185 unit 3 Flashcards
Describe four aims of the nurse in the role of a counselor
Promoting health
preventing illness
restoring health
facilitating coping with disability and death
promoting health
health teaching varied and range from teaching passive exercises to a patient with left-sided paralysis to designing a safe exercise program for a young athlete.
Developmental and maturational issues, normal childbearing, hygiene, nutrition, exercise, mental health, spiritual health.
preventing illness
counsel women of childbearing age about health practices that promote optimal fetal development, teach parents how to make their home safe for a toddler, or counsel people at high risk for heart disease, cancer, or communicable diseases. First aid, safety, immunizations, screening, identification and management of risk factors.
restoring health
preoperative and postoperative teaching; sexual counseling for a patient recovering from a myocardial infarction, and lifestyle counseling for a patient with an ostomy. Orientation to a treatment center and staff, patients and nurses expectations of one another, the illness and physical condition anatomy and physiology, etiology of the problem, the significance of symptoms, prognosis The medical and nursing regimens and how the patient can participate in care. Self-care practices the patient and family need to manage the patients condition independently.
facilitating coping with disability and death
How the patients physical and mental condition affects other areas of functioning; lifestyle counseling. Measures that maximize independence and enhance self-concept. Stress management. Environmental alterations. community resources. Appropriate referrals. Grief and bereavement counseling.
define counseling as it relates to the role of the nurse
the interpersonal process of helping patients make decisions that promote their overall well-being. Counseling may be formal or informal. The interpersonal skills of warmth, friendliness, openness, and empathy are necessary for successful counseling. involve listening carefully to the patients or family questions, concern, demands, and complaints and then responding in an effective manner.
identify problems that may indicate a need for counseling
DECISIONAL CONFLICT - ability to authorize withdawal of life-sustaining treatment despite believing this to be in the patient best interest.
Hopelessness - progression of debilitating symptoms and belief that even god has abandoned me
impaired social interaction - communication barriers
situational low self-esteem - recent lay-off and divorce
describe the arousal mechanism
RAS
state of arousal
situational
situational crisis, which occurs when a patient faces an event or situation that causes a disruption in life.
developmental
a developmental crisis can occur when a person is going through a developmental stage or passage.
motivational
an evidence-based counseling approach that involves discussing feeling and incentives with the patient.
short-term
focuses on the immediate problem or concern of the patient or family. it can be a relatively minor concern or a major crisis, but in any case, it needs immediate attention. Short-term counseling might be used during a situational crisis, which occurs when a patient faces an event or situation that causes a disruption in life.
long-term
extends over a prolonged period. a patient experiencing a developmental crisis, for example, might need long-term counseling. a developmental crisis can occur when a person is going through a developmental stage or passage.
identify situations that may call for a referral
needs specialized counseling from a nurse with advanced training or from other health care professionals.
self esteem
the need to feel good about oneself and to believe that others hold on in high regard
self actualization
is the need to reach one’s potential through full development of one unique capability
self concept
which is the mental image or picture of self, has the power to either encourage or thwart personal growth.
discuss the dimensions of self-concept
SELF-KNOWLEDGE- abilities, nature, limitations
SELF-EXPECTATION-realistic or unrealistic
SELF EVALUATION- view of oneself in relation to events, situations
describe the factors affecting self-concept
developmental considerations culture internal and external resources history of success and failure crisis or life stressors aging, illness or trauma
developmental considerations
as a person matures, the criteria that mark the experiences necessary for a positive self-concept change.
culture
if culture is stable little tension will be experienced between what culture expects of the child and what the child expect of self. parents might expect children to behave according to their own cultural norms, peers and society, as well as the adolescent desire to belong may create the desire to abandon old cultural belief, attitudes, and practices among many of these children. conflict between parents and children as well as cultural confusion occur.
internal and external resources
the degree to which a person integrates healthy, useful internal resources or personal strengths is associated with how well a person has been able to establish a postive self-concept. one person might use humor as both an effective coping mechanism and a successful interpersonal tool. self con-cept is also associated with the ability to identify and use external resources such as a network of support people, adequate finances, and organizational supports. People who feel more positively about themselves tend to feel connected to others and to society; they can identify and use more external resources.
history of success and failure
people with a history of repeated failure might perceive themselves as failures and actually perpetuate this image by unconsciously encouraging others to treat them this way they come to fear success and find it easier to fail even though they do not like it. a series of successful experiences especially when occuring in the context of an accepting, nurturing, caring relationship might condition a person to strive for the next success, and a positive self-concept might be forged that expects success and makes it happen.
crisis or life stressors
might call forth a personal response and mobilize a person talents, resulting in good feeling about oneself, or it might result in emotional paralysis with diminished self-concept. factors that determine a person’s response to crisis: the person’s perception of the event, the person’s situational supports, the coping mechanisms the person possess.
identify ways to assess a person self-concept
personal identify - describe a person a conscious sense of who they are “ how would you describe yourself “.
personal strengths - asking pointed questions about personal strength can help a patient identify positive factor.s
body image - response to deformity or limitation - the person’s subjective view of one physical appearance.
independent - dependence patterns
self-esteem - socialization and communication
role performance
identify ways to assess a person self-concept
personal identify - describe a person a conscious sense of who they are “ how would you describe yourself “.
personal strengths - asking pointed questions about personal strength can help a patient identify positive factor.s
body image - response to deformity or limitation - the person’s subjective view of one physical appearance. Adaptive response - The patient exhibits signs of grief and mourning. Maladaptive responses - patient continues to deny and avoid dealing with the deformity or limitation, engage in self-destructive behavior.
independent - dependence patterns - ADAPTIVE RESPONSES - patient assumes responsibility for care ( makes the decision), develops new self-care behaviors, uses available resources, interacts in a mutually supportive way with family.
MALADAPTIVE RESPONSES - The patient assigns responsibility for his or her care to others, becomes increasingly dependent, or stubbornly refuses necessary help.
self-esteem - “ Tell me what you like about yourself “ - the greater the discrepancy, the lower the self-esteem the smaller the discrepancy the higher the self-esteem.
socialization and communication - ADAPTIVE - maintains usual social patterns, communicates needs and accepts an offer of help, serves as a support for others.
MALADAPTIVE - isolates oneself, exhibits superficial self-confidence, is unable to express needs(become hostile, ashamed, frustrated, depressed)
role performance - illness or developmental processes such as aging make it necessary to alter or relinquish previous role. people experience such alteration as major losses thus all people who roles are altered or compromise are at risk for disturb self-concept.
identify and use personal strengths
encourage pt to identify their strength.
replace self-negation with positive thinking.
notice and reinforce patient strengths.
encourage pt to will for themselves the strengths they desire and to try them on.
help patients cope with the necessary dependency resulting from aging or illness.
maintain a sense of self
help pt maintain a sense of self and worth - use looks, speech, and judicious touch to communicate worth.
acknowledge the pt status, roles, individuality.
speak to the pt respectfully and in a nonpatronizing manner.
converse with the pt about the pt life experience.
address the pt by preferred name whenever entering the pt room.
offer the pt a simple explanation before initiating any procedure.
move the pt body respectfully if the pt is unable to do this.
respect the pt privacy and sensibilities.
acknowledge and allow expression of negative feelings.
help the pt to recognize strengths and explore alternatives.
change a negative self concept
The general principle is to help the pt alter one perspective of a situation from a more negative view to a more positive view process known as reframing. help the pt identify and describe in detail how the pt thinks andd feels about situations related to self concept.
explore with the pt alternative ways of viewing the same situation.
teach the pt to red flag faulty thinking behavior as soon as the pt is aware of it. the goal is to replace the negative thinking and self talk with thinking and self talk that will develop a more positive self image.
help the pt explore the positive dimensions of oneself that the patient wishes to develop, and incorporate this new knowledge into the self-concept.
develop a positive body image
express interest in and accptance of the pt through verbanl and non verbal expression. allow the pt to share one feeling openly. sitting quietly by the pt for a few minutes, with a few words such as “ how are things”, communicates to the pt your willingness and readiness to share the pt experience.
explore with the pt his or her feelings about altered body image and the pt perceptions about the meaning and consequences of such alteration.
of special population - children - adolescents - elderly
FOR CHILDREN/ADOL - look at the positive and negative, listening, using the language of self-esteem, helping children meet expectation, and promoting a feeling of success. ELDERLY - identify ones own attitudes and feeling about aging and older adult.
address senior respectfully communicating that you take their concern seriously
respect and affirm senior intellect, individuality, personal strength, culture, and spirituality.
adjust communication style to accomodate any sensory or cognitive deficits.
encourage sharing of life experiences.
assist the person to identify strengths and coping mechanisms to deal with problems.
provide a safe environment for older adults to communicate such concerns as interpersonal or physical loss, feelings about illness and death, sexuality, or financial issues.
advocate for seniors needing help in attaining services necessary to meet their health care needs.
explore the personal meaning of dependency for the person, and help seniors adapt both physically and emotionally to any necessary dependency. personal identity, body image, self-esteem, and role performance.
evaluate the effectiveness of nursing interventions to promote healthy responses in the nurse
is comfortable with body image and able to use it effectively to meet human needs.
is able to describe self positively
is able to meet realistic role expectations without undue anxiety and fatigue
is capable of interacting appropriately with environment while recognizing self to be a separate and distinct entity
kinesthesia(body position and movement)
- Kinesthetic - external sense of position of body parts and body movement.
visceral(internal organs)
- Visceral - large organs within the body have sensations that make us aware of them (Full Stomach).
sterognosis(solidity,size,shape, and texture)
perception of solidity or objects
stimulus
an agent, act, or other influence capable of initiating a response by the nervous system must be present
receptor
or sense organ receive the stimulus and convert it to a nerve impulse
nervous pathway
the nerve impulse must be conducted aong a nervous pathway from the receptor or sense organ to the brain
brain translation
a particular area in the brain must receive and translate the impulse into a sensation
describe the arousal mechanism
RAS - Reticular Activating System
- Mediates arousal
- A poorly defined network that extends from the hypothalamus to the medulla
- The optimal arousal state is a GENERAL drive state called SENSORISTASIS
- Nerve impulses from al the sensory tracts reach the RAS which then selectively allow certain impulses to reach the cerebral cortex + be perceived
- The MESENCEPHALIC appears to be the center of the system + stimulation of this area produces the most pronounced + long lasting effects on the cerebral cortex
- Monitors and regulates incoming stimuli, this maintaining, enhancing or inhibiting incoming cortical arousal
- The stimulus must usually be variable or irregular to evoke a response
- need to be conscious
state of arousal -
identify and describe sensory alterations
sensory deprivation - - Results when a person experiences decreased sensory input or input that is monotonous, unpatterened or meaningless
- Decrease in or lack of meaningful stimuli
- Monotonous sensory input
- Interference with the processing of information
- RAS unable to maintain normal stimulation to cerebral cortex - remaining stimuli becomes overly noticeable and distorted - fills in sensory gap (EX: pain, distant noises)
- Alterations in perception, cognition, and emotion
sensory overlord - Results when a person experiences so much sensory stimuli that the brain is unable to either respond meaningfully or ignore the stimuli
- The person feels out of control + ma exhibit all of the manifestations observed in sensory deprivation
- The amount + quality of stimuli necessary to produce overload may differ greatly from person to person
- Influenced by age, culture, personality + lifestyle
Nursing care focuses on reducing distressing stimuli and helping the patient gain control over the environment.
sensory deficit - Impaired or absent functioning in one or mroe senses
State of Awareness
—CONSCIOUS STATE—
Delirium - Disorientation, restlessness, hallucinations, agitation, alternating with other conscious states.
Dementia - Difficulties with spatial orientation, memory, language; changes in personality.
Confusion - Reduced awareness, easily distracted, easily startled by sensory stimuli, alternates between drowsiness and excitability; resembles minor form of delirium state.
Normal consciousness - Aware of self and external environment, well-oriented, responsive.
Somnolence - Extreme drowsiness, but will respond normally to stimuli.
Minimally conscious states - Part consciousness; sleep-wake cycles present; some motor function, including automatic movements; inconsistently follows commands.
Locked-in syndrome - Full consciousness; sleep-wake cycles present; quadriplegic, auditory and visual function preserved; emotion preserved
State of Awareness
—UNCONSCIOUS STATE—
Asleep - Can be aroused by normal stimuli (light touch, sound, and the like)
Stupor - Can be aroused by extreme and/or repeated stimuli.
Coma - Cannot be aroused and does not respond to stimuli.
Vegetative State - Cannot be aroused. Sleep-wake cycles, postures or withdraws to noxious stimuli, occasional nonpurposeful movement, random smiling or grimacing.
Sensory Awareness
Ability to perceive environmental stimuli and body reactions and to respond appropriately
Reasons for Sensory Overload (person unable to process or manage the amount or intensity of sensory stimuli - no meaningful response)
- Increased quantity or quality of Internal Factors: pain hypoxia, anxiety, electrolyte imbalances
- Increase quantity or quality of external stimuli (environment) noisy healthcare setting, intrusive diagnostic studies, contacts with strangers
- Increased quantity or intensity of information: severity or amount of medical or teaching data
- Inability perceptually to disregard or ignore stimuli: NS disorder, (attention deficit disorders) CNS stimulation: drugs, caffeine
nervous pathway
the nerve impulse must be conducted along a nervous pathway from the receptor or sense organ to the brain
define stress
a condition in which the human system responds to change in it normal balanced state.
define stressor
anything that is perceived as challenging threatening, or demanding.
define adaptation
the change that takes place as a result of the response to a stressor
define homeostasis
various physiologic mechanisms within the body respond to internal change to maintain relative constancy in the internal environment
describe the mechanisms of maintaining homeostasis
the effect of physiologic ad psychological stress are interrelated as are the mechanism that is consciously or unconsciously used to maintain homeostasis in response to stress.
identify the effects of stress
interactions with basic human needs stress in health and wellness prolonged stress family response to the stress of illness crisis - maturational - situational - adventitious
2 Physiologic Homeostasis Syndromes
- ) LOCAL Adaptation Syndrome (LAS)
2. ) GENERAL Adaptation Syndrome (GAS)
Local Adaptation Syndrome + 2 Most Common Types
- Part of Physiologic Homeostasis
- A LOCALIZED response of the body to stress. It involves only a SPECIFIC body part (such as a tissue or organ) instead of the whole body
- The stress precipitating the LAS may be traumatic or pathologic
- Primarily homeostatic, SHORT TERM, ADAPTIVE response
2 Most Common Types:
- ) REFLEX PAIN RESPONSE: Response of the CNS to pain. It is RAPID and automatic, service as a PROTECTIVE mechanism to prevent injury.
- ) INFLAMMATORY RESPONSE: Is a LOCAL response to injury or infection. It serves to localize and prevent the spread of infection and promote wound healing.
General Adaptation Syndrome (GAS) + its 3 Stages
- Part of Physiologic Homeostasis
- A biochemical model of stress developed by Hans Selye (1976)
- Describes the body’s general response to stress, a concept essential in all areas of nursing care
- It is a physiologic response to stress + the response results from either physical or emotional stressors
- It is a factor in mental illness, social isolation and loss (or lack) of human relationships
3 Stages:
1.) ALARM REACTION: Initiated when a person perceives a specific stressor and various defense mechanisms are activated. The perception of the threat may be conscious or unconscious. The autonomic nervous system initiates the FIGHT OR FLIGHT RESPONSE., preparing the body to either fight off the stressor or to run away from it. Hormone levels rise to prepare the body to react called the SHOCK PHASE + is characterized by an increase in energy levels, oxygen intake, cardiac output, blood pressure and mental alertness. During the 2nd phase of the alarm reaction, countershock, there is a reversal of body changes.
- ) STAGE OF RESISTANCE: Adaptation to the stressor. Vital signs, hormone levels and energy production return to normal. If the stress can be managed or confined to a small area (LAS), the body regains homeostasis. If the damage is too great, the adaptive mechanisms become exhausted.
- ) STAGE OF EXHAUSTION. Results when the adaptive mechanisms can no longer provide defense. Without defense against the stressor, the body may either rest and mobilize its defenses to return to normal or reach total exhaustion and die.
Psychological Homeostasis + 4 Types
- Each person needs to feel loved and a sense of belonging to feel safe and secure and to have self esteem. When these needs are not met or a threat to need fulfillment occurs, homeostatic measures in the form of coping or defense mechanisms help return the person to emotional balance.
- Everyone frequently encounters physical, psychological and social changes in their internal and external environments. A perrson’s perception of these changes may be conscious or unconcious. if the person has the necessary resources, adapation takes place and balance is maintained. If the resouces cannot be reestablish balance, a state of stress results. The person’s responses and the degree of stress depend in part on the nature, intensity, timing, number and duration of stressors.
4 Types:
- ) MIND-BODY Interaction
- ) ANXIETY
- ) COPING MECHANISM
- ) DEFENSE MECHANISM
Mind-Body Interaction
- There is a relationship between psychological stressors and the physiologic stress response (GAS).
- It is thought that humans react to threats of danger as if they were physiologic threats. A person perceives the threat on an emotional level and the body prepares itself either to resist the danger or to run away from it (the flight or flight response).
- With prolonged stress, some may develop chronic diarrhea while others may develop nausea or heart palpitations. Such Illnesses are real and are called PSYCHOSOMATIC DISORDERS because they physiologic alterations are thought to be at least partially caused by psychological influences.
- Researchers have found that the number of changes a person has in one’s life (both positive + negative) can be correlated with illness. When energy is expended to adapt to the event, the person’s resistance to illness is lowered.
Anxiety + its 4 Levels
The most COMMON response to stress
- A vague, uneasy feeling of discomfort or dread from an often unknown source
- A feeling of apprehension caused by anticipating danger and enables the person to take measures to deal with a threat.
- In contrast, FEAR is a response to a KNOWN threat.
4 Levels of Anxiety:
- ) MILD: Present in day to day living. It increases laertness and perceptual fields and motivates learning and growth. It may interfere with sleep but it also facilitates problem solving. Manifested by restlessness and increased questioning.
- ) MODERATE: Narrows a person’s perceptual fields so that the focus is on immediate concerns, with inattention to other communications and details. Manifested by a quavering voice, tremors, increased muscle tension , “butterflies in the stomach” and slight increases in respirations and pulse.
- ) SEVERE: Creates a vary narrow focus on specific details, causing all behavior to be geared toward getting relief. The person has impaired learning ability and is easily distracted. Is characterized by extreme fear of a danger that is NOT real., by emotional distress that interferes with everyday life and by avoiding situations that cause anxiety. Manifested by difficulty communicating verbally, increased motor activity, etc. At this point, anxiety is no longer functioning as a signal for danger or motivated by a needed change but results in MALADAPTIVE behaviors
- ) PANIC: Causes the person to lose control and experience dread and terror. The person is unable to learn, concentrates only on the present situation and often experiences feelings of impending doom. Can lead to exhaustion and death.
Coping Mechanisms
- Anxiety that is managed unconsciously
- Behaviors used to decrease stress and anxiety
- Many are learned based on one’s family, past experiences and sociocultural influences and expectations
Includes:
- Crying, laughing, sleeping and cursing
- Physical activity, exercise
- Smoking, drinking
- Lack of eye contact, withdraw
- Limiting relationships to those with similar values and interests
- Moderate, severe and panic levels of anxiety are greater threats and involve more complex coping mechanisms and are categorized as task-oriented reactions that involve consciously thinking about the stress situation and then acting to solve problems, resolve conflicts or satisfy needs and include attack behavior, withdraw and compromise
Defense Mechanisms
- An unconscious reaction to stressors
- These mechanisms protect one’s self esteem and are useful in mild to moderate anxiety
- When extreme they distort reality and create problems with relationships. At that point, they become maladaptive instead of adaptive.
crisis
a disturbance caused by a precipitating event, such as a perceived loss, a threat of loss, or a challenge, that is perceived as a threat to self. may be maturational, situational, or adventitious.
maturational crisis
occur during developmental events that require role change, such as when a teenager transitions into adulthood.
Situational crises
occur when a life event disrupts a person’s psychological equilibrium, such as loss of a job or death of a loved family member.
effects of stress on basic human needs
physiologic - change in appetite, activity, or sleep
safety/security - feels threatened or nervous. uses ineffective coping mechanisms. is inattentive.
Love/belonging - is withdrawn and isolated. blames others for own faults. demonstrates aggressive behaviors. becomes overly dependent on others.
self-esteem - become a workaholic. exhibits attention-seeking behaviors.
self-actualization - refuses to accept reality. centers on own problems. demonstrates a lack of control.
factors that affect stress
developmental and situational
developmental stress
occurs as a person progresses through the normal stages of growth and development from birth to old age.
examples - infant learning to trust others
toddler learning to control elimination
school-aged child socializing with peers
adolescent striving for independence
middle-aged adult accepting physical signs of aging
older adult reflecting on past life experience with satisfaction
situational stress
does not occur in predictable patterns as one progresses through life. can occur at any time, although the person’s ability to adapt may be strongly influenced by his or her developmental level.
example - illness or traumatic injury marriage or divorce loss - belonging, relationship, etc new job role change
type of stressors
physiologic, psychosocial, personal factors
psychosocial stressors
- ) Accidents, causing stress for the vicim, the person who caused the accident and the efamilies of both
- ) Stressful or traumatic experiences of family members and friends
- ) Horrors of history
- ) Fear of aggression or mutilation, such as muggings, rape, murder and terrorism
- ) Events of history that are brought into our homes through television such as wars, earthquakes and violence in schools
- ) Rapid changes in our world and the way we live, including changes in economic and political structures and rapid advances in technology
almost an infinite variety.
physiologic stressors
have both a specific effect and a general effect. the specific effect is an alteration of normal body structure and function. the general effect is the stress response. primary physiologic stressor includes chemical agents, physical agents, infectious agents, nutritional imbalances, hypoxia, and genetic or immune disorders.
personal factors
one physiologic reserve and genetic inheritance are important in maintaining homeostasis and adapting to stressors.
