1.3 Stress Adaptation Flashcards by jodi Trethewey

Potential Stressors for Older Patients

Older Patients

Unfamiliar surroundings
Health problems
Cost of healthcare
Loss of independence
Fear 
Lack of knowledge
Loss of family & friends 
Change in functional ability

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Potential Stressors for Nurses

Nurses
Dealing with difficult people
12+ hour shifts, no breaks
Mandatory OT
Workload/ low staffing ratios
Floated to unfamiliar units
Dealing with death & dying
Organizational philosophy conflict.
Lack of rewards & decision making

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Selye’s GAS How do we respond to Stress?

Stress: a disturbance in person’s normal balanced state.

Stage 1: Alarm: Occurs when one feels threatened

Stage 2 Resistance: Mobilization of resources to solve the problem.

Stage 3: Exhaustion: Adaptation fails and level of function decreases.

Stress has continued for some time, resistance is lost r/t energy supply being depleted, chronic stress damages nerve cells in tissues and organs. (Maladaptation)

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Psychological Responses to Stressors

see chart

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Physiological Response to Stressors

Muscle tension
Stiff neck
HA
Nail biting
Dry mouth
Cardiac dysrhythmias 
Increased blood glucose
Increased urinary frequency or decrease output
Diarrhea or constipation 
Weight or appetite changes 
Hyperventilation 
Chest Pain

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Maladaptive Responses

Maladaptive

Consume excess caffeine
Abuse alcohol
Smoking, chewing tobacco
Street drug use
Abuse of OTC meds
Avoiding social activities

**Adaptive behaviors contribute to resolution of stress whereas maladaptive behaviors lead to further problems

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Adaptive Responses

Adaptive

Proper nutrition- helps maintain homeostasis and resisting stress

Exercise- emotional and physical homeostasis proper weight decrease CV risk factors associated with stress

Adequate sleep & rest periods

Leisure activities- provide joy and satisfaction and are restorative to the person

Time management- helps person feel in control of situation therefore decreasing stress.

**Adaptive behaviors contribute to resolution of stress whereas maladaptive behaviors lead to further problems

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Teach Stress Management Techniques

Exercise
Relaxation techniques
Guided imagery
Acupuncture
Massage
Humor- Laughing releases endorphins and relieves stress 
Journal writing
Listen to music 
Positive self talk

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Teach Stress Management Techniques Nursing Intervention

Nursing Interventions
Referrals as needed
Explain procedures
Assess coping strategies 
“how do you handle stress”
“How well do these methods work”
“what do you do to stay healthy”

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Defense Mechanisms

see chart

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Addictive Disorders

A compulsive preoccupation with obtaining the substance, loss of control over consumption, and development of tolerance and dependence on the substance.

Caffeine
Nicotine
Drugs
Alcohol

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Substance Abuse Terms

Abuse

Abuse:

continued use of substance for at least 1 month in a way that is inconsistent with social norms.

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Substance Abuse Terms

Dependence

Dependence:
Use of substance is no longer under control of person for at least 3 months. Substance used regardless of adverse effects

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Substance Abuse Terms

Tolerance

Tolerance:

Initial amount no longer elicits the same response need more of substance to get desired effect.

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Substance Abuse Terms

Withdrawal

Withdrawal:

Wide array of symptoms that occur in dependent person who stops use of substance.

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Substance Abuse in Older Adult

Less likely to be recognized r/t symptoms confused with other conditions.

Increased risk for falls can lead to loss of independence

ETOH increases risk of HTN, cardiac dysrhythmias, CA, GI, depression, and bone loss. Depression & ETOH abuse most frequently found disorders in completed suicides.

Symptoms of abuse often treated rather than confronting the abuse.

Often result of misuse of prescribed and OTC drugs & ETOH

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Effects of Alcohol on Body

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Disrupts sleep cycle & quality of sleep
Intensifies obstructive sleep apnea
Higher mortality rate r/t accidents, impaired judgment, & increased confidence with ETOH level of 0.05%
ETOH level of 0.5% or greater cause coma, resp. depression, death.

Effects of Alcohol on Body

Chronic ETOH

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Chronic ETOH consumption creates cross-tolerance to: 
General anesthetics
 barbiturates
 benzodiazepines
Other CNS depressants

Effects of stopping ETOH Abruptly

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Brain becomes overly excited because receptors previously inhibited are no longer inhibited.
Hyper excitability of brain manifestations:
Anxiety
Tachycardia
HTN
Diaphoresis
N/V
Tremors
Sleeplessness & irritability

Complications of ETOH Abuse

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Severe neurologic & psychiatric disorders
Liver damage (hepatitis or cirrhosis)
Malnutrition
Acute & chronic pancreatitis
Thiamine (vitamin B1) deficiency- leads to neurological impairments
Erosive gastritis

Complications of ETOH Abuse Myocardial disease

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Myocardial disease: ETOH causes accumulation of lipids in myocardial cells = enlarged and weak heart.

s/s similar to CHF

Complications of ETOH Abuse Erosive gastritis

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Erosive gastritis: ETOH causes inflammation of stomach lining by breaking down stomach’s protective mucosal barrier allowing hydrochloric acid to erode stomach wall.

s/s = N/V, distention, bleeding r/t damage to blood vessels.

Complications of ETOH Abuse Alcoholic hepatitis

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Alcoholic hepatitis: complete cure if ETOH stops

S/S: N/V, lethargy, anorexia, elevated WBC, fever, jaundice, ascites and wt. loss in severe cases.

Can sometimes lead to hepatic encephalopathy (increase urea and ammonia levels = confusion, depression, sleep disturbance, apathy).

Complications of ETOH Abuse Thiamine deficiency

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Thiamine deficiency leads to neurological impairments

Complications of ETOH Abuse Thrombocytopenia

Thrombocytopenia: platelet production is impaired r/t toxic effects of ETOH. Person is at risk for hemorrhage. Abstinence reverses deficiency

Complications of chronic ETOH Wernicke’s Encephalopathy S/S

Wernicke’s Encephalopathy Acute phase B1 deficiency s/s: Nystagmus- rapid involuntary movement of eyeballs Ptosis- drooping upper eyelid Ataxia- poor coordination and unsteadiness Confabulation: presentation of incorrect memories ranging from subtle alterations to bizarre fabrications. People are not doing it intentionally. Confusion Coma & possible death

Complications of chronic ETOH Korsakoff’s Psychosis S/S

Korsakoff’s Psychosis Chronic phase Secondary dementia from B1 deficiency. ``` s/s: Progressive cognitive deterioration Confabulation Myopathy Neuropathy ```

ETOH Withdrawal S/S

Early signs occur few hours after substance cessation peaking 24-48 hours. ``` S/S: Tremors, seizures possible Agitation Anxiety Tachycardia, tachypnea Hyperthermia Insomnia ```

ETOH Withdrawal Treatment

Treatment Goal to minimize adverse outcomes. Administer multiple B vitamins (banana bag) Thiamine (vitamin B1) given for weeks after to prevent Wernicke’s encephalopathy Close monitoring of patient for safety. Fluid & electrolyte replacements

Delirium Tremens (DT’s)

Medical Emergency occurs 2-5 days after ETOH stopped lasts 2-3 days ``` Symptoms: Disorientation Paranoid delusions Visual hallucinations Markedly increased withdrawal symptoms Confusion Fever Diaphoresis ```

DT’s Screening Tool- CIWA Assessment

Clinical Institute Withdrawal Assessment ``` Assesses level of withdrawal symptoms: N&V Tremors Paroxysmal Sweats Anxiety Agitation Tactile, visual, & auditory disturbances HA Orientation ``` Score of 8 or < indicates minimal withdrawal symptoms 9-15 moderate 16 or > severe withdrawal with increased risk of DT’s and Seizures

Physical Assessment substance abuse

Focused physical assessment with substance abuse patient includes: LOC Orientation to time, place, person, & mental status Observe general health (ht, wt., balance, gait, skin color, hair, & nails) Nutritional status Evidence of recent or past trauma Vital signs including orthostatic and blood sugar Skin turgor and presence of edema.

Pharmaceutical Treatments of Withdrawal

see chart

Safety Considerations

``` Close monitoring/place in gown Never leave suicidal pt. alone Monitor unconscious pts. for aspiration. Do not lay supine Seizure precautions Monitor for DT’s 72 hours after Assess for falls 1:1 if needed Regular /irregular room checks Maintain safety is priority! ```

Safety Considerations Nursing Interventions

``` Nursing Interventions: Accepting attitude Maintain safe environment Active listening Establish trust ```

Dealing with Agitated Behaviors

Remain calm don’t take personal Inform them what is being done Validate feelings Encourage appropriate expression of feelings Don’t turn your back Place yourself by the door Don’t enter room alone Keep distance at arms length Don’t wear stethoscope around neck or other attire If anger escalates to violence priority is your own safety and safety of others in area.

Caffeine

Stimulant that increases HR & acts as a diuretic Found in soft drinks, coffee, tea, chocolate, energy drinks, & some pain relievers. 300 mg/day is safe for most >600 mg/day considered excessive Consumption of large quantities can cause high cholesterol and insomnia Withdrawal- headaches and irritability

Nicotine

Found in cigarettes & chewing tobacco Stimulates receptors in brain causing vasoconstriction HR increases, tremors seen in moderate doses. Increase in gastric acid secretion & increased GI motility CNS stimulant – releases dopamine & norepinephrine reinforces addictive cravings. Withdrawal- nervousness, cravings, restless, irritability, impatience, increased appetite, weight gain #1 cause of preventable death & disease among women.

Smoking Cessation

Chantix Nicoderm gum and patches Zyban

Oxycontin Express

Interesting link to a video regarding drug abuse and Health care (47 min) https://www.youtube.com/watch?v=wGZEvXNqzkM

1.3 Stress Adaptation Flashcards

(40 cards)