Transcript Chapter 29
Chapter 29: Mental and Emotional Responses to Medical Illness Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Mind/Body Connection Historically, the scientific community considered the body, mind, and spirit as separate entities Physical health and illness were the primary focus Few focused on concurrent mental and emotional responses to physiologic problems Holistic model is gaining prominence Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 2 Theories of Illness or Disease: Biologic, Multi-causal and Psychosocial Offer a framework for understanding the stress response as well as its relationship to physiologic and psychologic interactions Signs and symptoms of disease are observable and quantifiable Homeostasis; a dynamic state created by feedback and regulation processes Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 3 Common Psychosocial Responses to Stress and Illness Fear Anxiety Feelings of powerlessness and helplessness Hostility Anger Depression that often prohibits effective coping and adaptation Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4 General Adaptation Syndrome Hans Selye Stress: negative and positive Distress Eustress Psychologic stress Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 5 Stages of General Adaptation Syndrome Brief alarm reaction: “flight or fight” Resistance Exhaustion Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 6 Coping Resourcefulness and ability to manage the stress of daily circumstances, such as the challenges posed by pain, disability, or acute or chronic disease Coping mechanisms: Conscious or unconscious Adaptive or maladaptive Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 7 Adaptation A complex and continuously demanding process, particularly in accepting loss of independence and valued roles The current Western health care model includes a greater emphasis on health promotion across the life span, self-care management, and a holistic approach in managing acute and chronic psychosocial and physiologic health problems Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 8 Nurse’s Role The nurse has essential roles in helping patients recognize the impact of stress, assisting them in selecting appropriate coping mechanisms, and promoting the best possible quality of life. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 9 HIV/AIDS HIV Infection Asymptomatic or symptomatic Defect in natural immunity against disease Opportunistic infections Certain cancers AIDS Asymptomatic Fatal Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 10 Epidemiology Only AIDS reported to CDC; thus HIV infection statistics unavailable Trends: Incidence of AIDS Prevalence of AIDS AIDS deaths Heterosexual exposure Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 11 Cultural Considerations Difficult to reach populations Cases in rural areas Backward migration Issue: Adequacy of care Women and adolescent girls Especially African Americans Heterosexual contact Drug use Issues: Delayed testing, shock/disbelief, stigma Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 12 Cultural Considerations, cont’d. Lack of trust in health care system Socioeconomic issues Lack of insurance Competing needs Immigration status Different world views about health and illness Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 13 Etiology of Psychologic Distress with HIV/AIDS Consider history of mental illness predating HIV infection Mood and/or cognitive disorders Adjustment disorders with: Anxiety Depression Disturbance of conduct Major depression Substance abuse AIDS dementia complex Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 14 Biologic/Neuropsychiatric Factors AIDS Dementia Complex Moderate signs of depression and dementia Characterized by apathy, withdrawal, fatigue, hypersomnia, anorexia, weight loss, psychomotor retardation, subtle cognitive deficits Acute psychotic presentation Characterized by delusions, hallucinations, psychomotor agitation, mania with grandiosity, profound cognitive impairment Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 15 Symptoms of AIDS Dementia Poor concentration Difficulty problem solving Apathy Social withdrawal Forgetfulness Slowness of thought Motor deficits Tremor Impaired repetitive movements Ataxia Imbalance Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 16 Individuals Needing Intervention Believe selves at risk, but not tested HIV+ but asymptomatic Symptomatic, no AIDS-defining condition Full-blown AIDS Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 17 Adjustment Disorder Diagnosis pertains to reaction to having a life-threatening illness Begins within 3 months of onset of a stressor Ends within 6 months after stressor or its consequences have subsided Differential diagnoses: major depressive episode, personality disorder, bereavement reaction, PTSD, stress disorder, psychologic factors related to a medical condition Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 18 HIV-Related Problems Anxiety and depression related to deteriorating health Social rejection related to HIV+ status Increased drug use related to HIV+ status Shame/guilt related to stigmatized sexual practices Guilt/fear related to having put others at risk Homicidal ideation toward party who infected patient Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 19 Pharmacologic Intervention Medical HAART and mega-HAART Psychopharmacology Antidepressants Anxiolytics Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 20 Integrative Therapies Acupuncture Massage Herbs (in consultation with physician) Vitamins Meditation Relaxation techniques Stress reduction Spiritual practices Moderate exercise Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 21