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8/12/2019 Coping and Nursing Management
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Assessment Interview
How long have you been dealing with
these stressors?
How do you usually handle stressful
situations?
Cry
Get Angry
Assessment Interview
Talk to someone (Who?)
Withdraw from the situation
Control others or situation
Go for a walk or perform physical
exercise
Try to arrive at a solution
Pray
Assessment Interview
Laugh, joke or use some other
expression of humor
Meditate or use some other
relaxation technique such as yogaor guided imagery
How well does your usual coping
strategy work?
NURSING DIAGNOSIS
Anxiety: Vague,
uneasy feeling of
discomfort
Anxiety: Vague, uneasy feeling
of discomfort
ASSESSMENT
SUBJECTIVE:
I really feel nervous and I cant sleep ...
[scared, regretful, feeling of impending
doom]
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Fear: Response to
perceived threat [realor imagined] that is
consciously recognized
as a danger.
Fear: Response to perceived threat [real or
imagined] that is consciously recognizedas a danger.
ASSESSMENT
SUBJECTIVE:
I feel alarmed whenever Im near an
elevator
[Identifies object of fear; being scared, and
alarmed, decreased self assurance]
Fear: Response to perceived threat [real or
imagined] that is consciously recognized
as a danger.
OBJECTIVE:
PR = 121 beats per minute
RR = 29 cycles per minute
(+) Pupil Dilation
(+) Pallor
(+) Increased Perspiration
Fear: Response to perceived threat [real or
imagined] that is consciously recognized
as a danger.
NURSING DIAGNOSIS:
Fear related to _______ as manifested by_________.
Related Factors:
Natural or innate origin (sudden noise, height, pain)
Separation from support system in potentially
stressful situation (hospitalization, treatments)
Impaired Adjustment :
Inability to modify
lifestyle in a manner
consistent with a change
in health status.
Impaired Adjustment : Inability to modify
lifestyle in a manner consistent with a change
in health status.
ASSESSMENT
SUBJECTIVE:
Im diabetic but I still love eating
chocolates. Im having a hard timeexercising.
[Denial of health status change, Failure toachieve optimal sense of control]
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Impaired Adjustment : Inability to modify
lifestyle in a manner consistent with a change
in health status.
OBJECTIVE:
(FBS) Fasting Blood Sugar: 225 mg / dl
(+) Demonstration of non acceptance of
health status change.
Impaired Adjustment : Inability to modify
lifestyle in a manner consistent with a changein health status.
NURSING DIAGNOSIS:
Impaired Adjustment related to ________ asmanifested by _________.
Related Factors:
Disability or health status requiring change inlifestyle
Negative attitudes toward health behavior
Lack of motivation to change behavior
INEFFECTIVE
COPING
Ineffective Coping
Ineffective Coping: Inability
to form a valid appraisal ofthe stressors, inadequate
choices of practiced
responses, or inability to
use available resources.
Ineffective Coping
ASSESSMENT
SUBJECTIVE:
After my husbands death, I always feel
tired I cant sleep and I dont like eating
[Verbalizations of inability to cope or inability
to ask for help; sleep disturbance; fatigue]
Ineffective Coping
OBJECTIVE:
BP = 220 / 120 mm Hg
(+) Poor concentration
(+) Irritable bowel
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Ineffective Coping
NURSING DIAGNOSIS:
Ineffective Coping related to _________ asmanifested by _________.
Related Factors:
Situational / Maturational Crisis
High Degree of Threat
Inadequate resources available
PLANNING
PLANNING
Decrease or resolve anxiety.
Increase ability to manage or
cope with stressful events orcircumstances.
Improve role performance.
INTERVENTIONS
INTERVENTIONS
Encouraging Health Promotion
Strategies
Minimizing Anxiety
Mediating Anger
Using Relaxation Techniques
Encouraging Health
Promotion
Strategies
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Encouraging Health Promotion
Strategies
EXERCISE
NUTRITIONSLEEP
TIMEMANAGEMENT
EXERCISEPhysiologic Benefits:
Improved muscle Tone
Increased cardiopulmonary function
Weight Control
Psychologic Benefits:o Relief of Tension
o A feeling of well being and relaxation
EXERCISE
2005, Federal
Dietary Guidelines
Advisory Committee
recommend:
30 minutes of
daily exercise
NUTRITION
AVOID:
ExcessCaffeine
Salt
Sugar
Fat
SLEEPSLEEP restores thebodys energy level.
To ensure adequatesleep, clients may needhelp to attain comfortand to learn techniquesthat promote peace ofmind and relaxation.
TIME MANAGEMENT
People who manage
their time effectively
usually experience
less stress because
they feel more in
control of their
circumstances.
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Mediating Anger
Mediating Anger
FONTAINE and FLETCHER (2003)
recommend the following
strategies for dealing with clients
anger:
Mediating Anger
Know and understand your own
response to the feelings and
expression of anger.
Accept the clients right to beangry.
Try to understand the meaning of
the clients anger.
Mediating Anger
Ask the client what contributed to
the anger.Help the client own the anger.
Dont assume responsibility.
Let clients talk about their anger.
Listen. Act calmly as possible.
Using Relaxation
Techniques
Using Relaxation Techniques
Breathing
Exercises
Massage
ProgressiveRelaxation
Imagery
Biofeedback
Yoga
Meditation
Therapeutic
Touch
Music Therapy
Humor and
Laughter
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BREATHING EXERCISES
ABDOMINAL(DIAPHARGMATIC)
BREATHING
It permits deep fullbreaths with littleeffort.
PURSED LIPBREATHING
The purse lip creates aresistance to the airflowing out of the lungsthereby prolongingexhalation.
Client inhales to a countof 3 and exhales to acount of 7.
MASSAGE
Manipulating soft tissues with the
hands to promote relaxation.
Includes: EFFLEURAGE
(stroking)
PETRISSAGE (kneading)
TAPOTEMENT (tapping)
MASSAGE
Massage aids the body to
heal itself!
Improves blood flow and
movement of lymph fluid.
Speeds the removal ofmetabolic products
Allows more oxygen and
nutrients reach the cell
MASSAGE
Release muscle tension
Improves joint flexibility,
ROM Improves posture
Lowers BP
Slows heart rate
Promotes deeper and
easier breathing
MASSAGE
Improves health of the skin
Relaxed state of alertness
Reduces mental stress
Increases capacity for
clearer learning
Satisfies the need for caring
and nurturing
PROGRESSIVE RELAXATION
Systematically TENSING
RELAXING muscle groups from
head to toe.
Duration: 15 to 30 minutes
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PROGRESSIVE RELAXATION
TENSE each muscle group for 5
to 7 seconds then RELAXquickly
- Face, jaw, mouth (squint eyes,
wrinkle brow)
- Neck (pull chin to neck)
- Right hand (make a fist)
PROGRESSIVE RELAXATION
- Right arm (bend elbow tightly)
- Left hand (make a fist)
- Left arm (bend elbow tightly)
- Back shoulders, chest (shrug
shoulders up tightly)
- Abdomen (pull stomach in)
PROGRESSIVE RELAXATION
- Right upper leg (push leg down)
- Right lower leg and foot (point
toes toward body)
- Left upper leg (push leg down)
- Left lower leg and foot (point toes
toward body)
IMAGERY
IMAGERY isFormation of a
mentalrepresentationof an objectthat is usuallyonly perceivedthroughsenses.
IMAGERY
GUIDED IMAGERY is a state of
focused attention, much like
hypnosis.
GUIDED IMAGERY can help us
stop troublesome thoughts and
focus on images that help us
relax.
GUIDED IMAGERY
Images maybe created by the THERAPIST.
FEELING STATE
-move from a feeling state oftension to one of peace.
Ex: Imagine self at a beach or
floating gently on water
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GUIDED IMAGERY
END STATE
-Imagine self in the situationwished for.
Ex: See self as strong and
healthy
GUIDED IMAGERY
CELLULAR
-Imagine events at a cellular level
Ex: Imagine natural killerssurrounding and attacking cancercells.
BIOFEEDBACK
Biofeedback is a method for
learned control of physiologic
responses of the body. It is a
relaxation technique that useselectronic equipment to amplify
the electrochemical energy
produced by body responses.
BIOFEEDBACK
Conscious control of bodily
processes normally thought to bebeyond voluntary command:
muscle tension, heartbeat, blood
flow, peristalsis and skin
temperature can be voluntarily
controlled.
BIOFEEDBACK
Feedback provided through:
Temperature meters indicates
temp. changes
EMG (electromyography) record
electrical activity of muscles
YOGA
First practiced in INDIA.
Typical Yoga Session: 20
minutes to an hour.
Beginning researches
indicates people with
diabetes who practice
yoga may increase the
release of insulin from
the pancreas.
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MEDITATION
Meditation is a general term for a wide
range of practices that involve relaxing the
body and easing the mind.
Can be practiced individually or by groups.
If practiced regularly such as 20 minutes
twice a day, it produces widespread
positive effects.
MEDITATION
GUIDELINES:
1. Create a special time and place.
2. SIT. Avoid a lying position.
3. Support palms on thighs and close eyes.
4. Deep breathing or progressive relaxation
exercise.
5. Focus attention completely.
6. Practice daily for 10 to 20 minute period.
THERAPEUTIC TOUCH
Therapeutic touch is a process by
which energy is transmitted or
transferred from one person to
another with the intent ofpotentiating the healing process
of one who is ill or injured.
MUSIC THERAPY
QUIET, soothing music without words is often
used to induce relaxation.
Music recordings are often used to relax and
distract client in operative settings, ICUs,
birthing rooms, rehabilitation and physical
therapy units.
HUMOR AND LAUGHTER
Humorin nursing is defined as helping the
client to perceive, appreciate and express
what is funny, amusing or ludicrous in order
to establish relationships, relieve tension,
release anger, facilitate learning or cope with
painful feelings.