Nursing Foundations - Unit 4 (Coping-Stress & Loss-Grief)

olanjones's version from 2016-04-12 04:09

Coping/Stress Tolerance Pattern

Question Answer
What impact do coping strategies have on health?a person’s response to stress is affected by a complex interaction of social, emotional, and physiological factors that both singularly and collectively influence health and well-being
What is problem-focused coping?efforts to improve the situation by making changes (taking action)
What is emotion-focused coping?thoughts/actions that relieve emotional distress but may not change the situation (reframing)
Short-term coping strategiestemporarily reduce stress but may be destructive/detrimental (smoking)
Long-term coping strategiescan be constructive and realistic
What is the result of effective coping?Adaptation
What is the result of ineffective coping?Maladaptation
Ego-defense mechanismsdefense mechanisms that occur at the unconscious level to ward off anxiety. Includes: rationalization, denial, regression, projection, displacement
Four levels of anxietyMild – increased questioning, increased arousal/alertness (can be adaptive), Moderate – voice tremors/pitch changes, shakiness, slight increase RR/HR (can impair), Severe – inability to relax/focus, H/A, nausea, dizziness (severely impairs), Panic – unpredictable response, distorted perception, inability to function (debilitates)

Coping/Stress Nursing Strategies

Question Answer
What are the components of the nursing assessment for coping/stress?nursing history (perceived stressors, past/present coping strategies), interview (scale to rate specific stressors, duration), physical exam (verbal, motor, cognitive, physical manifestations)
Nursing interventions for clients with stress1. Mediating anger 2. Minimizing anxiety 3. Encouraging health promotion strategies 4. Using relaxation techniques
Crisis statetemporary upset – inability to cope with a particular situation using customary problem solving methods
Characteristics of person in crisisPerception of event is distorted, Situational support is inadequate, Coping mechanism are inadequate
Goals of crisis interventionStabilization, Mitigation, Restoration, Referral (work through crisis to resolution and restore to pre-crisis level of functioning)
Crisis counselingfocuses on solving immediate problems and involves individuals, groups, or families
Strategies for burnout preventionTime-management (MOST important), Nurture altruistic egoism, Set realistic/achievable goals, Develop awareness of stressors, Use assertiveness, Healthy lifestyle choices, Practice detachment

Stress Models

Question Answer
What are the three models of stress?Stress as stimulus (Holmes & Rahe), Stress as response (Selye’s GAS), Stress as transaction (Lazarus)
What is Holmes & Rahe stress model?Live event/circumstances have degrees of stress attached to them – rated life scale with numerical value but the stress that events bring is interpreted personally [stress as stimulus]
Stages of General Adaptation Syndrome1. Alarm (stressor is perceived, drop in homeostasis) 2. Resistance (adaptation resources/endocrine mobilization) 3. Exhaustion (energy stores depleted) [stress as response]
What is the end result of GAS?If energy stores are replenished – return to homeostasis (recovery), If energy not replenished – death
Describe Stress as transactionstress refers to any event in which environmental and internal demands tax adaptive resources of the individual, social system, or tissue system. Person and environment are inseparable

Coping/Stress Pattern NANDA labels

Question Answer
What constitutes Anxiety ?Vague, uneasy feeling of discomfort or dread accompanied by autonomic response (source is often unknown/non-specific)
What are characteristics of Anxiety ?Diminished productivity, apprehensive, distressed, awareness of physiological symptoms
What outcome/intervention can be used with Anxiety ?Outcome: Client will demonstrate improved concentration and accuracy of thoughts Intervention: Use empathy to encourage the client to interpret the anxiety symptoms as normal
What constitutes Ineffective Coping: Individual?Inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to used available resources
What are characteristics of Ineffective Coping: Individual?changes in usual communication patterns, decreased use of social support, destructive behavior toward self or others, inability to meet basic needs
What outcome/intervention can be used with Ineffective Coping: Individual?Outcome: Client will seek help from a health care professional as appropriate Intervention: Collaborate with the client to identify strengths such as the ability to relate the facts and recognize the source of stressors

Loss & Grief Pattern

Question Answer
Types of lossActual, Perceived, Situational/developmental, Anticipatory
How does age influence loss and grief responses?As one ages, they become more familiar with loss, usually increasing their understanding and acceptance of life, loss, and death. Children differ not only in their understanding of loss but also in the way they may be affected (e.g. loss of a parent)
How does bereavement differ from mourning?bereavement is the subjective experience of the survivor, mourning is the behavioral process through which grief is eventually resolved/altered
How do culture and religion impact the grief response?culture may determine how death is viewed and how mourners behave, rituals (religious/spiritual) may help legitimize emotional/physical ventilation, provide a focus for managing confusion, disorganization, and loss of control which promoting social interaction
What is palliative care?care that focuses on control of symptoms and compassion - 1. Help to minimize loneliness, fear, depression 2. Maintain client’s sense of security and dignity 3. Help client accept losses 4. Provide physical comfort
How may a nurse help facilitate the grieving process? Explore and respect cultural, religious, personal values, Teach what to expect, Encourage expression and sharing of grief with support system
When is the grieving process completed?grief work is never completely finished, healing occurs when the pain is less

Grief Models

Question Answer
Kulber-Ross1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance
Engle1. Shock and disbelief 2. Developing awareness 3. Restitution 4. Resolving the loss 5. Idealization 6. Outcome
Sander1. Shock 2. Awareness of loss 3. Conservation/withdrawal 4. Healing (the turning point) 5. Renewal
Worden1. Accepting the reality of loss 2. Working through pain of grief 3. Adjusting to the environment without the deceased 4. Emotionally relocating the deceased and moving on with life

Loss & Grief NANDA labels

Question Answer
What constitutes Anticipatory Grieving?Intellectual and emotional responses and behaviors by which individuals, families, communities work through the process of modifying self-concept based on the perception of potential loss
What are characteristics of Anticipatory Grieving?Grieving for losses experienced during deteriorating illness, and the future that will be filled with loss
What outcome/intervention can be used with Anticipatory Grieving? Outcome: Client will discuss that meaning of the anticipated loss and the functioning of the family Intervention: Develop a trusting relationship both with the client and with the family by using presence and therapeutic communication techniques
What constitutes Complicated Grieving?A disorder that occurs after the death of a significant other in which the experience of distress accompanying bereavement fails to follow normative (or cultural) expectations and manifests in functional impairment
What are characteristics of Complicated Grieving?Decreased functioning in life roles, experiencing somatic symptoms of deceased, verbalizes feeling of shock, detachment, disbelief, persistent painful memories
What outcome/intervention can be used with Complicated Grieving?Outcome: Client will express appropriate feelings of guilt, fear, anger, or sadness Intervention: Educate the client and their support system that grief resolution is not a sequential process and that the positive outcome of grief resolution is the integration of the deceased into the ongoing life of the griever

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