Dysfunctional or Maladaptive Response to Stress - Essay Example

Case Study Essay on Dysfunctional or Maladaptive Response to Stress, Anxiety State and Substance Abuse / Dependence In the healthcare setting, nurses are the first ones who get to interact with clients. There are ways on how nurses evaluate a person with maladaptive response to stress, is anxious and with episodes of substance abuse. Nurses should know the factors that contribute to the development of the client’s situation. Nurses play an important role in helping the client understand her susceptibility to harm due to her weaknesses, in identifying strengths that could help her adjust to her situation and be on her way to recovery. All these will be discussed in this essay. Stress occurs when we feel a threat to our safety and security. How individuals cope with anxiety and stress is important in understanding how individuals are functioning in their personal, social and occupational roles (Keltner, Schwecke, & Bostrom. 2007). Stress models help nurses to know how stress affects clients and their physiological responses to stress. These responses are known as general adaptation syndrome which has three stages: alarm reaction, resistance and exhaustion. Alarm reaction causes increased alertness and anxiety. Resistance happens as body adapts to stress using coping mechanisms. Exhaustion occurs as stress overwhelms the client. These stages result from feelings of anxiety. An anxious person can be evaluated using the four levels of anxiety: mild, moderate, severe and panic (Keltner et al., 2007). In mild anxiety, the body is prepared for constructive action due to increased alertness. The person can still adapt and be productive. In moderate anxiety, the body is prepared for protective action. The individual experiences moderate muscle tension, easily distracted but can focus with assistance, has slightly increased respiratory and heart rates. In severe anxiety, body is prepared for fight or flight response. There is extreme muscle tension, increased perspiration, sleep disturbance, difficulty focusing, ineffective reasoning and problem solving and may result to suicidal and homicidal ideations if prolonged. During the panic level, there is actual flight, fight or immobilization. A person feels overwhelmed, out of control and totally drained. Suicide attempts or violence occurs at this level. (Keltner et al., 2007). Basing on the general adaptation syndrome and levels of anxiety, the client is in the stage of exhaustion and is experiencing panic level of anxiety. People experience stress everyday as it results from both positive and negative experiences. Stressors are stimuli that cause a person to experience stress and are classified into internal, external, developmental or situational stressors. (Kozier, Erb, Berman, & Snyder., 2004). How these stressors affect a person would depend on the person’s developmental stage. Turner and Lloyd (2004) showed that accumulated high levels of lifetime exposure to adversity is an important risk factor for subsequent onset of depressive and anxiety disorder in young adults. As a nurse, we can further evaluate the client using the nursing process which is the basis of all nursing actions. Assessment of subjective and objective cues of the client is done first. The client manifested ineffective coping to stress as she reported episodes of sleep disturbance, fatigue, emotional tension, lack of appetite and substance abuse. She also showed decreased use of social supports, poor concentration and destructive behavior towards self as evidenced by deep lacerations on her wrists. (Doenges, Moorhouse, & Geissler-Murr., 2008). A study on Prevalence, Correlates, Disability and Comorbidity of DSM-IV Alcohol Abuse and Dependence in the United States was done and it has been found out that there is significant association between anxiety disorder and alcohol dependence. (Hasin, Stinson, Ogburn, & Grant., 2007.). In persons with general adaptation syndrome, 3% of them are alcohol dependent (Hasin et al., 2007. p. 835). 30.3% of the population experienced alcohol use disorder during their lifetime and 12.5% of this group developed alcohol dependence. It was also shown that people at the younger age bracket have higher risk to have alcohol dependency (Hasin et al., 2007. p. 837). The client is also in a state of severe to panic anxiety. Subjectively, she manifested fearfulness, feeling a sense of impending doom, fatigue and sleep disturbance. Objectively, it can be seen that the client has extraneous movements (continually wrings her hands), has diminished productivity at work, insomnia, loss of appetite for more than 3 months and difficulty concentrating (Doenges et al., 2008). She also showed that she is undergoing chronic type of post-trauma syndrome which is sustained maladaptive response to a traumatic event (Doenges et al., 2008). The death of her sister 13 months ago could have contributed to her condition. Because of this, she lost interest in usual activities, had appetite changes, sleep disturbance and chronic fatigue. She also manifested alienation and substance abuse (Doenges et al., 2008). Research showed that chronic depression tend to occur in 10-15% of bereaved individuals (Bonanno. 2004. p. 23). Death of a loved one causes grief to people and each person has a way of coping with this grief. Others cope by using positive emotion by increasing communication with their support group (Bonanno. 2004). Linda’s support group is far away from her. She has no immediate significant other to help her deal with the grief. Having post-traumatic stress disorder also puts Linda at risk for substance abuse. In a study done by Breslau, Davis and Schultz (2003), among persons with post-traumatic stress disorder, 15.8% has alcohol dependence and 10.6% developed drug dependence (Breslau et al., 2003. p.292). The nurse plays a crucial role in helping a client to effectively cope with stress by developing a plan aimed at assisting a client overcome her situation. This plan should aim at decreasing anxiety, increasing ability to deal with stress and improve role performance (Kozier et al., 2004. p.1022). For a plan to be successful, the nurse should establish a therapeutic relationship with the client. To decrease client’s anxiety, a nurse needs to listen attentively, encourage client to discuss her feelings to help increase her awareness of connection between feelings and behaviors (Keltner et al., 2007), provide an atmosphere of trust, stay with client to promote safety, control environment to minimize additional stressors like providing care by the same nurse as possible (Kozier et al., 2004). Involve the client in activities like walking or playing games to help her release nervous energy. The client can increase her ability to deal with stress when the nurse helps client to identify situations that cause anxiety, verbalize feelings, identify personal strengths, identify ways of managing stress like exercise, massage, and meditation (Kozier et al., 2004). Low-Dose Mindfulness-Based Stress Reduction (Klatt, Buckworth, & Malarkey. 2008) was used in a study with working adults as subjects. It used mindfulness meditation to teach nonjudgmental awareness of sensation, emotion, cognition and perception. Improvement on quality of life scales, depression, anxiety, coping style and social functioning were noted (Klatt et al., 2008). The last goal is to promote client’s wellness. Encourage client to have an exercise program, a balanced diet, rest and sleep to energize body and enhance coping abilities. List available support groups to provide ongoing support. Encourage client to avail of programs like stress management and behavior therapy. Manualized cognitive behavior therapy or seeking safety therapy is done by having 1-hour individual sessions twice a week for 12 weeks (Hien, Cohen, Miek, Litt, & Capstick., 2004. p. 1427). Using this approach, there has been significant decrease in substance use and psychological symptoms in women with comorbid post-traumatic stress disorder and substance abuse (Hien et al., 2004. p.1426). During a crisis, anxiety usually reaches severe or panic level. It occurs suddenly, client perceives it as life threatening, communication with significant others is decreased and there is a feeling of displacement from familiar surroundings and people (Kozier et al., 2004. p. 1025). A person in crisis undergoes a period of disorganization when the individual has the tendency to depend on others for guidance and assistance. This period is so distressing that a person can tolerate it only for 4-6 weeks. If help is not attained and crisis is not resolved within this period, the person in crisis becomes exhausted and physically ill, adopt dysfunctional coping patterns, become violent or attempt suicide to escape pain (Keltner et al., 2007). The factors that caused Linda to hurt herself were depression from the death of her sister, significant decrease in family support, unfamiliarity with her environment and people around her and no established social connections. Despite Linda’s current situation, there are factors in her life that can help her regain good mental health. She is an educated 28 year old young adult. Her age and educational attainment are good factors in helping her to be compliant to her treatments which could hasten her recovery. She could also relate well to the healthcare professionals especially the nurse who is taking care of her. This leads to a better therapeutic nurse-patient relationship. Being employed, Linda has the financial capability to seek treatment for her condition and avail of programs for stress management, exercise, yoga and meditation. Before Linda’s current hospitalization, she has called Lifeline on many occasions but did not follow up on advice. Crisis intervention centers rely on telephone counseling known as hotlines. (Kozier et al., 2004). That Linda is aware of her current emotional and psychological status and calling a hotline indicates that she wants to be helped. This also shows that Linda knows that there are support groups available to help people with problems like her. The nurse as a patient advocate has the responsibility to plan with the client for implementation of care with the goal of achieving client’s wellness. Planning, setting goals and choosing appropriate interventions are essential to creating the best plan of care for the client and delivery of quality nursing care. Using basic nursing knowledge and skills coupled with client’s cooperation, it will not be difficult for Linda to achieve good mental status. References 1. Bonanno, G. (2004). Loss, Trauma, Human Resilience: Have We Underestimated the Human Capacity to Thrive After Extremely Aversive Events?. American Psychologist, 59 (1), 20-28. doi: 10.1037/0003-066X59120 2. Breslau, N., Davis, G., & Schultz, L. (2003). Post-Traumatic Stress Disorder and the Incidence of Nicotine, Alcohol and Other Drug Disorders in Persons who have Experienced Trauma. Arch. General Psychiatry, 60. p. 289-294. Retrieved from http://www.archgenpsychiatry.com. 3. Doenges, M., Moorhouse, M.F., & Geissler-Murr, A. (2008). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales. Philadelphia: F. A. Davis Company. 4. Hasin, D., Stinson, F., Ogburn, E., & Grant, B. (2007). Prevalence, Correlates, Disability and Comorbidity of DSM-IV Alcohol Abuse and Dependence in the United States (Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch. General Psychiatry, 64 (7). p. 830-842. Retrieved from http://www.archgenpsychiatry.com. 5. Hien, D., Cohen, L., Miele, G., Litt, L.C., & Capstick, C. (2004). Promising Treatments for Women with Comorbid PTSD and Substance Use Disorders. American Journal of Psychiatry, 161(8). p. 1426-1432. Retrieved from http://ajp.psychiatryonline.org. 6. Keltner, N., Schwecke, L.H., & Bostrom, C. (2007). Psychiatric Nursing. St. Louis, Missouri: Mosby. 7. Klatt, M., Buckworth, J., & Malarkey, W. (2008). Effects of Low-Dose Mindfulness-Based Stress Reduction on Working Adults. Health, Education and Behavior Online First. doi: 10.1177/1090198108317627 8. Kozier, B., Erb, G., Berman, A.., & Snyder, S. (2004). Fundamentals of Nursing: Concepts, Process and Practice. Upper Saddle River, New Jersey: Prentice Hall. 9. Turner, R. J., & Lloyd, D. (2004). Stress Burden and the Lifetime Incidence of Psychiatric Disorder in Young Adults: Racial and Ethnic Contrasts. Arch. General Psychiatry, 61. p. 481-488. Retrieved from http://www.archgenpsychiatry.com. Read More