mental health ch 19 illness and hospitalization

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mowgli
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mental health ch 19 illness and hospitalization
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2012-03-21 12:38:20
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health care in hospital
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  1. 5 stages of illness
    • 1 Symptoms
    • 2.sick role
    • 3. medical care
    • 4 dependency
    • 5 recovery & rehabilitation
  2. Symptoms
    when one becomes awarethat something is not right

    can be emotional or physical

    actions taken based on decision to act and accompanying emotional response

    one may treat self if s/s are mild
  3. What enters into determining if illness exists?
    • nature of syptoms
    • knowledge odf indiv
    • availability of treatment resources
  4. what usually governs behavior during the 1st stage of illness?
    emotional response
  5. Sick Role
    when individual recognizes presenes of health problem

    one who is sick seeks to confirm from fam, friends, & co-workers

    social group supports the presence of the illness and the individual whether they continue to deny illness or play the sick role
  6. purpose assuming "sick role" serves
    one is excused from daily tasks,

    permission given to heal & rest

    people pitch in & help by picking up the slack by assuming sick person's duties

    able to focus on restoring health
  7. Medical Care
    if the person remains ill and self remedies don't help, they might seek professional help

    • professional can confirm illness, offer assistance, and educate
    • or the person can continue to deny illnes

    many people "shop around" in a attempt to recieve Dx more to their liking
  8. Dependency
    During this stage individuals accept the attention of others

    one who relys on the kindness and energy of others has chosen the dependency role

    people in this stage need to be emotionally supported

    may feel gratefull for help but resentful to limitiations of illnes
  9. Recovery & Rehabilitation
    this occurs suddenly-response of drug therapy

    can occur slowly-recovery from CVA or mental disorder

    if recovery is quick and complete-the individual continues the same role as before illness

    for longer recovery - long term arrangments are made (at home if possible)

    when not possible indiv uaually transferred to another instituiton for further rehab
  10. Impact on Illness
    • is NOT ISOLATED-
    • SERIOUS
    • Some may react to illness with anxiety, anger, denial, shock, or withdrawal
    • If the illness involves a change in physical appearance it will have a strong impact on the individual’s BODY IMAGE
    • •Self-esteem issues are also impacted and this can take a toll on the family as the affected person starts lacking self-confidence
    • •Prolonged illness can cause “situational stress" to the family’ or stress due to the actual situation at hand that would not have existed if the family member would not have become sick
    • • Often, new roles and habits must be established- this adds stress to the family unit
  11. NOT ISOLATED
    affects the activities of the individual and those in contact with them

    challenges resources & changes activities of all those involved
  12. Body image challenges
    can occure with surgery, extensive Dx procesures

    also if illness progresses beyond expected time
  13. differant degrees of impact of illness
    short term/acute -little affect on behavior
  14. more serious- can lead to major emotional & behavioral changes
  15. SERIOUS
    mental/physical problems may have emotional and behavioral changes
  16. Illness Behaviors
    • some emotions serve to protect from further stresses or mobilize resources
    • others can be destructive if they block efforts toward resolving health problems
  17. Denial
    Psycological defense mechanism used to ward off painfull fellings
  18. –clients require pt and understanding
    struggling with emotional aspects of illness and attempting to restore themselves to more comfortable state of functioning
  19. when can denial be helpfull
    when it allows time to collect and reorganize thoughts and plans
  20. When can denial be harmful/deadly
    if it clouds judgment from taking steps to restore health
  21. Hospitalization
    Placement in an in-patient care facility for continuous nursing care and organized medical staff

    •Remember that people and their attitudes can be affected by other’s experiences

    seen as a crisis for most people

    •The person who is ill must rely on their coping skills that are being challenged by the anxieties of being ill

    •Most feel hospitalization is a crisis- some have difficulty coping
  22. What ways are people hospitalized
    • 1. Planned in advance admission
    • 2. Emergency requiring special health care resources
  23. ER admit
    there is NO time to prepare emotionally to the fact that hospitalization is eminent

    in an emergency situation, one is admitted to the hospital in a time of crisis

    lives are suddenly interupted

    • if illness is long term, lifestyle adjustments must be made quickly
    • •ALL hospitalized patient’s must deal with issues of feeling out of control and dependency
    • •**Those who are hospitalized due to a pre-existing condition, usually have some time to prepare for hospitalization both physically and emotionally
  24. Situational Crisis
    One that relates to external or env problem

    precisis behaviors consists of efforts to deal with the health problem

    the crisis is in being removed from one's familiar home env to be cared for by strangers
  25. When one is hospitalized..
    •all pts feel out of control and dependent on the mercy, knowledge, and expertiese of unknown care providers

    Causes high anxiety

    •One goes from being an individual to a “client or patient”

    •Think of the paperwork = one becomes a medical record #

    • •The armband = the persons identity
    • •The hospital gown = strips the persona of part of their identity

    •One is touched and asked personal questions by strangers

    Remember that when focusing on the physical problem, that the personal has emotions and feelings attached!
  26. 3 stages
    • Overwhelm
    • STABILIZATION-
    • ADAPTATION-
  27. Overwhelm
    • being separated from loved ones
    • •left alone in a strange environment
    • this is often exhausting
  28. •People who are ill are often exhausted – we all know you CAN NOT rest in the hospital!
  29. •High anxiety secondary to medical procedures, some painful
  30. STABILIZATION
    • patient gains some strength to re-establish some identity
    • •Individuals become self centered in this stage
  31. ADAPTATION-
    • The individual has regained enough of their personal identity to adapt
    • •Often becomes interested/willing to learn about health problems
    • •Uses coping techniques and interested in preventative measures
    • •Energy is replenished- body feels better
    • •Emotional responses are stable
    • •IF… transferred to another institution, the crisis begins again!!
  32. Psychiatric hospitalization
    • •Individuals and family members must deal with the stigma of being admitted into a psychiatric facility
    • •Friends may not want to discuss the illness with the client and may not know how to offer support
    • •Insurance companies may refuse payment
    • Employers may wuestion individual's fitness for the job
    • •The diagnostic label will follow people for years if not forever
    • •Admission may make the person feel that they are “crazy”
    • •The client may fear other client’s behavior
    • •Fear what will happen after release
  33. Psychosocial care
    •good physica care is 1st place to start in meeting emotional needs of ill person

    good psychosocial care starts with first- assess coping abilities

    •Try to identify problems before a crisis begins, plan preventative interventions

    •Use active listening skills

    •Encourage discussion of anxieties and fears

    •Clarify the clients perception of the problems

    •DO NOT pass judgment
  34. more psychosocial care
    • •Create an accepting environment
    • •Establish a trust in the therapeutic relationship
    • •Assist the client in coping with the fight or flight response brought on by crisis if illness and hospitalization
    • •Encourage relaxation and teach relaxation techniques
    • •Be alert for any cultural practices that may assist in the healing process
    • •Assess any possible risk factors
    • •Remember risk factors may be very evident, sometimes not- so SAFETY!
  35. Support the S. O.’s
    •Families are what the client perceives them as – may not be “traditional”

    •Some men who are the support of the family, may feel inadequate, humiliated when illness strikes

    •Family should be kept informed of progress

    •Family members are also in crisis- if the family feels the client is being cared for well, there will be decreased anxiety
  36. Pain management
    •The same nursing for the mental health care patient – but…

    •Pain may be perceived differently, exaggerated, or ignored

    good to learn about pt/s viewpoints to help plan/implement effective pain relief measures

    pain viewd differantly depending on experiences, attitudes, anxieties

    •Some may drug seek

    •Some may attempt to od

    •Some will refuse meds to exert control
  37. Ways to manage pain effectively
    mutual goal setting using the pain scale pt pick target pain score

    this helps both set attainable goals for pain nangagement

    asses pt's pain frequently

    try natural remedies first

    pain has emotional compound attached to it
  38. external loss
    incluedes those losses outide the individual
  39. internal loss
    personal and inclued losses that involve some part of oneself
  40. loss
    • a state in which something valued that was formerly present is changed or gone.
    • It can no longer be seen, felt, heard , known, or experienced
  41. characteristics of loss
    • actual
    • potential
    • imagined
    • temporary
    • perminant
    • expected
    • unexpected
    • sudden
    • gradual
  42. actual loss
    an actual threat or situation based in reality
  43. potential loss
    definded by individual experiencing it
  44. imagined loss
    percieved as a loss
  45. what dictates how a loss is defined
    the value, importance, and significance of the item to the individual
  46. maturational loss
    individual must give up something to gain a higher level of development
  47. situational loss
    occurs in response to external events

    individual has no control ove the event leading to the loss
  48. reactions to loss depends on
    person's level of development, past experiences and current support system
  49. newborn and infants understanding of losss
    • feel the loss of their caregiver
    • but show little emotional reaction to loss as long as their basic needs are being met
  50. toodlers understanding of losss
    they have no grasp of the real meaning of loss
  51. preschooler understanding of losss
    • use magical thinking(feel their thoughts, etc control events) to explain loss.
    • cannot understand a permenent loss
  52. school age understanding of losss
    • have some idea about cause and effect
    • s
    • till assosciate bad thoughts/etc. to loss

    • they experience great feeling of grieg over the loss of a
    • body part or function

    may feel overwhelming responsibility & guilt about event

    respond well to simple logic
  53. 6/7 year old understanding of losss
    often apply a broad def to loss (esp death) by giving responsibility for loss to devil, god or bogyman
  54. 9/10 years old understanding of losss
    • most kids have adult concept of loss and death
    • know about differant kinds of loss

    attitudes, reations, and responsesa to their lossess are now firmly established
  55. adolescent understanding of losss
    react with adult thinking and childlike emotions

    understand concepts but are least likely to accept the situation

    griev acutely over loss of a body part or frunctioin and feer rejection from peers

    don't want to stand out
  56. adults understanding of losss
    ble to percieve vents more abstarcatly than younger individuals

    most able to accept their losses and frow fro their experiences

    develop a "hardiness"
  57. hardiness
    a sense of self-confidence and understanding about life and death

    helps stave off depression

    able to problem solve and are in control of their emotions and reactions to loss
  58. General Adaptation Syndrome
    biochemical reactions of the stress response and their effects on various body systems

    named by Hans Selye

    • 1 Alarm
    • 2. Resistance
    • Exhaustion

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