NURS 2003H Nursing Therapeutics Lecture 1 PDF

WEEK 1 Lecture NURS 2003H NURSING THERAPEUTICS THE CONCEPT OF STRESS Dr. Victoria Reid-de Jong  1 2 3 4 Discuss the Examine the three Explore the role of Describe definition and...

WEEK 1 Lecture NURS 2003H NURSING THERAPEUTICS THE CONCEPT OF STRESS Dr. Victoria Reid-de Jong  1 2 3 4 Discuss the Examine the three Explore the role of Describe definition and stages of Selye’s the nervous and physiological theories of stress. general adaptation endocrine systems in effects of stress and syndrome. the stress process. strategies to manage stress. TODAY’S OBJECTIVES  WHAT WORDS OR ACTIONS DO YOU USE TO EXPRESS STRESS IN YOUR LIFE? I am anxious, cry, get angry  A non-specific occurs when one perceives response of the they cannot adequately cope with the demands being It is a phenomena body to any It is subjective made on them…or when demand made on their well-being is threatened (Folkman & Lazarus) it (Seyle) can be difficult to describe physically, emotionally, financially, socially, mentally internal mechanisms that each individual have make it different for each individual THE CONCEPT OF STRESS WHAT IS STRESS? What is stressful to one person may not be stressful to another Stress is subjective Uplifts Hassles if you view things positively, or more critically, it will influence how you perceive stress  Hardiness - way a person deals with stress (commitment, control, openness to change)…internal locus of control Sense of coherence - how a person sees the world and one’s life in it (optimistic; life is meaningful) more in themselves, spirituality (religion), internal rather influenced by the outer world FACTORS Resilience - being resourceful, flexible, and using problem- solving strategies AFFECTING Attitude – positive versus negative PERCEPTION OF STRESS  THEORIES OF STRESS Stress as a Stimulus (Holmes, Rahe, Masuda & Miller) Measurement tool: Social Readjustment Rating Scale Stress as a Transaction (Lazarus & Folkman)  Neuro-scientific way of appraising stresses cognitively primary, secondary appraisal Stress as a Response (Selye)  General Adaptation Syndrome STRESS AS A STIMULUS (HOMES, RAHE, MASUDA & MILLER) ❖Stress is a stimulus that causes a response. ❖The assumption is that frequent changes in life make people more at risk of developing stress and illness. Having multiple stressors e.g paramedics ❖The tool they developed is called the Social Readjustment Rating Scale. the amount of stressors they are exposed to have a link with developing chronic disease https://www.google.ca/search?q=social+readjustment+rating+scale&rlz=1C1GGRV_enCA759CA759&sour ce=lnms&tbm=isch&sa=X&ved=0ahUKEwiVktCMhL_YAhUoxYMKHWjfCdoQ_AUICigB&biw=1280&bih=869 #imgrc=wFREudOS4mq0FM:  STRESS AS A NOTE this there is something that happens neurophysiologically that TRANSACTION allows the person to appraise the stimulus first individual will determine if it is irrelevant, stressful , benign LAZARUS & positive (you stress(marathon runners, athletes, propelled by stressors in a positive way FOLKMAN SELYE’S THEORY OF STRESS AS A RESPONSE Physical response to stress is the General Adaptation Syndrome (GAS) Which is composed of 3 stages: ❖Alarm Reaction ❖Stage of Resistance ❖Stage of Exhaustion ALARM REACTION Acute Stress “Fight or flight” response  NOTE THIS: liver-stores glycogen lysis- "death of" so the body can use it (vessels get when they are under smaller) stress epinephrine- specific to heart breath faster to get norepinephrine- peripheral greater oxygenation vascular system breathing from the NOTE THIS belly- shallow breathing (increases oxygen to various parts) prioritize more blood flow to the vital organs/ core Stroke volume: SYMPATHOADRENAL RESPONSE amount of blood when your heart beats STAGE OF ALARM REACTION  Person uses a variety of physiological resources to help them cope with the stress they are experiencing (neuro-endocrine immune response) It is with hope that a person will adapt and return to a normal state of equilibrium (homeostasis) STAGE OF when these resources are implemented. allostasis - achieving homeostasis in the presence of a challenge (sterling, 1988) RESISTANCE Physical energy is still being used at this point to adapt to the stress. It is when the person is not able to adapt, they enter in the next phase of the GAS STAGE OF EXHAUSTION ❖The final stage of the GAS. ❖All physical resources have been expended. ❖May see an improvement in physiological symptoms prior to death (i.e., increase in mental alertness, normalization of vital signs). ❖Can be remedied if person is treated medically/ psychologically. PHYSIOLOGICAL RESPONSES TO STRESS course of action is executed when the current stressor is alayzed. cerebral Cerebral Cortex higher brain cortex refers to past experiences and considers future consequences Processing of stress stimuli Limbic System motions, fear, anxiety, crying, frustration mediates out emotions and behaviours. may Relays information bring out survival and self-protection emotions/behaviours during stress central connection between nervous and Hypothalamus endocrine system Regulates SNS and PNS Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved.  aldosterone- manage sodium and potassium levels neo-new cor- core- HYPOTHALAMIC- cortisol PITUITARY- ADRENAL RESPONSE TO STRESS Anterior Pituitary releases POMC Pro-opiomelanocortin stimulates exercise B-endorphins & ACTH we need an increase during stress Blunts perception of pain diuretic- makes you pee Morphine-[like] effect gluconeogenesis- new glucose antidiuretic- stops pee, makes you not want to pee  PHYSIOLOGICAL RESPONSES TO STRESS There are bi-directional neurochemical links between the nervous, endocrine and immune system. no need to focus too much on this COPING Emotion-focused coping Problem-focused coping  Managing emotions related to stressors  Attempting to find solutions to problem and create a sense of well-being meditation, yoga, prayer, relaxation activities Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. COPING STRATEGIES Relaxation Strategies Stress Management Techniques Relaxation breathing Thought stopping Meditation Humour Imagery Assertive behaviour Music Yoga Muscle relaxation Social support Journal keeping Colouring Biofeedback  Paramedics brough Pawanpreet Dhaliwal, a 48-year- old female (pronouns she/her) to the ER following an MVA. During your assessment you observe Pawanpreet APPLICATION to be pale, diaphoretic and anxious. Vital signs: T 36.5 P 132/min R 24/min BP 152/80 OF CONCEPTS O2 saturation 98% on room air TO A CASE 1. Explain each abnormal finding using physiological concepts of the stress response. STUDY 2. In what stage of the GAS do Pawanpreet’s physical exam findings and vital signs correlate? 2. Discuss strategies you would incorporate into your nursing practice when caring for Pawanpreet. Box breathing  References Tyerman, J., Cobbett, S., Harding, M., Kwong, J., and Hagler, D. (2023). Medical-surgical nursing in Canada: Assessment and management of clinical problems. (5th Canadian ed.). Toronto, On: Elsevier.