4.
Help client with problem solving and
decision making as indicated
5. Encourage the client and/or significant
others to ventilate
6. Utilize therapeutic touch as appropriate
7. Assist in discussions of future plans as
appropriate
19. Stress Management
o Stress: a universal phenomenon, stress
requires change or adaptation so that the
person can maintain equilibrium
o Stress can be internal or external
o Nature of stressor involves:
1. Intensity
2. Scope
3. Duration
4. Other stressors: their number and nature
o Categories of stressors - and examples
1. Physical - drugs or alcohol
2. Psychological - such as adolescent
emotional upheaval, or unexpressed anger
3. Social - isolation, interpersonal loss
4. Cultural - ideal body image
5. Microbiologic - infection
o The greater the stressor as preceived by
the client, the greater the stress response
o Stress response involves both localized
and general adaptation
G. Factors affecting stress response
1. Personal: heredity, gender, race, age
personality, cognitive ability
2. Sociocultural: finances, support systems
3. Interpersonal: self-esteem, prior coping
mechanisms
4. Spiritual: belief system
5. Environmental: crowding, pollution,
climate
6. Occupational: work overload, conflict,
risk
H. Physiologic indicators of stress
I. Emotional/behavioral indicators of stress
J. Stress can cause a variety of emotional
and physical disorders
K. Stress management strategies
L. The non-compliant client does not
cooperate with the treatment plan
1. Behavior characteristics
a. does not take prescrived medication
b. continues activities restricted by provider
of care, such as smoking
c. does not follow prescribed activities, such
as exercise
2. Nursing interventions
a. explore the reasons for non-compliance
i. lack of understanding - reinforce teaching
ii. lack of family support - involve family and
support groups
iii. side effects - refer to provider of care
iv. finances and access - refer to Social
Services
v. negative attitude toward treatment -
encourage expression
b. express genuine concern for client
c. discuss imporvement potential
2. Schizophrenia
G. Definition: a multifaceted psychosis with
early onset; criteria from DSM IV as follows:
1. When disease is in active phase, client
shows psychotic behaviors. (Psychosis is
severe ego dysfunction. Psychosis is also
part of other DSM-IV diagnoses of
dysfunctions of thought and sensorium.)
2. Findings involve many psychological
processes
3. Previously, client had functioned at a
higher level
4. Schizophrenia normally sets in before 30
years of age
5. Findings last six months or more
6. Not caused by affective or organic mental
disorder
7. Involves hallucinations and/or delusions
H. General characteristics of schizophrenia -
six losses: S-S-O-B-E-R
1. Self-care often fails
2. Social adjustment is impaired
3. Orientation to the environment is lost
4. Boundaries between self/others dissolve
5. External/internal stimuli are confused
(delusions/hallucinations)
6. Reality testing fails
I. Etiologies of Schizophrenia
1. Biogenetic (possible hereditary factor)
2. Biochemical
b. dopamine hydrochloride - too much
neurotransmitter for neural activity
c. research has suggested abnormalities of
neurotransmitters norepinephrine,
serotonin, acetylcholine and GABA (gamma
aminobutyric acid).
3. Contributing factors
a. poor relationships with primary caretaker
b. dysfunctional family systems
c. double-bind communication
d. stressful life events
e. decreased socio-economic status (SES)
D. Findings of schizophrenia
3. Positive findings
a. hallucinations
b. delusions
c. looseness of associations
d. agitated or bizarre behaviors
4. Negative findings
a. apathy
b. poverty of speech or content of speech
c. poor social functioning
d. anhedonia
e. Social withdrawal
E. Positive findings
3. Acute onset
4. Normal premorbid functioning
5. Normal social functioning during
remission
6. Normal CT scan
7. Normal neuropsychological test results
8. Favorable response to antipsychotic meds
9. Appear early in illness
10. Often precipitate hospitalization
11. Alterations in thinking, perceiving and
behavior
F. Negative findings
3. Insidious onset
4. Premorbid history of emotional problems
5. Chronic deterioration
6. Demonstration of atrophy on CT scan
7. Abnormalities on neuro-psychological
testing
8. Poor response to antipsychotic meds
9. Interferes with person's ability to:
a. initiate and maintain relationships
b. initiate and maintain conversations
c. hold a job
d. make decisions
e. maintain adequate hygiene and grooming
G. Alterations in thinking
3. Types of delusions
a. ideas of reference
b. persecution
c. grandeur
d. somatic delusions
e. jealousy
f. control/being controlled
g. thought-broadcasting
h. thought insertion
i. thought withdrawal
4. Associative looseness
5. Neologisms