Stress, NRSG3301, Crystal Treige, Winter 2024 PDF

Stress C LASS NRSG3301 C RYSTAL TREIGE MN NP PRESENTATION CREATED BY C. TREIGE 2024 Concept(s) & Exemplar(s) Concept(s): Stress Exemplar(s): Traumatic injury, physical disability, & change in health status Sudden infant death syndrome...

Stress C LASS NRSG3301 C RYSTAL TREIGE MN NP PRESENTATION CREATED BY C. TREIGE 2024 Concept(s) & Exemplar(s) Concept(s): Stress Exemplar(s): Traumatic injury, physical disability, & change in health status Sudden infant death syndrome PRESENTATION CREATED BY C. TREIGE 2024 Stress Stress refers to an internal or external event or demand of life experienced by the individual that is perceived and appraised for scope and meaning on a continuum to determine whether resources and abilities for management are available, exceeded, or exhausted. ◦ Stress is a common topic in society. The term stress is frequently used to describe a feeling of pressure or emotional strain from life’s demands, perceived events, and stimulus. ◦ The experience of stress involves cognitive appraisal, perception, physiological and psychological manifestations, feelings, and symptoms (Giddens, 2021) PRESENTATION CREATED BY C. TREIGE 2024 Matching Key Terms 1. Cognitive appraisal a) Describes the body’s short-term and 2. General adaptation syndrome long-term reactions to stress 3. Coping b) Condition in which all competing elements are in balance 4. Equilibrium c) Individual’s perception regarding how stressful an event is or will be d) Cognitive and behavioral efforts to manage stress PRESENTATION CREATED BY C. TREIGE 2024 Scope of Stress No stress Challenging Threatening Experience is Experience is perceived as Experience is perceived as easily manageable but requires perceived as taxing; manageable, and mobilization exceeds existing equilibrium is not of resources; is not resources; causes disrupted. harmful, and equilibrium disruption to is maintained. equilibrium; can impact health. PRESENTATION CREATED BY C. TREIGE 2024 Self-Analysis of Stress Response Collaborative Learning #1 In your learning groups, share a time you or someone you know experienced a challenging stressor and a situation of alarm. What measures were taken to manage the situation? PRESENTATION CREATED BY C. TREIGE 2024 Stress PRESENTATION CREATED BY C. TREIGE 2024 Physiology and the Stress Response Central nervous system Limbic system Sympathetic nervous system Endocrine system PRESENTATION CREATED BY C. TREIGE 2024 Sympathetic Nervous System Response to Stress (Giddens, 2021) PRESENTATION CREATED BY C. TREIGE 2024 Effects of Stress on the Body Decreased immune functions Hypertension Atherosclerosis Increase platelet reactivity Abdominal obesity Bone demineralization Atrophy of neurons in hippocampus and prefrontal cortex ** Increased activity of amygdala (Giddens 2021) PRESENTATION CREATED BY C. TREIGE 2024 Variations and Context SOURCES OF STRESS TYPES OF STRESS Physiological Acute Psychological/Emotional Episodic Chronic PRESENTATION CREATED BY C. TREIGE 2024 Stress Lifespan and cultural considerations: Young children - unable to identify specific emotions (lack ability to cope with crisis and trauma) Older adults - may be resistant to expressing emotions (private matters) Some cultures – pain and sorrow = weakness ** Response varies throughout the lifespan and with cultures** PRESENTATION CREATED BY C. TREIGE 2024 Consequences of Stress Central nervous system Central nervous system Immune system Musculoskeletal system Gastrointestinal system Integumentary system PRESENTATION CREATED BY C. TREIGE 2024 Clinical manifestations Difficulty problem solving Intense emotional reaction Disorganized thought process with Increased sensory input and difficulty processing information bombardment Disorientation Hypervigilence Vulnerability Intense physical reaction depicted in the flight-or fight response Increased tension and helplessness By definition, event usually is time limited and resolves within 6 weeks (Giddens, 2021) Fearful and sense of being overwhelmed PRESENTATION CREATED BY C. TREIGE 2024 Populations at Greatest Risk Collaborative Learning #2 In your learning groups, identify and discuss the populations at greatest risk for stress. Include a rationale. Population Group Rationale PRESENTATION CREATED BY C. TREIGE 2024 Recognizing Stress Collaborative Learning #3 In your learning groups, create a list of common symptoms and clinical findings associated with challenging and threatening stress. Discuss why each symptom or clinical finding occurs from a physiological perspective. Symptom/Clinical Finding Rationale PRESENTATION CREATED BY C. TREIGE 2024 Assessing Stress History (past medical hx., current conditions, current medications) Individual’s appraisal of the stressor “What is the meaning of this event for you?” It is also important to ask the individual how he or she has coped with stressful events in the past. For example, did this person seek support from another person? Did he or she turn to alcohol or other substances? Learning the individual’s perception of the effectiveness of these coping behaviors helps to gain insight into the strengths and/or weaknesses of the individual’s coping patterns. (Giddens, 2021) PRESENTATION CREATED BY C. TREIGE 2024 Examination Findings Usually consistent with SNS activation Acute phase (tachycardia, irregular heart rate, elevated Bp, tachypnea, excessive sweating, dilated pupils, muscle tension) Findings may not be present with chronic stress Ensure cardiac, respiratory, MSK and neuro systems complete General observations (personal appearance, grooming, facial expressions and affect) PRESENTATION CREATED BY C. TREIGE 2024 Clinical Management: Primary Prevention Stress management and reduction techniques Counseling Maintenance of positive relationships Family, friends, social networks, and others Maintenance of optimal health Wellness programs Health education PRESENTATION CREATED BY C. TREIGE 2024 Clinical Management: Secondary Prevention and Screening Collaborative Learning #4 What are examples of screenings for stress across the lifespan? What is the appropriate situation during which to use these? PRESENTATION CREATED BY C. TREIGE 2024 Stress What you can do… 1. Make contact and connect with the individual 2. Assess immediate safety needs 3. Determine thought processes 4. Scan for physical distress 5. Listen intently, supporting emotional reactions 6. Explore perceptions of the crisis 7. Identify coping strengths] 8. Develop a support and a follow-up plan (Giddens, 2021) PRESENTATION CREATED BY C. TREIGE 2024 Interventions Therapeutic lifestyle change Music therapy Relaxation strategies Complementary and alternative therapies Fostering social supports Exercise Education PRESENTATION CREATED BY C. TREIGE 2024 Maladaptive Coping Responses Use/Abuse of alcohol and/or other substances Smoking Excessive eating Denial Withdrawal Avoidance (Giddens, 2021) PRESENTATION CREATED BY C. TREIGE 2024 Pharmacological Therapy Anxiolytics Hypnotics Antidepressants Psychotherapeutics Muscle relaxants Antimigraine agents Selective serotonin reuptake inhibitors (SSRIs) (older adults) PRESENTATION CREATED BY C. TREIGE 2024 Counseling Consists of individual or group therapy and includes multiple techniques including: Cognitive behavioral therapy Meditation Relaxation techniques and massage Time management Health education (Giddens, 2021) PRESENTATION CREATED BY C. TREIGE 2024 Interrelated Concepts Collaborative Learning #5 In your learning group, write a short case involving a person who is experiencing multiple stressors that are perceived as a threat. Develop a concept model showing the interrelationships of the concepts. PRESENTATION CREATED BY C. TREIGE 2024 Interrelated Concepts PRESENTATION CREATED BY C. TREIGE 2024  Communicating Difficult Information ◦ Greet individual with warmth, a kind smile (only if appropriate), and an introduction. ◦ Inform them that you are there and will assist during this difficult time. ◦ Provide privacy, tissues, a drink, and a place to sit down to discuss the information. ◦ Inquire about what they know, answer questions, and provide support. ◦ Apprise them of the current circumstances in terms that they can understand (Giddens, 2021) PRESENTATION CREATED BY C. TREIGE 2024 COMMUNICATION Respond to their feelings and offer support. Ask what they need from you and what has helped in the past to cope with difficult situations. Incorporate cultural and religious practices of the individual in crisis to provide comfort. Inform them you will facilitate communication and provide direction about the best means of accessing information. Focus on the immediate reaction and needs of the individuals in crisis. Write down specific contact numbers and instructions. Check back with them as needed to see how they are doing (Giddens, 2021) PRESENTATION CREATED BY C. TREIGE 2024 Traumatic Life Event Many patients suffer unnecessary stress when they do not receive adequate attention for all the symptoms/concerns accompanying their traumatic injury/change in health status. Careful evaluation of the client should include: Physical concerns Psychosocial concerns Spiritual concerns (Giddens, 2021) PRESENTATION CREATED BY C. TREIGE 2024 Traumatic Life Event Nurses are responsible for Educating patients and families Supporting patients and families Clarifying patient’s values (decision-making about treatments) (Giddens, 2021) PRESENTATION CREATED BY C. TREIGE 2024 Traumatic Life Event Throughout the course of a traumatic injury/change in health status, clients and their families will encounter Complicated treatment decisions Bad news Many emotional responses (Giddens, 2021) PRESENTATION CREATED BY C. TREIGE 2024 Traumatic Life Event When clients and families receive bad news: Interpret the technical information necessary for making decisions without hiding behind medical jargon Realize that when the client needs to talk may be when it is least convenient for you Be fully present during any opportunity for communication (this is often the most helpful form of communication) Allow the client and family to set the agenda regarding the depth of the conversation (Giddens, 2021) PRESENTATION CREATED BY C. TREIGE 2024 EFFECTIVE LISTENING Resist the impulse to fill the “empty space” in communication with talk. Allow the client and family sufficient time to reflect and respond after asking a question. Prompt gently: “Do you need more time to think about this?” Avoid distractions (noise, interruptions). Avoid the impulse to give advice. Avoid canned responses: “I know just how you feel.” Ask questions. Assess understanding – your own and the client’s – by restating, summarizing, and reviewing. (Giddens, 2021) PRESENTATION CREATED BY C. TREIGE 2024 SPIRITUALITY May contain features of religiosity, but the two concepts are not interchangeable. Highly personal (who we are, who we want to be, what we value, etc.) Signs that may indicate spiritual distress include the following: Questions of religious faith and beliefs (e.g. – “Why would God allow this to happen to me?”) Other difficult questions, such as “Why is this happening to me?” Expressions of anxiety, hopelessness, guilt, shame, failure, remorse, and/or regret Feelings of abandonment (Giddens, 2021) PRESENTATION CREATED BY C. TREIGE 2024 Communication Exercise Groups of 2 1. One student to talk and the other student to listen. 2. Talkers speak for 3 minutes about a significant problem that concerns them and they are willing to share. NO interruption 3. The listener should provide empathic nonverbal support (nodding, looking attentive, touching etc.) 4. At the end of 3 minutes the listener should make a short affective, empathic statement that summarizes his/her understanding of the talker's experience. NEXT: Switch roles. PRESENTATION CREATED BY C. TREIGE 2024 Communication Exercise What it was like to Listen for 3 minutes without interrupting Talk for 3 minutes without interruption What were: Effective nonverbal empathic actions Ineffective nonverbal empathic actions Effective verbal empathic actions Ineffective verbal empathic actions (Giddens, 2021) PRESENTATION CREATED BY C. TREIGE 2024 SUDDEN INFANT DEATH SYNDROME (SIDS) “…the sudden death of an apparently healthy infant that remains unexplained after other possible causes have been ruled out through autopsy, death scene investigation, and a review of the medical history.” (p. 1024) Most common 2-4 months 95% before 6 months > boys > low birth weight > low SES No single pathological cause has been identified In Canada, from 2015 to 2020, there were approximately 1,700 deaths per year among infants under the age of 1. On average, 1 in 15 (110) of these deaths occurred while the infant was sleeping (Stats Canada, 2021). PRESENTATION CREATED BY C. TREIGE 2024 Risk Factors INTRINSIC EXTRINSIC genetic predisposition (breathing and arousal), prone sleeping position male gender bed sharing prematurity, protective brain centers are use of soft bedclothes or mattresses immature putting the infant to sleep on upholstered furniture prenatal exposure to cigarette smoke or alcohol or adult mattresses exposure to cigarette smoke PRESENTATION CREATED BY C. TREIGE 2024 CLINICAL MANIFESTATIONS The principal manifestation of SIDS is silent death. The child may be found in any position. No warning signs Struggle to change positions Frothy, blood tinged secretions from the mouth and nares Diagnostic Evaluation Diagnosis is confirmed through autopsy. A medical history of the infant and family should be taken. The infant is examined for signs of illness or trauma. The death scene is also investigated. PRESENTATION CREATED BY C. TREIGE 2024  Education Eliminating maternal smoking Positioning-Back to sleep campaign 50% decrease Sleep environment [should monitor for overheating] Eliminating bed-sharing [increases the risk] Breastfeeding [reduces risk of SIDS by 50%] Pacifiers Immunizations PRESENTATION CREATED BY C. TREIGE 2024 Assessment Family Centered To ER confused Assess knowledge of the situation, emotional status, and coping strategies Plan teaching and support Calm, slow, and non-threatening manner Never imply negligence or any involvement in the death Slow to comprehend and answer, may need t repeat Give them time PRESENTATION CREATED BY C. TREIGE 2024  INTERVENTIONS Calm and compassionate support, coping with many emotions: guilt, anger, and emotional pain. Provide a quiet room, dim lighting and a chair. Someone remain with them to assist with calls to family, friends, or clergy. The nurse should accompany the physician when the parents are informed of the child’s death. Provide the opportunity to say good-bye to their child. Make sure you offer. PRESENTATION CREATED BY C. TREIGE 2024 EVALUATION Is the family able to verbalize feelings associated with the death of the child? Has the family joined a support group or identified a support system? Has the extended family mobilized to support the family? Is the family using effective coping skills to work toward an understanding of the child's death? **Evaluation may not occur during the initial trauma PRESENTATION CREATED BY C. TREIGE 2024 EXPECTED OUTCOMES The parents and family will verbalize feelings related to the death of the infant. The parents and family will identify strengths and accept support of other family members, friends, professionals, and support groups. The parents will verbalize an understanding of the cause of their child's death. PRESENTATION CREATED BY C. TREIGE 2024 References Buchanan,L.(2017).Chapter31:Stress.In J. Giddens(Ed.),Concepts for nursing practice, 2nd edition (pp. 301-308).St.Louis,MO: Elsevier. Cataletto,M. (2012).Loweringtheriskof SIDS.NursingMadeIncrediblyEasy!,10(1), 55-56. Day,R,Paul,P.,Williams,B.,Smeltzer,S.,&Bare,B.(2010).Brunner & Suddarth's textbook of Canadian medical-surgical nursing (2nded.,2ndCanadianed.).Philadelphia:WoltersKluwer/LippincottWilliams& Wilkins. Giddens, Jean F. Concepts for Nursing Practice. Available from: Pageburstls, (3rd Edition). Elsevier Health Sciences (US),. Roberts,A., &Ottens,A(2005).Theseven-stagecrisisinterventionmodel:Aroadmapto goalattainment, problemsolving,andcrisisresolution.Brief Treatment and Crisis Intervention, 5(4), 329-339. Jakubec,S..(2014).Chapter24:CrisisandDisaster.In C.Pollar,S.Ray,&M. Haase(Eds.),Varcarolis's Canadian Pyschiatric Mental Health Nursing: A Clinical Approach (pp.491-508).NewYork,NY:Springer. Trakalo,K.., Horowitz,L.,&McCulloch,A., (Eds.)(2015).Module 31:StressandCoping.In Nursing: A concept-based approach to learning, Vol. 1& 2. (pp.1895-1916&1927-1934).Boston,MA: Pearson Education. Vincenzi,F.(2017).Thepathophysiologyof stress.Retrievedfrom https://depts.washington.edu/abrc/stress/vincenzi.pdf PRESENTATION CREATED BY C. TREIGE 2024