1.0 Human Flourishing, Stress, Communication, Family, Psych Flashcards
Review physiological response to stress (GAS) and the variables that affect the stress response
GAS:
Physical response to stress: nervous, endocrine and immune
3 Stages:
Alarm:
Sympathetic nervous stimulation, shock and countershock phases
Resistance:
Adaptation to stressor- expand energy. Dependent on balance of magnitude of stressor and coping resources
Exhaustion:
Adaptation cannot be maintained, resources are depleted. Require outside sources of adaptive energy (medical and nursing care), rest or death
Stressors:
Intensity, duration, number, type
Perception
Conditioning factors
Causes, TX, nursing responsibilities, etiology, pathophysiology, and signs & symptoms of cortisol deficiency
ADDISON’S DISEASE
Addison’s Disease (cortisol deficiency):
Causes:
Primary: adrenal dysfunction (autoimmune, adrenal damage; hemorrhage, trauma, sepsis, anticoagulant, tumors)
Secondary: pituitary fails to produce Adrenocorticotropic hormone (ACTH) (withdrawal of steroid therapy (high doses or long durations)
Manifestations: r/t increased ACTH levels and decreased aldosterone, cortisol
Aldosterone deficiency:
Hyponatremia- dizziness, confusion, irritability
Hyperkalemia- cardiac dysrhythmias
Hypovolemia- hypotension, shock, syncope
Cortisol deficiency:
Hypoglycemia
Decreased stress response
Lethargy, weakness, anorexia, N/V, diarrhea
ACTH excess (in primary): hyperpigmentation
Diagnosis:
Serum lytes, glucose
Decreased cortisol levels
ACTH levels, ACTH stimulation test
Causes, TX, nursing responsibilities, etiology, pathophysiology, and signs & symptoms of cortisol excess
CUSHINGS DISEASE
Cushing’s Syndrome (excess cortisol):
Causes: Long term steroids use Pituitary adenomas cause increased Adrenocorticotropic hormone (ACTH) Adrenal tumors Ectopic ACTH produced by other tumors
Manifestations: r/t exaggerated cortisol actions Fat deposits (ab obesity, moon face, buffalo hump) Hypertension Increased Na+ Hyperglycemia Muscle weakness/wasting Thin skin, striae Infections, delayed healing Emotional changes Osteoporosis
Diagnosis:
Serum electrolytes, glucose
Cortisol levels: increased serum and urinary
Dexamethasone suppression test
In relation to stress adaptation, explain why acute adrenal insufficiency (Addison’s crisis) is such a
life-threatening emergency
Addison’s Crisis:
Life-threatening, acute adrenal insufficiency
Triggers: Surgery Trauma Systemic infection Abrupt withdrawal of long term steroids
S/S: High fever Profound weakness Severe pain in ab, back, legs Severe vomiting, diarrhea Dysrhythmias, possibly r/t increased K+ Hypotension= shock= coma= death
TX:
Fluid replacement (D5.9NS, need dextrose, Na and fluid)
Glucocorticoids (hydrocortisone, fludrocortisone)
Treat precipitating stressor (infection)
Describe the patient’s behavioral patterns as attempt is made to adapt to stress of critical illness
(PGAS).
Psychological Gas (PGAS) Alarm: anxious depressed crying nervous jittery
Resistance:
use of coping mechanisms
able to solve problems
able to cope
Exhaustion:
destructive behaviors
severe addictions
Describe the major response of fear during the alarm stage of the PGAS, and what can be done to
reduce it.
Psychological Gas (PGAS)
Alarm: Anxious Depressed Crying Nervous Jittery
Reduction interventions:
Describe a crisis situation, including potential precipitating events
Crisis- Altered family processes:
Change in role responsibilities Multiple stressors Family loss of control Anxiety over patient condition Cultural factors: meaning of sickness and health, caregiver responsibility, pain, death and dying, grief Spiritual crisis
Patient and family behavioral reactions to stress: Anxiousness Aggressiveness and irritability Depression Withdrawal Decreased motivation Lethargy Forgetfulness Suspicion Somatization Changes in eating/sleeping patterns
Discuss the phases of crisis and behaviors that occur during each phase
Crisis phases:
Phase: Initial impact Self expression: shock depersonalization Reality expression: reality is clearly perceived Emotional: docility Cognitive: organized and automatic Physical: automatic
Phase: realization
Self expression: threat to existing structures
Reality expression: perceived as overwhelming
Emotional: panic, anxiety, helplessness
Cognitive: disorganization, inability to plan or to reason or to understand situation
Physical: acute somatic damage requiring full medical care
Phase: defensive retreat
Self expression: attempt to maintain old structures
Reality expression: avoidance of reality, wishful thinking, denial, repression
Emotional: indifference or euphoria except when challenged, in which case anger, low anxiety
Cognitive: defensive reorganization, resistance to change
Physical: physical recovery from acute phase, functional return to maximum possible level
Phase: acknowledgement, renewed stress
Self expression: giving up existing structure, self depreciation
Reality expression: facing reality facts impose themselves
Emotional: depression with apathy or agitation, bitterness, mourning, high anxiety, if overwhelming= suicide
Cognitive: defensive breakdown, disorganization/reorganization in terms of altered reality perceptions
Physical: physical plateau, gradual slowing of movement until no change is experienced
Phase: adaptation and change
Self expression: establishing new structure, sense of worth
Reality expression: new reality testing
Emotional: gradual increase in satisfying experiences, gradual lowering of anxiety
Cognitive: reorganization in terms of present resources and abilities
Physical: no change in physical disability
Identify the guidelines for crisis intervention
.
Describe sleep pattern disturbances that may occur in the critical care environment
Sleep pattern in ICU:
Sleep problems (NREM & REM sleep):
NREM: relax, decreased HR/resp/BP, increased circulation, decreased metabolism, increased marrow activity.
REM (75%): increased temp, SNS, decreased EEG, dreams, adrenal release, cyclical
Describe feelings of the family in critical illness and in the critical care environment. How does the
family cope? What cultural differences are there within these families
Impact of ICU
Experiences:
Nutritional deficits
Anxiety: perceived/actual threat to health (variable surprise= panic). Loss of control- body function.
Environmental stress: lights, noise, equipment, 24/7 activity. isolation from support people
Pain
Sleep problems (NREM & REM sleep):
NREM: relax, decreased HR/resp/BP, increased circulation, decreased metabolism, increased marrow activity.
REM (75%): increased temp, SNS, decreased EEG, dreams, adrenal release, cyclical
Impaired communication
Sensory-perception problems:
Deprivation: sensory stimuli, day-night, familiar, isolation, comfort touch
Overload: light, noise, equipment lights and alarms, pain, procedures
Identify nursing interventions to reduce stressors and facilitate adaptive family coping in critical illness.
(Include communication techniques.)
NI to reduce fear and enhance pt and family coping:
Acknowledge and identify source of emotional discomfort
May exhibit SNS s/s and prolong alarm stage
Stress reducers:
Give information in simple explanations
Prepare before seeing patient
Continuity of care, order and predictability
Promote sleep
Increase sense of control for pt and family
Don’t personalize “negative” reactions or get defensive
Encourage verbalizations
Reduce sensory overload
Involve family in care
Refer to support systems: spiritual care, SW, community support
Discuss anticipated results of the following diagnostic tests for a person with Addison’s disease
Diagnostic test results for person with Addison’s disease:
sodium potassium glucose BUN calcium cortisol levels WBC’s ABGs: pO2 pCO2 HCO3
Discuss the cultural beliefs and health practices of Arab Americans and Muslims
COMMUNICATION/SPACE/TIME
Arab American and Muslims
Communication/space/time:
Communication with few words
Family and others are expected to understand implied communication via nonverbal gestures
Eye contact with same gender accepted, discouraged with different genders
Tough between men and women forbidden except for family members
Tough between same genders is common
Affection/tough is give to children from all family members
Personal space is small
Verbal expression loud and often impassioned
Small talk and rituals prior to discussing main busines are important
Sharing cup of tea promote positive relationship, provider to receive more info/history
Verbal agreements common and more binding than written
Concept of time is very relaxed except for business/specific social engagements
Pt may appear late for appointments or come to appointments on wrong day
Discuss the cultural beliefs and health practices of Arab Americans and Muslims
FAMILY
Arab American and Muslims
Family:
Family more important than individual
Maintenance of family honor important
patriarchal and oldest male makes all major decisions
Son’s sometimes consult mother related to health decisions
Young defer to the old when decisions are made
Women primarily confined to home to run household
Family members take care of family and often live nearby
Children, especially sons are responsible for caring for elderly parents
Children are raised by mother until 10 yr old then the sons are raised by fathers
Family origin important to social status
Fathers and sons provide for unmarried sisters
