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Mental health and stress - Chapter 13

Terms in this set (57)

stress
natural part of life
-associated with development or exacerbation of symptoms of mental illness
-approached from several overlapping theoretical perspectives: physiologic, psychological, social
Postive stress experience
helps develop successful coping skills
Negative stress experience
can result in negative mental & physical health consequences
Biologic perspective of stress
-Homeostasis VS Allostasis
-Acute Stress
-Chronic stress
Homeostasis
body's tendency to resist physiologic change and hold bodily functions relatively consistent, well-coordinated & usually stable
Allostasis
dynamic regulatory process that maintains homeostasis through a process of adaptation
Acute stress
-intense biopsychosocial reaction to a threatening event
-usually time limited
-can lead to physiologic overload
-"fight or fight" response
Fight or flight SNS effect
-increase serum glucose
-Increase cardiac output & blood pressure
-increased oxygen tension & hematocrit
Fight or flight purpose
-increased energy
-increased blood flow
-increased supply of oxygen in blood
fight or flight response PNS effect
-decreased sexual & sex hormone activity
-decreased growth, repair & maturation
-decrease digestion, assimilation & whole food distribution
Chronic stress
-oncoming physiologic reaction to events resulting in "wear and tear" on body
-negatively impacts health and well-being
-maladaptive when prolonged
-contribute to risk for illness
-General adaptation syndrome (GAS)
General Adaptation Syndrome (GAS)
-Eustress
-distress
Eustress
stress evoked by positive beneficial energy that motivates and results in feelings of happiness, hopefulness & purposeful movement
Distress
stress evoked by negative draining energy that results in anxiety, depression, confusion, helplessness, hopelessness & fatigue
Allostatic Load
consequence of wear and tear on body and brain leads to ill health
Consequences of chronic stress
-suppress immune system
-sustained activation of SNS
-impairment in memory, immunity, cardiovascular metabolic function
-compromises health
-increase susceptibility to illness
Chronic stress and mental health
-Apply diathesis-stress model
-Genetic predisosition increase susceptibility of developing disorder
-Adverse effects during childhood increase risk of mental disorder in adulthood
-stress reduction leads to positive mental health
Diathesis- stress model
Theory that attempts to explain a disorder as the result of an interaction between predispositional vulnerability (diathesis) and stress caused by life experiences
C
The PMHRN is assessing a new patient who has recently been admitted to the inpatient psychiatric unit. Which factor should alert the nurse to the possibility this patient has experienced chronic stress?
A. Decreased WBC count
B. Apparent inactive HPA axis
C. History of multiple infections
D. Decreased hormone levels
Psychosocial Perspective of stress
-transactional stress model
Transactional stress model
-describes psychological experience of stress
-stress is an interactive process between real or perceived internal or external environmental demands
Appraisal
-consideration of demands, constraints, resources and personal goals and beliefs
primary appraisal
-evaluation of events as a threat, harm or challenge
-Goal relevant?
-Goal consistent with values and beliefs ?
-Personal commitment?
secondary appraisal
explanation of outcome of events
values and goals
-cultural, ethnic, family, religious values
-individualized
- the more important the goal or more difficult the goal is to obtain increases stress
-positive emotions
Type A personality
-competitive
-aggressive
-ambitious
-impatient
-alert
-tense
-restless
Type B personality
-relaxed
-easygoing
-easily satisfied
Type C personality
-introverted
-respectful
-conforming
-complaint
-eager to please
Type D personality
-increased negative emotions
-pessimism
-non-sharing or emotions
Social support
-Three functions: emotional support, Tangible support, informational support
-Enhances health outcomes
-Reduces mortality
Social support cultural factors
-expectations and role strain
-violate group values VS individual needs
Social support employment factors
-significant beyond economic compensation
-Unemployment vey stressful
Social support Gender influences
expectations of women VS men
Life events
-Can affect individual
-recent life changes questionnaire
-Relationship between recent life changes and severity of near-future illness
-likelihood of illness is greater if several life changes occur in short period of time
emotional responses to stress
-Psychophysiologic reactions that define a persons mood
-Categories: Negative, Positive, Borderline
Negative emotional responses to stress
-anger
-fright
-anxiety
-guilt
-shame
-sadness
-envy
-jealousy
-disgust
Positive emotional responses to stress
-happiness
-pride
-relief
-love
Borderline emotional responses to stress
-Hope
-Compassion
-Empathy
-Sympathy
-Contentment
Themes that summarize dangers or benefits
-anger
-fright
-anxiety
-guilt
-shame
-sadness
-envy
-jealousy
-disgust
-happiness
-pride
-relief
-love
-Compassion
Coping
-deliberate, planned psychological effort to manage stressful demands
-no one strategy is best for all situations
-some situations require combination of strategies and activities
-Reappraisal provides feedback on strategies
Problem focused coping
identify and eliminate the source of stress
emotion focused coping
reduce stress by interpreting the situation to change its meaning
Adaptaion
-persons capacity to survive and flourish
-effect on 3 important areas: Health, Psychological well-being, & Social Functioning
Healthy coping
using strategies to reduce stress and promote longterm health. EX: exercise, sleep & nutrition
Psychological well being
-Ideal outcome= feeling good about how stress is handled
-Everyone responds differently
- +/- outcomes
Social functioning
-can be seriously impaired during stressful events
- Negative emotions = impaired
- Positive emotions = positive
Physical assessment
-review of systems
-Physical functioning
-Pharmacologic assessment
Pharmacologic assessment
-addictive substances
-prescriptions
-over-the-counter
-Herbs
Psychosocial assessment
-focus on emotions and severity
-coping strategies
therapeutic communication techniques
-negative VS positive emotions
-problem-focused or emotion-focused coping
-Recent life changes questionnaire
-social network
-size & extent of social network
-functions network serves
-degree of reciprocity between pt & network members
-degree of interconnectivity
Priorities of nursing care
-depend on pts response to stress
-could focus on reestablishing basic functional patterns
-may focus on psychological issues
-focus on coping skills
Nursing interventions
-focus on supporting healthy behaviors
-nutrition
-exercise
-relaxation techniques
-improve coping skills
-distraction or guided imagery
-spiritually oriented interventions
psychosocial nursing interventions
-problem solving
-family interventions
Evaluation & treatment outcomes
-initial plan of care guides evaluation
-individual, family, network outcomes
mild anxiety
ones ability to understand information may actually increase
moderate anxiety
-decrease problem-solving skills & may hamper ability to understand info.
-VS may increase & pt appears visibility anxious
Severe anxiety
-restlessness
-decreased perception
-inability to take direction
Panic anxiety
-completely distracted
-unable to function
-disoriented
-may lose touch with reality
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