Psychiatric Mental Health NursingEve Karpinski, APHN-BC, RN-BC

Lecture 1

Your psychiatric book does not have a chapter on Stress Adaptation.

Review notes below. Visit youtube.

Youtube sites to reviewStress and Memoryhttp://www.youtube.com/watch?v=OHl7BewJ0yUHow the Body Works : Center of Emotion and

Memoryhttp://www.youtube.com/watch?v=lZ4mdXAtnEsHow the Body Works : Physical Responses to

Emotionhttp://www.youtube.com/watch?v=SS_qMHPI0XMStress and Stressorshttp://www.youtube.com/watch?v=bCtLTVFlhz4Stress Management 1 - Stress Exhaustionhttp://www.youtube.com/watch?v=sEq7fB9jDyQ

Question 1How stress are you now?1. Not at all.2. Mildly3. Moderately4. Severely

What are you feeling related to your stress level?

StressThe word stress lacks a definitive definition.Adaptation is defined as restoration of

homeostasis to the internal environmental system.

Adaptation includes responses directed at stabilizing internal biological processes and psychological preservation of self-identity and self-esteem.

Stress as a Transaction Between the Individual and the Environment

Individual’s perception of the event: The way you interpreted the event is how you respond to the event.

Primary appraisal – a judgment about the situation in one of the following ways:

Secondary appraisal –

Precipitating event –

The physiological of stress . “Fight or Flight” ResponseWhen the body encounters a stressor, it prepares itself for

“fight or flight.” Identify the adaptation responses that occur in the initial stress

response in each of the physical components listed.Physical component Adaptation ResponseAdrenal medullaEyeRespiratory systemCardiovascular systemGastrointestinal systemLiverUrinary systemSweat glandsFat cells

Releases norepinephrine and epinephrine.Pupils dilate.Secretion is increased from lacrimal glands.Bronchioles dilate.Respiration rate is increased.Increased force of cardiac contractionIncreased cardiac outputIncreased heart rateIncreased blood pressureDecreased gastric and intestinal motilityDecreased secretionsSphincters contractIncreased glycogenolysis and gluconeogenesisDecreased glycogen synthesisIncreased ureter motilityBladder muscle contractsBladder sphincter relaxesIncreased secretionLipolysis

Stress MasteryStress Mastery is the utilization of coping

strategies in the response to stressful situations.

Adaptive coping strategies protect the individual from harm and restore physical and psychological homeostasis.

Coping strategies are considered maladaptive when the conflict being experienced goes unresolved or intensifies.

Effects of chronic Stress Increase GluconeogenisisDecrease ImmuneDecrease inflammatory responseRetention of sodium and waterDecrease in libido, frigidity and impotenceIncrease in blood pressure

The parasympathetic nervous systemRelaxationBody repair and restorationLower heart rateLower blood pressureLower glucose and insulinBlood directed to digestionDecrease in oxygen consumption CO2

elimination.

Unhealthy Coping Strategies

SmokingDrugsAlcoholOver eating/poor eating

habits.What other unhealthy

coping strategies can you think of?

Healthy Coping StrategiesAwareness Relaxation Meditationcommunication with

caring other Problem-solving PetsExercise

Your own thoughtsLaughterAromatherapyMassageJournaling MusicHydro-therapy

What are your coping strategies?Are they healthy strategies?

From the following case study, identify the predisposing factors (genetic influences, past experiences, and existing conditions) that influence Robert’s adaptation response. What is the precipitating stressor in this situation?Robert, age 56, was admitted to the emergency room of a large hospital at 2:00 a.m. after vomiting a largeamount of blood. In doing the admitting assessment, the nurse learned the following about Robert:

A.His father and brother are both recovering alcoholics.

B. Robert had his first drink at age 12 and has been continually increasing the amount and requency of drinking since that time

C. His mother died of lung cancer when Robert was 23. She was a heavy smoker. Robert smokes three packs of cigarettes a day.

D. He has been hospitalized only once before, about 3 months ago, and diagnosed with an ulcer.The doctor told him at that time he must stop drinking and smoking in order for the ulcer to heal.

E. Robert is married and has three children. He has a long history of moving from one job toanother, staying only until his drinking interferes with his work performance and attendance. He was fired from his job yesterday and spent the evening and nighttime hours drinking two fifths of bourbon. He was engaged in this activity at the time the hematemesis began.

F. Because of the erratic job history, Robert and his wife experience severe financial difficulties.His wife shows much concern for Robert’s condition and stays by his side during the emergency admission. She states to the nurse, “I want so much for our marriage to work, but he is drinking more and more all the time and still doesn’t see his drinking as a problem. Every time he gets fired, he blames his boss.”