NCM-112-Intro

387 flashcards

● A stressor sequence
● A chronic intermittent stressor
● A chronic enduring stressor
STRESS AS A STIMULUS FOR
DISEASE
❏ineffective coping
❏lack of effective coping skills is often a source of
additional distress for the person
❏When a person endures prolonged or
unrelenting suffering, the outcome is frequently
the development of a stress-related illness.
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PSYCHOLOGICAL RESPONSES TO
STRESS
❑mediating process
❑consciously or unconsciously reacts
to manage the situation
APPRAISAL OF THE STRESSFUL
EVENT
❏Cognitive appraisal (Lazarus, 1991) is a process by
which an event is evaluated with respect to what is at
stake(primary appraisal)and what might and can be
done(secondary appraisal).
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❏Primary appraisal- nonstressful or stressful.
❏Secondary appraisal- what might and can be done
about the situation.
❏Reappraisal- a change of opinion based on new
information.
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COPING WITH THE STRESSFUL
EVENT
❏Coping- the cognitive and behavioral efforts made to
manage the specific external or internal demands that
tax a person’s resources
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COPING WITH THE STRESSFUL
EVENT
❏Resilience -a personal trait and a process.
❏A resilient individual maintains flexibility even in difficult
circumstances and controls strong emotional reactions
using appropriate communication and problemsolving
skills.
PHYSIOLOGIC RESPONSE TO STRESS
❏a protective and adaptive mechanism to maintain the body’s
homeostatic balance.
❏it activates a series of neurologic and hormonal processes
within the brain and body systems.
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GENERAL ADAPTATION
SYNDROME
1. Alarm phase, the sympathetic fight-or-flight response is
activated with release of catecholamines and the onset of the
adrenocorticotropic hormone (ACTH)–adrenal cortical
response.
2. Resistance stage- adaptation to the noxious stressor occurs,
and cortisol activity is still increased.
2. Exhaustion stage- endocrine activity increases, which has
negative effects on the body systems (especially the
circulatory, digestive, and immune systems) that can lead to
death.
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LOCAL ADAPTATION
SYNDROME
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❏inflammatory response and repair processes that occur at
the local site of tissue injury.
❏The local adaptation syndrome occurs in small, topical
injuries
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INTERPRETATION OF STRESSFUL
STIMULI BY THE BRAIN
❏The neural and hormonal actions that maintain homeostatic
balance are integrated by thehypothalamus.
❏Limbic system- regulates emotions and many visceral
behaviors.
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SYMPATHETIC NERVOUS SYSTEM
RESPONSE
❏rapid and short lived
❏Norepinephrine is released - increase in function of the vital
organs and a state of general body arousal
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SYMPATHETIC–ADRENAL–
MEDULLARY RESPONSE
❏SNS stimulates the adrenal medulla to release the hormones
epinephrine and norepinephrine into the bloodstream
❏fight-or-flight response
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.
HYPOTHALAMIC–PITUITARY
RESPONSE
❏longest-acting phase of the physiologic response
❏occur in persistent stress
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IMMUNOLOGIC RESPONSE
❏The immune system is connected to the neuroendocrine
and autonomic systems.
❏All of these possible autonomic and neuroendocrine
responses can interact to initiate, weaken, enhance, or
terminate an immune response.
❏When responses to stress are ineffective, they are referred
to as maladaptive.
❏Maladaptive responses are chronic, recurrent responses or
patterns of response that do not promote the goals of
adaptation.
MALADAPTIVE RESPONSES
TO STRESS
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❏If the sympathetic–adrenal–medullary response is prolonged
or excessive -high blood pressure, arteriosclerotic changes,
and cardiovascular disease.
❏If the production of ACTH is prolonged or excessive-
withdrawal and depression.
❏In addition, the immune response is decreased and
infections and tumorsmay develop.
MALADAPTIVE RESPONSES
TO STRESS
INDICATORS OF STRESS
22
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STRESS AT THE CELLULAR LEVEL
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CONTROL OF THE STEADY STATE
NEGATIVE FEEDBACK
HOMEOSTASIS, STRESS,
AND ADAPTATION
❏Negative feedback mechanisms throughout the body
monitor the internal environment and restore homeostasis
when conditions shift out of the normal range.
❏Major organs affected are the heart, lungs, kidneys, liver,
gastrointestinal tract, and skin.
❏“organs of homeostasis or adjustment”
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CONTROL OF THE STEADY STATE
POSITIVE FEEDBACK
❏intensifies a change in the body's physiological condition
rather than reversing it.
❏As the system becomes more unbalanced, disorder and
disintegration occur.
❏Exceptions - - -
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CELLULAR ADAPTATION
CELLS
❏maintenance function- activities that the cell performs with
respect to itself
❏specialized function- those that the cell performs in relation
to the tissues and organs of which it is a part
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CELLULAR ADAPTATION
CELLS
❏hypertrophy
❏atrophy
❏hyperplasia
❏dysplasia
❏metaplasia
CELLULAR ADAPTATION
CELLS
❏hyperplasia -iincrease in the number of new cells in an
organ or tissue
❏dysplasia -bizarre cell growth resulting in cells that differ in
size, shape, or arrangement from other cells of the same
tissue type
❏metaplasia -a cell transformation in which one type of
mature cell is converted into another type of cell
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CELLULAR INJURY
❏Injury
-defined as a disorder in steady-state regulation
CELLULAR INJURY
Causes of disorder and injury in the system
1. hypoxia
2. nutritional imbalance
3. physical agents- temperature extremes, radiation,
electrical shock, and mechanical trauma
4. chemical agents- poisons, drugs, alcohol, etc.
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CELLULAR INJURY
Causes of disorder and injury in the system
5. infectious agents- viruses, bacteria, rickettsiae,
mycoplasmas, fungi, protozoa, and nematodes
6. immune mechanisms
7. genetic defects
CELLULAR RESPONSE TO INJURY:
INFLAMMATION
❏Cells or tissues of the body may be injured or killed by any of
the agents (physical, chemical, infectious) described earlier.
❏When this happens, an inflammatory response (or
inflammation) naturally occurs in the healthy tissues adjacent
to the site of injury.
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CELLULAR RESPONSE TO INJURY:
INFLAMMATION
FUNDAMENTAL CONCEPTS
❑Each body system
Inflammation
❏a localized reaction intended to neutralize, control, or
eliminate the offending agent to prepare the site for repair.
❏a nonspecific response
❏serve a protective function.
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CHEMICAL MEDIATORS
OF INFLAMMATION
1. Histamine -present in many tissues of the body but is
concentrated in the mast cells
2. Kinins- cause vasodilation and increased vascular
permeability
3. Prostaglandins- another group of chemical substances
SYSTEMIC RESPONSE
TO INFLAMMATION
1. Fever- endogenous pyrogens released from neutrophils and
macrophages
2. Leukocytosis- release of neutrophils from bone marrow,
may occur, enhancing the body’s ability to fight infection.
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TYPES OF
INFLAMMATION
ACUTE INFLAMMATION
❏characterized by the local vascular and exudative changes
❏usually lasts less than 2 weeks.
❏immediate
❏serves a protective function
TYPES OF
INFLAMMATION
CHRONIC INFLAMMATION
❏injurious agent persists and the acute response is perpetuated
❏symptoms are present for many months or years.
❏debilitating and can produce longlasting effects
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CELLULAR HEALING
❏reparative process begins at approximately the same time as
the injury
❏Regeneration
❏Replacement
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CELLULAR HEALING
1. Regeneration- defect is gradually repaired by proliferation
of the same type of cells as those destroyed
❏labile -multiply constantly to replace cells worn out
by normal physiologic processes
❏permanent -neurons
❏stable -have a latent ability to regenerate
CELLULAR HEALING
2. Replacement- cells of another type, usually connective tissue,
fill in the tissue defect and result in scar formation
❏first
❏second
❏third-intention healing
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NURSING MANAGEMENT
❏A major role of nurses is the early identification of both
physiologic and psychological stressors.
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❏Stress management is directed towardreducing and
controlling stress and improving coping.
1. Promoting a Healthy Lifestyle
2. Enhancing Coping Strategies
performs
specific
3. Relaxation Techniques
○ a quiet environment
○ a comfortable position
○ a passive attitude
○ a mental device
❏Stress management is directed towardreducing and
controlling stress and improving coping.
4. Educating About Stress Management
5. Promoting Family Health
6. Enhancing Social Support
7. Recommending Support and Therapy Groups
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END
CHRONIC ILLNESS AND
DISABILITY
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OVERVIEW OF
CHRONICITY
1. DEFINITION OF CHRONIC
CONDITIONS
❏Illnessis the response a person has to a disease.
❏Chronic illnessis defined as a condition that requires
continuing management over a long period—years or even
decades.
❏WHO (2014a) defines it as a long-lasting condition that can
usually be controlled but not cured
❏noncommunicable diseases
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2. CAUSES OF CHRONIC
CONDITIONS
❏A decrease in mortality from infectious diseases
❏Aggressive management of acute conditions
❏Lifestyle factors
❏Longer lifespans because of advances in
technology and pharmacology
❏Improved screening and diagnostic procedures
3. CHARACTERISTICS OF CHRONIC
CONDITIONS
•Managing chronic illness involves more than treating medical problems.
•Chronic conditions usually involve many different phases over the course of a
person’s
lifetime.
•Keeping chronic conditions under control requires persistent adherence to
therapeutic regimens.
•One chronic disease can lead to the development of other chronic conditions.
•Chronic illness affects the entire family.
•The day-to-day management of illness is largely the responsibility of people with
chronic disorders and their families.
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3. CHARACTERISTICS OF CHRONIC
CONDITIONS
•The management of chronic conditions is a process of discovery.
•Managing chronic conditions must be a collaborative process that involves many
different health care professionals working together with patients and their
families.
•The management of chronic conditions is expensive.
•Chronic conditions raise difficult ethical issues for patients, families, health care
professionals, and society.
•Living with chronic illness means living with uncertainty.
4. IMPLICATIONS OF
MANAGING CHRONIC
CONDITIONS
•Alleviate and manage symptoms
•Psychologically adjust to and
physically
accommodate disabilities
•Prevent and manage crises and
complications
functions
to sustain optimal life for an
•Carry out regimens as prescribed
•Validate individual self-worth and
family functioning
•Manage threats to identity
•Normalize personal and family life as
much as possible
•Live with altered time, social
isolation,
and loneliness
•Establish the networks of support
andresourcesthatcanenhance
quality of life
•Return to a satisfactory way of life
•Die with dignity and comfort
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5. PHASES OF CHRONIC
CONDITIONS
•The course of an illness can be thought of as a trajectory that can be managed
or shaped over time, to some extent, through proper illness management
strategies.
5.1 PRETRAJECTORY PHASE
Description: Genetic factors or lifestyle behaviors that place a person or community
at risk for a chronic condition.
Focus of Nursing Care: Refer for genetic testing and counseling if indicated; provide
education about prevention of modifiable risk factors and behaviors.
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5.2 TRAJECTORY ONSET PHASE
Description: Appearance or onset of noticeable symptoms associated with a
chronic disorder.
•includes period of diagnostic workup and announcement of diagnosis
•may be accompanied by uncertainty
Focus of Nursing Care: Provide explanations of diagnostic tests and procedures
and
reinforce information and explanations given by primary health care provider.
•provide emotional support to patient and family
5.2 STABLE PHASE
Description: Illness course and symptoms are under control as symptoms, resulting
disability and everyday life activities are being managed within limitations of
illness.
•illness management centered in the home
Focus of Nursing Care: Reinforce positive behaviors and offer ongoing monitoring.
•provide education about health promotion and encourage participation in health
promoting activities and health screening
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5.3 UNSTABLE PHASE
Description: Characterized by an exacerbation of illness symptoms, development
of complications, or reactivation of an illness in remission.
•Period of inability to keep symptoms under control.
•May require more diagnostic testing and trial of new treatment regimens or
adjustment of current regimen.
Focus of Nursing Care: Provide guidance and support.
•reinforce previous teaching
5.4 ACUTE PHASE
Description: Severe and unrelieved symptoms or the development of illness
complications necessitating hospitalization, bed rest, or interruption of the person’s
usual activities to bring illness course under control.
Focus of Nursing Care: Provide direct care and emotional support to the patient and
family members.
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5.5 CRISIS PHASE
Description: Critical or life-threatening situation requiring emergency treatment or
care and suspension of everyday life activities until the crisis has passed.
Focus of Nursing Care: Provide direct care, collaborate with other health care team
members to stabilize patient’s condition.
5.6 COMEBACK PHASE
Description: Gradual recovery after an acute period and learning to live with or
to overcome disabilities and return to an acceptable way of life.
Focus of Nursing Care: Assist in coordination of care.
organism.
❑Compensatory
•rehabilitative focus may require care from other health care providers.
•provide positive reinforcement for goals identified and accomplished.
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5.7 DOWNWARD PHASE
Description: Illness course characterized by rapid or gradual worsening of a
condition.
•physical decline accompanied by increasing disability or difficulty in controlling
symptoms.
•Requires biographical adjustment and alterations in everyday life activities.
Focus of Nursing Care: Provide home care and other community-based care to help
patient and family adjust to changes and come to terms with these changes.
•assist patient and family to integrate new treatment and management strategies.
5.8 DYING PHASE
Description: Final days or weeks before death.
•characterized by gradual or rapid shutting down of body processes, biographical
disengagement and closure, and relinquishment of everyday life interests and
activities.
Focus of Nursing Care: Provide direct and supportive care to patients and their
families through hospice programs.
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6. APPLYING THE NURSING
PROCESS USING THE PHASES OF
THE CHRONIC ILLNESS SYSTEM
The focus of care for patients with chronic conditions is determined largely by the
phase of the illness and is directed by the nursing process, which includes
assessment, diagnosis, planning, implementation, and evaluation.
STEP 1: IDENTIFYING SPECIFIC
PROBLEMS AND THE TRAJECTORY
PHASE
•Assessment enables the nurse to identify the specific medical, social,
and psychological problems likely to be encountered in a phase.
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STEP 2: ESTABLISHING AND
PRIORITIZING GOALS
•The nurse helps prioritize problems and establish the goals of care.
•Identification of goals must be a collaborative effort, with the patient, family,
and nurse working together, and the goals must be consistent with the abilities,
desires, motivations, and resources of those involved.
STEP 3: DEFINING THE PLAN OF ACTION
TO ACHIEVE DESIRED OUTCOMES
•Identify a realistic and mutually agreed-on plan for achieving goals, including
specific criteria that will be used to assess the patient’s progress.
•The identification of the person responsible for each task in the action plan is
also
essential.
•Identification of the environmental, social, and psychological factors that might
interfere with or facilitate achieving the desired outcome is an important part
of planning.
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STEP 4: IMPLEMENTING THE PLAN
AND INTERVENTIONS
•Help patients implement the actions that allow patients to live with the symptoms
and therapies associated with chronic conditions, thus helping them to gain
independence.
•Work with each patient and family to identify the best ways to integrate
treatment
regimens into their ADLs to accomplish two tasks:
(1) adhering to regimens to control symptoms and keep the illness stable
(2) dealing with the psychosocial issues that can hinder illness management
and affect quality of life.
STEP 5: FOLLOWING UP AND
EVALUATING OUTCOMES
•Determine if the problem is resolving or being managed and if the patient and
family are adhering to the plan.
•Maintaining the stability of the chronic condition while preserving the patient’s
control over his or her life and the patient’s sense of identity and accomplishment
is a primary goal.
•Consideration of alternative strategies or revision of the initial plan may be
mechanisms
foradjusting internal
warranted.
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7. HOME AND COMMUNITY-BASED
CARE
•One of the major goals of nursing today should be the prevention of chronic
conditions and the care of people with them.
•This requires promoting healthy lifestyles and encouraging the use of safety and
disease-prevention measures.
•Prevention should also begin early in life and continue throughout life.
•Patient and family teaching is an important nursing role that may make the
difference
in the ability of the patient and family to adapt to chronic conditions.
•Learning needs change as the trajectory phase and the patient’s personal situation
change.
OVERVIEW OF
DISABILITY
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1. DEFINITIONS OF DISABILITY
•Limitation in performance or function in everyday activities (difficulty talking,
hearing, seeing, walking, climbing stairs, lifting or carrying objects, performing
ADLs, doing school work, or working at a job).
•A severe disability is present if a person is unable to perform one or more
activities, uses an assistive device for mobility, or needs help from another person
to accomplish basic activities.
2. CATEGORIES OF DISABILITY
•Disabilities can be categorized as developmental disabilities, acquired
disabilities, and age-associated disabilities.
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2.1 DEVELOPMENTAL DISABILITIES
•occur any time from birth to 22 years of age and result in impairment of physical
or mental health, cognition, speech, language, or self-care.
•Examples of developmental disabilities are spina bifida, cerebral palsy, Down
syndrome, and muscular dystrophy.
•Some developmental disabilities occur as a result of birth trauma or severe illness
or injury at a very young age.
2.2 ACQUIRED DISABILITIES
•occur as a result of an acute and sudden injury (e.g., traumatic brain injury,
spinal cord injury, traumatic amputation), acute nontraumatic disorders (e.g.,
stroke, myocardial infarction), or progression of a chronic disorder (e.g.,
arthritis, multiple sclerosis, chronic obstructive pulmonary disease, blindness
due to diabetic retinopathy).
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2.3 AGE-RELATED DISABILITIES
•occur in the elderly population and are thought to be due to the aging process.
•Examples of age-related disabilities include osteoarthritis, osteoporosis, and
hearing
loss.
3. MODELS OF DISABILITY
•These include the medical and rehabilitation models, the social model,
the biopsychosocial model, and the interface model.
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3.1 MEDICAL MODEL
•This model equates people who are disabled with their disabilities and views
disability as a problem of the person.
•Health care providers, rather than people with disabilities, are viewed as the
experts
or authorities.
•Management of the disability is aimed at cure or the person’s adjustment and
behavior change.
•The model is viewed as promoting passivity and dependency.
•People with disabilities are viewed as tragic.
3.2 REHABILITATION MODEL
•It regards disability as a deficiency that requires a rehabilitation specialist or other
helping professional to fix the problem.
•People with disabilities are often perceived as having failed if they do not
overcome
the disability.
conditions
promote the steady
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3.3 SOCIAL MODEL
•views disability as socially constructed and as a political issue that is a result of
social and physical barriers in the environment.
•Its perspective is that disability can be overcome by removal of these barriers.
3.4 BIOPSYCHOSOCIAL MODEL
•integrates the medical and social models to address perspectives of health from a