Understanding Stress: Side Effects and Reactions

Side Effects of Stress

• The brain's initial response to a demand or challenge
• The hypothalamus initiates chemical releases, activating the sympathetic nervous and adrenal-cortical systems
• "Fight-or-flight" response can be triggered

Stress Reaction

• Can manifest as increased heart rate, blood pressure, breathing rate, tensed muscles, sweating, and digestive issues like nausea, diarrhea, or constipation
• May result in weakened immune system, emotional and behavioral reactions (anxiety, depression, irritability, and altered eating/sleeping patterns)
• Reactions vary from person to person, with activation of the sympathetic nervous system

Stress vs. Anxiety

• Stress is the body's response to external pressures or threats
• Stress results in physiological and emotional reactions that can be acute or chronic
• Anxiety is a heightened state of arousal and worry, not always linked to a clear external cause
• Anxiety includes persistent and excessive worry

Generalized Anxiety Disorder (GAD)

• Most commonly diagnosed in women
• Characterized by excessive worrying about everyday events and activities
• Lasts over 6 weeks to months and hinders ability to function

GAD Treatments

• SSRIs like paroxetine, escitalopram, citalopram, fluoxetine, and sertraline act as antidepressants to regulate mood and reduce anxiety
• SNRIs such as duloxetine and venlafaxine
• Benzodiazepines like alprazolam (short-term), diazepam (acute, short-term), lorazepam, and chlordiazepoxide enhance GABA and calm the brain
  • Short-term use is advised because chronic use can cause dependence and severe withdrawal
• Buspirone acts as an anxiolytic to regulate mood and anxiety
• Other options include beta blockers (propranolol), gabapentin, antihistamines, anticonvulsants, and antipsychotics
• Psychotherapy, including behavioral therapy (teaching ways to decrease anxiety) and cognitive behavioral therapy (combining cognitive therapy with behavioral therapies)
• Acceptance & Commitment therapy (ACT) involves accepting thoughts and feelings rather than trying to eliminate them
• Intrapersonal therapy explores how intrapersonal relationships impact mental health.
• Self-help strategies: Exercise, recreation therapy, and stress management
• Client education and counseling

Panic Attack Nursing Care

• Stay with the patient
• Encourage slow breathing and grounding techniques
• Avoid stimulants
• Use 5-4-3-2-1 grounding technique
• Help identify anxiety triggers, anticipate situations, and use nonverbal communication skills
• Encourage the patient to express feelings/concerns, maintain a calm manner, and use low-pitched, slow, simple repetition statements

Benzodiazepines Effects

• Commonly used to treat somatic and psychological symptoms of anxiety disorders
• Quick onset of action but have the potential for dependence, so only to be used for short time
• Monitor for side effects like sedation, ataxia, decreased cognitive function, dizziness, and respiratory depression
  • Report paradoxical reactions (opposite of intention), agitation, talkativeness, and loss of impulse control
• Not recommended for substance abuse patients and carefully weigh pros/cons for pregnancy

Schizophrenia Phases

• Prodromal phase is the first phase
  • Gradual onset of non-specific behaviors like changes in sleep, suspiciousness, decreased attention to ADLs, disconnection, depressed mood, irritability, and problems with focusing/understanding
  • Can last for weeks up to 7 years
• Acute phase involves active psychotic symptoms and exhibiting positive and negative symptoms
• Recovery phase includes the quiet diminution of active symptoms
  • Depression can emerge, including being socially withdrawn, and conceptual disorganization
• Maintenance phase
  • Long-term management and functional recovery

Schizophrenia Delusional Disorder & Genetics

• No biomarkers to assist in diagnosis
• Diagnosed in 1% general population (more common in males aged 15-25)
• Delusions that last 1 month or longer (grandiose, persecutory, somatic, or referential themes)
• 80% risk due to genetics
• Can be multifaceted, from genetic/biological factors to environmental factors like starvation, social determinants (lower socioeconomic class), or health (city, childhood, trauma, cannabis use, stressful life events)
• Utero stress may alter neurodevelopment by impacting glutamate receptors

Schizophrenia Disorganized Thoughts

• Associative looseness, including haphazard and illogical thinking (poor concentration, loosely connected thoughts)
• Switches from one thought to another (example: "I like hotdogs. Look at my cat.")
• Word salad (doesn't make sense), a jumble of words meaningless to the listener
• Clang associations (rhymes), based on the sound of words involving words that rhyme
• Neologisms (making up words) have meaning to the patient but not the listener
• Echolalia (repeating everything you say) where the patient cannot generate their own words
• Tangentiality answers question indirectly, wandering off topic or going off on tangents and not reaching a point
• Concrete thinking (lack abstract thinking), literal interpretation ideas/stimuli
• Critical thinking delays point, includes random, tedious/unnecessary details

Schizophrenia vs. Medical Issues

• Rule out substance abuse, neuro disorders, and metabolic disorders before diagnosing schizophrenia

First Generation Antipsychotics Side Effects

• High risk for Extrapyramidal Symptoms (EPS)
• Sedation and anticholinergic effects
• Orthostatic hypotension, seizures, photosensitivity, sexual dysfunction, amenorrhea, gynecomastia, weight gain
• Neuroleptic Malignant Syndrome & Prolonged QT

Extrapyramidal Side Effects (EPS)

• Acute Dystonia: Muscle spasms, rigidity
• Akathisia: Restlessness, pacing
• Parkinsonism: Tremors, rigidity, bradykinesia Tardive Dyskinesia: Involuntary facial/tongue movements

Delusion Types

• Grandiose: Belief of special powers or identity
• Persecutory: Belief of being targeted or harmed
• Erotomanic: Belief someone (often famous) is in love with them

Hallucination Types

• Auditory (most common): Hearing voices or sounds
• Visual: Seeing nonexistent things
• Tactile: Feeling things on skin

Bipolar Disorder and Mood

• Alternating periods of mania, depression and stability

Mania Signs and Symptoms

• Severe or intense mood and disturbances
• Persistent elevation, expansiveness, and irritability
• Elevated mood including euphoria and grandiosity
• Hyperactivity (decreased need for sleep, impulsivity, pressured speech, racing thoughts)
• Increased energy / goal directed activity or energy

Lithium Side Effects

• Early signs include GI issues (metallic taste, N/V/D), fine hand tremors, generalized weakness, thirst, and polyuria
• Moderate toxicity (1.5 mEq/L) includes coarse tremors, confusion, muscle hyperirritability (twitching), and unsteady gait
• Severe toxicity/overdose includes seizures, coma, oliguria or anuria (reduced/absent urine output can lead to kidney failure), and arrhythmias
• Therapeutic range: 0.8-1.2 mEq/L
• Maintenance Range: 0.8-1.0 mEq/L
• Toxic Range: Over 1.5-2.0 mEq/L

Lithium Blood Levels

• Therapeutic range: 0.8-1.2 mEq/L
• Maintenance Range: 0.8-1.0 mEq/L
• Toxic Range: Over 1.5-2.0 mEq/L

Cultural Intrapersonal Zones/Spaces (SATA)

• Intimate space (partners, core family; less than 1.5 feet)
• Personal space (friends, extended family; 1.5 - 4 feet)
• Social space (acquaintances, colleagues; 4 -10 feet)
• Public space (passers-by, strangers; more than 10 feet)

Culturally Sensitive Nursing Intervention/ Assessment

• Use the "Four Cs of Culture" model (Consider, Cause, Cope, Concern) when understanding the patient's perspective on their health condition
• Respect beliefs by using interpreters if needed and avoiding stereotypes
• Introduce yourself while standing an arm's length away from client
• Observe the client and family for eye contact, space, touch and other nonverbal behavior, following their lead
• Note language used and determine if an interpreter is needed
• Ask about health beliefs, preferred treatments, and decision-making roles

Herbal Supplements

• Kava Kava can worsen liver disease
• St. John's Wort interacts with SSRIs, posing a risk of serotonin syndrome

Nursing Cultural Competence (SATA)

• EBP that uses cultural values, beliefs, worldview, and practices of clients to improve client outcomes
• Nurses must combine knowledge and skills with awareness, curiosity, and sensitivity to client's cultural beliefs

Eastern Culture

• Family basis for identity, helps make decisions
• Deep personal connection to natural world and the tribe
• Body-mind-spirit one entity
• Time is circular and recurring, reincarnation
• Born into a fate; duty to comply
• Disease caused by fluctuations in opposing forces, lack of balance (yin and yang, hot and cold) Imbalance in daily routine, diet

Health Equality

• Nurses treat all clients as individuals and show respect for their dignity
• Equal treatment and support for all individuals
• Social justice that enables everyone to have a fair opportunity to obtain optimal health

Suicide Nursing Action

• Assess risk factors, ensure safety, and implement 1:1 observation if needed
• Create a safety plan
• Establish a therapeutic relationship
• Provide education and support

Therapeutic Nursing Skills in Court Ordered Treatment

• Ensure compliance, document behaviors, educate on rights
• Initiate direct care for client admission, treatment record, and care planning
• Demonstrate delegation to mental health workers
• Monitor safety
• Act as a liaison between client and members of the care team
• Collaborate with a pharmacist for medication management

Mental Health Staff Debriefing

• Process distressing events, improve coping
• Violent incidents are critical events and followed by debriefing
• Focused, purposeful discussion enhances education or informs improvements (debriefing) Provides help to staff process to event for coping and recovery
• Offer resources for further assistance in order to prevent post-traumatic stress and burnout
• Review all elements and areas needing improvement
• Consider client perspective and offer staff emotional support as needed, including expressive outlets for feelings, fears, and learning needs

Mental Health Hospital Admission Status

• Voluntary Admission requires patient consent to care and agreement to treatment and cannot be an immediate threat to themselves or others (free to leave at any time)
• Involuntary admission is based on danger to self/others
• Includes inpatient or outpatient procedures
• Confined against their will and may be held for up to 72 hours/court/case determines of the hold should continue

Assault-Patient

• Assess for aggression and implement de-escalation techniques
• Includes intention tort

Protected Health Information (PHI)

• HIPAA regulations protects confidentiality unless there is danger to self/others
• PHI includes information in medical records that can identify a patient

Ethical Principles of Nursing (SATA)

• Autonomy: Right to make own decisions
• Beneficence: Do good
• Nonmaleficence: Do no harm
• Justice: Fair treatment
• Fidelity: Keep commitments