1.3 Stress Adaptation Flashcards
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
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
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)
Psychological Responses to Stressors
see chart
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
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
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
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
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”
Defense Mechanisms
see chart
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
Substance Abuse Terms
Abuse
Abuse:
continued use of substance for at least 1 month in a way that is inconsistent with social norms.
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
Substance Abuse Terms
Tolerance
Tolerance:
Initial amount no longer elicits the same response need more of substance to get desired effect.
Substance Abuse Terms
Withdrawal
Withdrawal:
Wide array of symptoms that occur in dependent person who stops use of substance.
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
Effects of Alcohol on Body
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
Chronic ETOH consumption creates cross-tolerance to: General anesthetics barbiturates benzodiazepines Other CNS depressants
Effects of stopping ETOH Abruptly
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
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
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
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
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
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
