Coping and Nursing Management

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


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


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]


imagined] that is consciously recognized

as a danger.

OBJECTIVE:

PR = 121 beats per minute

RR = 29 cycles per minute

(+) Pupil Dilation

(+) Pallor

(+) Increased Perspiration


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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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.


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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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)


- 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)


- 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.

Coping and Nursing Management

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