Exam (elaborations)
NR-326 Mental-Health Nursing EDAPT NOTES WEEK 5
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NR-326 Mental-Health Nursing EDAPT NOTES WEEK 5
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Nursing Care of a Patient with Altered Stress Response• Maladaptive Clinical Manifestations o Client’s avoidance of the issue altogether may
lead to denying that a problem even exist
o Denial is maintained by distractions, such as excessive alcohol consumption,
overworking, or sleeping more than usual
o Internalizing the issue and blaming oneself leads to low self-esteem, and
depression
o Cognitive (thoughts) Memory problems
Lack of self-confidence
Constant worry
Difficulty making decisions
Negativity of self o Emotional (feelings)
Moodiness
Irritability
Feeling hopeless/helpless
Feeling depressed
Agitation or inability to relax o Behavioral (actions)
Changes in eating and/or sleeping patterns
Decline in performance productivity
Neglect of family responsibilities
Increased use of alcohol, tobacco, caffeine and/or other drugs
Social withdrawal
• Negative Coping Mechanism
o Blaming others for one’s behavior is a negative coping mechanism. All other
options are positive coping strategies; taking ownership for learning, and ways to
help the student be more successful in school.
• Stress Response
o Stress is a natural physical and mental reaction to life experiences. Everyone
experiences stress from time to time. Anything from everyday responsibilities to
serious life events such as new diagnosis, a pandemic, or the death of a loved one
can trigger stress. Short-term stress can be beneficial to health; it can help you
cope with potentially serious situations. The body responds to stress by releasing
hormones. Long-term stress will ultimately lead to maladaptive response if
untreated and adverse health problems
o Hypothalamus sends stress hormones and triggers Fight or flight response.
RR Increase
HR increases
Sick to stomach
Muscles are ready to respond
, o When stress response keeps firing and firing, day after day, it could put
physiological health at risk along with Psychological. Prolonged stress can lead to
maladaptive responses if untreated
Acute Stress = fight or Flight response
Prolonged Stress = Maladaptive response
• Stress Response Pattern o Life situation Perceived Stress Emotional Arousal
Physiological Arousal
Consequences
• Biology of Mental Health & Stress o Early response to stress happens in the brain o
Neurotransmitters are released (serotonin and adrenaline)
o Stress hormones are released which affect areas of the brain key for memory and
regulating emotions
o Repeated stress changes how well these systems control stress response o Long
term stress can change the structure of the brain, especially in areas supporting
leaning and memory
o Can affect nerve cells (grey matter) and connections between them (white
matter).
Changes can increase the likelihood of developing mental illness o
Stress is not an illness but there are connections between stress and mental
health diagnoses including
Depression
Anxiety
Personality Disorders
OCD
PTSD
o Chronic stress increases the risk of developing depression and anxiety in some
people
• Stress and Mental Health o Stress and anxiety are sometimes used interchangeably but
they are very different
Stress is the brain’s response to any demand; most often triggered by
change, positive or negative, real or perceive
Anxiety is the anticipation of future threats exacerbated by prolonged
stress.
o Long-term stress increases the risk of mental health problems like
Anxiey
Depress
Substance abuse
Eating disorders o Increases risk of medical problems like
Chronic pain
, GI conditions
Weakened immune response
Difficulty conceiving
High BP
CV Disease
Stroke
o Sign and Symptoms of stress maybe cognitive, emotional, physical, or
behavioral. o Severity can range from mild to severe o Too little stress = no
creativity, boredom, fatigue, and dissatisfaction o Optimal level Stress = more
creativity, motivation, and satisfaction o High levels of Stress= anxiety, panic,
anger, exhaustion, and even illness
• Altered Stress Response
o Responses to stress are affected by age, gender, culture, ethnicity, lifestyle, life
experiences, social support and pre-existing psychiatric disorders
o Multiple stressor at once = higher risk of maladaptive stress o Acute Stress
Headaches
N/V/D
Decreased appetite
Increases RR, HR, & BP
Loss of sex drive
Depressed immune system
Muscle Tension
Fight or flight o Prolonged Stress
Increased risk of stroke
Increased risk of MI
Weight gain or loss
HTN
Poor diabetes control
Increase Risk of Infection
Gastric Ulcers
Physical Pain
Maladaptive Response
• Warning Signs of Stress o Emotional
Early: anxiety/sadness, frustration, loss of sense of humor
Secondary: Overreaction, hopelessness, defensiveness o
Thoughts and Perception
Early: brain fog, reduced creativity, fear of rejection
Secondary: negative self-talk, feelings of unfairness, can’t switch
off
, o Physical
Early: muscle tension, headache, fatigue
Secondary: Heartburn, SOB, sleep disturbance
o Behavioral
Early: compulsive eating, hyperactivity, poor productivity
Secondary: Increased absenteeism, aggression and irritability, sudden
tears
• Mental Health and Stress
o Maladaptive responses to stress can lead to or co-exist with other mental health
disorders
o Clients with mental health disorders and stress can exacerbate their illness o
Clinical manifestations of mental illness are not always as clear, explicit, or
objective as the S/S of a physiological disorder
o S/S of mental disease can include
Social withdrawal
Changes in personal habits like ADLs (eating, grooming, and
hygiene)
Abnormal changes in mood
Changes in thought processes o Physiological findings will alert
the nurse that perhaps the psychological problem has been exacerbated or a
new onset of one has emerged
• Adjustment Disorders o Adjustment disorders are classified according to predominate
symptoms
Ex. Adjustment disorder with depressed mood o Symptoms of an
adjustment disorder start within three months of a stressful event and generally last
no longer than 6 month
o Chronic adjustment disorders can continue for more than 6 months especially if
the stressor is ongoing such as unemployment or a pandemic
o Untreaded adjustment disorders can lead to anxiety and depressive disorders
• Maladaptive Response to Grief
o Can be challenging to identify due to the length of time that a client goes through
the stages of grief
o Each client response and copes with stress differently
o As the nurse, assess the client throughout the grief process to identify if the client
needs support
o Never assume that the client has adapted without carefully recognizing and
analyzing cues
o Grief = denial Anger Depression Bargaining Acceptance
• Climate and Mental Health Stress o Medical and Physical Health
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