secretion triggers additional
hormone secretion
Negative Feedback= Positive ResultHigh blood glucose Sensor
MechanismControl center Effector Mechanism Pancreas Insulin Normal
glucose
Types of Cell Injury: ToxicEndogenous (inside
body) Metabolic errors Gross
malformations Hypersensitivity
reactions
Exogenous (outside body)
Alcohol Lead Carbon monoxide drugs
Types of Cell Injury: Infectious Viruses Fungi
Protozoa bacteria
Affect cell integrity by interfering with cell synthesis, producing mutant cells. Example: HIV alters the cell when the virus is replicated in the cells RNA.
Types of Injury: PhysicalThermal Electrical/
Radiationradiation therapy, x-rays, ultraviolent radiation
Mechanical Trauma
MVA, frostbite, ischemia
Surgery
Types of Injury: DeficitLack of basic requirement = cell disruption
or death Water Oxygen Nutrient Constant temperature & adequate waste
disposal aren’t maintained Cellular synthesis can’t take place
Illness Occurs when a person is no longer in a
state of “normal” health Enables a person’s body to adapt to the
disease Example: patient has CAD, DM, or
asthma but not ill all the time because their body has adapted to the disease (able to perform ADLs)
Cause of Disease Etiology = cause Cause may be
intrinsic-inside the body extrinsic-outside the body
Idiopathic = diseases with no known cause
Causes of Disease Intrinsic -hereditary, age, gender Extrinsic -infectious agents or behaviors:
nutritional problems, temperature extremes, inactivity, drug use, infectious agents, smoking, trauma, chemical exposure, psychologicalstressors
Internal Stressors: Originate within
Negative self talk Self-criticism Unrealistic
expectations Taking things
personally
Caffeine
Overloaded schedule
External Stressors:Originate outside body
Noise Bright lights Trauma Fires
Daily hassles Isolation
Stress ResponseAdaptive (+) Healthy Develop emotional
tolerance for negative life events
Maladaptive (-) Chronic recurrent
responses Precursors to disease
Defense mechanism determine response
Alarm Reaction (Flight-or-flight responseCNS aroused
Increases heart rate, force of heart contractionsoxygen intake, & mental activity.
Alarm Reaction
Resistance
Body responding to the stressor & attempts to return to homeostasis
Coping mechanism used
If stress resolves, the body should be able to return to normal state (recovery)
If stress doesn’t stop, the Exhaustion stage begins
ExhaustionMarks the onset of disease
The body no longer producehormones as in the alarm stage
Organ damage begins
Disease DevelopmentSigns & Symptoms
Increase or decrease inmetabolismor cell division
hypofunction
hyperfunction
Increase mechanical function:seizure
Disease Stages1. Exposure to injury: target tissue
exposed to a causative agent or is injured
2. Incubation period: no signs & symptoms evident
3. Prodromal period: mild nonspecific signs & symptoms
Disease Stages 4. Acute phase
Disease reached its full intensity & complications commonly arise
If pt can function its call the subclinical acute phase
Disease Stages5. Remission
occurs in some diseases; followed by another acute phase.
6. ConvalescenceRehabilitation; progress towards recovery
7. Recoveryregains health or normal functioning; no s & s
Stress & DiseaseCV disorders Coronary artery
disease Essential
hypertension Congestive heart
failure
Gastrointestinal disorders
Constipation Diarrhea Duodenal ulcer Anorexia nervosa Obesity Ulcerative colitis
Stress & DiseaseRespiratory
disorders Asthma Hay fever Tuberculosis
Skin disorders Eczema Pruritus Urticaria Psoriasis
Stress & DiseaseMusculoskeletal
disorders Rheumatoid
arthritis Low back pain Migraine
headache Muscle tension
Metabolic Disorders Hyperthyroidism Hypothyroidism Diabetes
Stress & Disease Cancer Accident
proneness Decrease immune response Menstrual
irregularities
STRESS RESPONSE: PAIN
C Washington RN, MSNEd
Pain Pain is an unpleasant sensation
Entirely subjective
Produces discomfort, distress, or suffering.
Pain Stimuli Causative Factor
Microorganisms Inflammation Impaired blood flow Invasive tumor Radiation Heat Obstruction Spasms
Example Menigitis Sore throat Angina Colon cancer Radiation for cancer Sunburn Kidney stone Colon cramping
Pain Stimuli Causative factor
Compression Decreased movement Stretching or straining Fractures Swelling Deposits of foreign tissue Chemicals Electricity Conflict, difficulty in life
Example Carpal tunnel syndrome Pain after cast removal Sprained ankle Fractured hip Arthritis Endometriosis Skin rash Electrical burn Psychogenic pain
Acute pain
• Short duration; split second to about six months
• Warns the client
that damage or injury has occurred in the body
• Subsides as healing occurs
• Associated with
increased pulse & blood pressure, sweating, pallor.
Chronic pain
• Prolonged duration; six months or longer
• Unresponsive to medical treatment
• Persists long after injury has healed
• Rarely accompanied by autonomic nervous system activity
Central Pain Related to lesion in brain Produce high frequency bursts of impulses perceived
as pain Cause:
-Vascular lesion-tumor-trauma-inflammation
Phantom Pain Occurs following amputation of body part Pain may include
-itching-tingling-pressure sensations-burning-stabbing sensations- States amputed limb is ”twisted or cramped”
Psychogenic Pain Absence of diagnosed physiologic cause/event Long history of severe pain Emotional needs prompt pain sensations Pain is real May lead to physiologic changes (muscle spasms) May result from interpersonal conflicts Depression present
STRESS RESPONSE: SHOCK
C Washington RN, MSNEd
Shock Widespread serious reduction of tissue
perfusion
Lack of O2 & nutrients
If prolonged, leads to generalized impairment of cellular functioning
Shock & Arterial Pressure Arterial pressure is driving force of blood flow toorgans. Dependent on Cardiac output to perfuse body Peripheral vasomotor tone to return blood &
other fluids to heart Amount of circulating blood ↓ cardiac output or perpheral vascular tone
with compensatory elevation in the other → hypotension
Shock: Client’s at Risk Very young & very old MI patients Severe dysrhythmia Adrenocortical dysfunction H/O recent hemorrhage or blood loss Burns Massive or overwhelming infection
Early signs: agitation & restlessness
Blood loss
Ischemia & ↓ tissue perfusion
Allergens
Spinal cord injury
Hypovolemic Shock 80 yr old woman Bowel obstruction Minimal urine
output NGT 1500 mL
bloody aspirate
Becomes comatose
BP 80/doppler HR 140 &
thready Resp 8 Temp
94F
Hypovolemic ShockImmediate
Intervention Notify MD Aid volume
restoration by monitoring IV infusion
Septic ShockCause: Release of bacterial toxins
Act directly on the blood vessels producing massive vasodilation and pooling septicemia
Factors Favoring Septic Shock
development of antibiotic-resistant organisms invasive procedures gram-negative rods in blood immunosuppression old age trauma presence of blood in peritoneal cavity increases
likelihood of peritonitis
Shock: Nursing Interventions
Maintain patent airway and adequate ventilation Establish and maintain airway Administer oxygen as ordered Monitor respiratory status, blood gases Start resuscitative procedures as
necessary
Shock: Nursing Interventions
Administer fluid and blood replacement as ordered
Diuretics to increase urine output after IVFs
Shock: Nursing Interventions
Sodium bicarbonate to treat acidosis
Calcium to replace Ca+ loss due to blood transfusions
Antiarrthythmic agents to stabilize heart rhythm
Shock: Nursing Interventions
Antibiotics to suppress organisms responsible for septic shock
Cardiotonic glycosides, such as, digitalis, to treat cardiac failure
Steroids to treat anaphylactic shock
Shock: Nursing Interventions
Minimize factors contributing to shock. Elevate lower extremities to 45°promote
venous return to heart; improves cardiac output
Avoid Trendelenburg's position: increases respiratory impairment
Shock: Nursing Interventions
Minimize factors contributing to shock. Promote rest- conserves energy
measures
Keep client warm
Shock: Nursing Interventions
Relieve pain by cautious use of narcotics Narcotics interfere with
vasoconstriction
When circulation improves, overdose may occur
Shock: Nursing Interventions
Maintain continuous assessment of the client Check vital signs frequently Report urine output less than 30 ml/hour Observe color and temperature of skin Monitor CVP Monitor ECG
Shock: Nursing Interventions
Monitor lab studies: CBC with differential Electrolytes BUN creatinine blood gases blood cultures cardiac enzymes
Psychological support:
reassure client to relieve apprehension
keep family advised