Definition of Stress: Stress is a reaction to changes in one's environment that are perceived as threatening or damaging to well-being.
Consequences of Stress: Can lead to anxiety; dysfunctional behavior often emerges when defense mechanisms are used in response to anxiety.
Defense Mechanisms: Psychological strategies used by individuals to manage conflict and anxiety. These mechanisms can be adaptive (helpful) or maladaptive (harmful).
Adaptive Use: Helps achieve goals and reduce anxiety in acceptable ways.
Maladaptive Use: Interferes with functioning and relationship dynamics. Excessive use can distort one’s orientation to reality.
Defense Mechanisms
Importance of Appropriate Use
Utilizing varying defense mechanisms based on situational demands is crucial; repetitive use of the same reaction is counterproductive.
Categories of Defense Mechanisms:
Altruism: Involves helping others to manage one’s own anxiety.
Adaptive Use: A nurse who lost a family member in a fire volunteers as a firefighter.
Maladaptive Use: Not applicable (always considered healthy).
Sublimation: Unacceptable impulses are replaced with acceptable expressions.
Adaptive Use: A person redirects anger at a supervisor by vigorously working out at the gym.
Maladaptive Use: Not applicable.
Suppression: Voluntarily ignoring unpleasant thoughts and feelings.
Adaptive Use: A student postpones thoughts about a previous argument to concentrate on a test.
Maladaptive Use: A person neglects the stress of unemployment until later.
Repression: Unconscious exclusion of unacceptable thoughts
Adaptive Use: Forgetting stage fright while preparing for a speech.
Maladaptive Use: Continually forgetting dental appointments due to fear of dentists.
Regression: Returning to earlier development stages.
Adaptive Use: A young child may wet the bed when stressed by the loss of a pet.
Maladaptive Use: Adults exhibiting childlike tantrums or throwing things when upset.
Displacement: Redirecting emotions from one target to another that is less threatening.
Adaptive Use: An adolescent angrily punches a bag after losing a game.
Maladaptive Use: An adult angrily destroys their child’s toy due to job loss.
Reaction Formation: Exhibiting the opposite of what one feels.
Adaptive Use: A person attempting to quit smoking preaches against nicotine.
Maladaptive Use: Complimenting a neighbor despite personal dislike.
Compensation: Emphasizing strengths while avoiding weaknesses.
Adaptive Use: A physically limited adolescent excels in academics.
Maladaptive Use: A shy person mastering computer skills to avoid socialization.
Identification: Adopting attributes of another individual/group.
Adaptive Use: A child with an illness plays nurse with dolls.
Maladaptive Use: Bullying others after observing abusive behavior.
Intellectualization: Detaching emotion from the situation.
Adaptive Use: A police officer focuses solely on investigation without personal feelings.
Maladaptive Use: Focusing on practical arrangements upon receiving terminal diagnosis without emotional acknowledgment.
Conversion: Physical manifestations in response to stress not linked to physical illness.
Adaptive Use: Not applicable.
Maladaptive Use: Experiencing deafness due to an emotional crisis.
Denial: Refusing to accept reality to manage anxiety.
Adaptive Use: Initial disbelief upon being diagnosed with cancer.
Maladaptive Use: A parent believes their deceased child will return home for the holidays.
Dissociation: Partial lack of connection with one’s identity or environment.
Adaptive Use: A parent ignoring distractions to focus while driving.
Maladaptive Use: Not remembering one’s identity after trauma.
Splitting: Viewing others as all good or all bad without middle ground.
Adaptive Use: Not applicable.
Maladaptive Use: A client idolizes a nurse one day and then refuses to speak to them the next.
Projection: Attributing one’s unacceptable thoughts onto another person.
Adaptive Use: A married client feeling attraction accuses spouse of infidelity.
Maladaptive Use: Attributing own feelings to others.
Anxiety
Conceptualizing Anxiety: Anxiety exists on a continuum, leading to decreased functioning as intensity increases.
Types of Anxiety Levels:
Normal Anxiety: Healthy and necessary for survival; motivates action.
Example: A nurse acts quickly to defuse a potentially violent situation.
Acute Anxiety: Immediate response to an imminent loss/change threatening security.
Example: Experiencing acute anxiety after the sudden death of a loved one.
Chronic Anxiety: Develops over time, often noticeable from childhood.
Symptoms may include fatigue and frequent headaches.
Data Collection
Identifying Anxiety Levels: Recognition of anxiety levels is crucial for therapeutic interventions.
Toxic Stress Response: Sustained stress may cause biological and neurological changes, leading to various somatic symptoms, such as:
Physical manifestations: Intestinal discomfort, body aches, shortness of breath.
Characterized by extreme fright and inability to engage with the environment.
Symptoms: Severe withdrawal, hallucinations, bodily dysfunction.
Patient-Centered Care
Therapeutic Practices: Strategies that help reduce anxiety include:
Engaging in aerobic exercise, moderating caffeine intake, and improving sleep quality.
Interventions to Moderate Anxiety:
Active listening: Encourages expression and builds trust.
Providing a calm presence: Helps clients focus and begin problem-solving.
Evaluating coping mechanisms: Assists clients in identifying adaptive and maladaptive mechanisms.
Exploring alternative solutions: Promotes problem-solving.
Encouraging participation in relieving activities: Such as exercise.
Assuring safety, maintaining calmness, and providing a quiet environment for severe anxiety cases.
Medications: When less restrictive measures fail, medication or restraint may be required to ensure safety.
Psychotic Disorders Overview
Schizophrenia and Related Disorders: Affect cognitive function, behavior, and reality perception.
Typical Onset: Occurs in mid-teens to mid-20s; can manifest in childhood or later adulthood.
Types Recognized by DSM-5-TR:
Schizophrenia: Symptoms last for at least 6 months and impair functioning.
Schizotypal Personality Disorder: Less severe impairment in personality functioning compared to schizophrenia.
Delusional Disorder: Involves persistent delusions without significant impairment.
Brief Psychotic Disorder: Symptoms last from 1 day to less than a month.
Schizophreniform Disorder: Symptoms similar to schizophrenia lasting from 1 to 6 months.
Schizoaffective Disorder: Co-occurrence of schizophrenia symptoms along with depressive or bipolar disorder symptoms.
Substance/Medication-induced Psychotic Disorder: Psychosis occurs due to substances or medications.
Characteristic Findings in Psychotic Disorders
Positive Symptoms (presence of abnormal behaviors):
Manifestations: Hallucinations, delusions, alterations in speech, bizarre behavior.
Negative Symptoms (absence of normal behaviors):
Manifestations: Blunted affect, poverty of speech (alogia), reduced energy (anergia), anhedonia, lack of motivation (avolition).
Cognitive and Affective Findings: Cognitive difficulties (decision-making, concentration, memory deficits) and emotional instability (mood swings, hopelessness).
Alterations in Thought and Speech
Delusions: Fixed false beliefs that are impossible to correct.
Common forms include persecution, grandeur, somatic delusions, jealousy, being controlled, and thought broadcasting/insertion.
Speech Alterations: Can include disorganized thought processes, neologisms, echolalia, clang associations, word salad, circumstantiality, and tangentiality.
Example of severe disorganization includes flight of ideas and inability to concentrate.
Hallucinations and Perception Alterations
Sensory Perceptions without external stimuli: Auditory, visual, olfactory, gustatory, and tactile hallucinations.
Form of Perceptions: Altered states like depersonalization (loss of identity) and derealization (disconnected environmental perceptions).
Behavioral Alterations: Extreme agitation, purposeless movements, waxy flexibility, motor retardation, impulsive behaviors, and boundary impairments.
Nursing Care for Psychotic Disorders
Milieu Therapy: Structuring the environment to alleviate anxiety and provide distraction from hallucinations.
Community Treatment Approaches: Assertive Community Treatment (ACT) provides case management for community living needs.
Communication Strategies: Promote therapeutic interactions that lower anxiety and enhance participation among clients.
Validating Feelings: Rather than disputing delusions, validate client experiences and feelings while maintaining focus on reality.
Monitoring for Risk: Assess for command hallucinations or paranoid delusions that may pose a risk of harm to self or others.
Discharge Planning: Evaluate client needs for ADLs and promote self-care in a structured manner while engaging family members in the care process.
Medications for Psychotic Disorders
Medications used: Antipsychotic medications to manage symptoms of schizophrenia spectrum and other psychotic disorders.
Goals: Suppressing acute episodes, preventing recurrence, and maintaining optimal functioning.
Types:
First-generation (conventional) antipsychotics: Target positive symptoms; associated with extrapyramidal side effects (EPS).
Second-generation (atypical) antipsychotics: Preferred due to efficacy on both positive and negative symptoms with fewer side effects.
Third-generation antipsychotics: Treat both positive and negative symptoms and enhance cognitive function with minimal EPS risk.