By: Vilma Mozo-Boniacio

The wear and tear that

life causes on the body.
The type of response
elicited depends on
individual perception of the
stressor.

SelyesStress-Adaptation
Theory (Hans Selye)
> identified General
Adaptation Syndrome
1. Alarm Reaction Stage
> stress stimulates the
body to send messages from
the hypothalamus to the
glands.
> level of anxiety is
mild (1+) to moderate (2+).
> learning and problem
solving may occur.
2. Resistance stage
> the digestive system reduces function
to shunt blood to areas needed for defense.
> fight, flight or freeze
> the use of coping and defense
mechanisms is increased.
> problem solving and learning is
difficult.
> psychosomatic symptoms begin to
develop.
> the level of anxiety is moderate (2+) to
severe (3+).
3. Exhaustion stage
> when the person responded
negatively to anxiety and stress.
> may result from the individuals
total inability to cope.
>anxiety is experienced at the
severe (3+) to panic (4+) levels.
> defenses are exaggerated and
dysfunctional, and the personality
becomes disorganized, thinking illogical
and decision making ineffective.
 Alsoknown as
bereavement

Refers to the subjective

emotions and affect, that
are a normal response to
the experience of loss.

Mourning is the outward

expression of grief.
 Kubler-Ross Stages of Grieving
(Elizabeth Kubler-Ross)
1.Denial shock and disbelief regarding the
loss.
2.Anger- may be expressed toward God,
relatives, friends, or health care providers.
3.Bargaining occurs when the person asks
God or fate for more time to delay the
inevitable loss.
4.Depression results when awareness of the
loss becomes acute
5.Acceptance occurs when the person shows
evidence of coming to terms with death.
Responses and Symptoms of Grief:
1.COGNITIVE: disrupt of assumptions and
beliefs, questioning and trying to make sense
of the loss.
2.EMOTIONAL: anger, sadness, anxiety
3.SPIRITUAL: disillusioned and angry with God
or other religious figures.
4.BEHAVIORAL: automatism, tearfully sobbing,
crying uncontrollably, showing great
restlessness, searching.
5.PHYSIOLOGIC: insomnia, headaches,
impaired appetite, weight loss, lack of energy,
palpitations, indigestion and changes in the
immune and endocrine systems.
 Assessment:
1. Adequate perception
regarding the loss.
2. Adequate support
while grieving.
3. Adequate coping
behaviors during the
process.
Nursing Diagnoses:
1. Grieving related to: (actual or
perceived loss:
Physiologic loss ( ex. loss of a limb)
Loss of security and sense of
belongingness (ex. Loss of loved one).

2. Anticipatory grieving related to:

Intellectual, emotional responses
behaviors
3. Dysfunctional grieving related to:

Extended unsuccessful use of

intellectual and emotional
responses by which individuals,
families, and communities attempt
to work through the process of
modifying self- concept based on
the perception of loss.
Nursing Interventions:
1. Explore clients perception and
meaning of his or her loss.
2. Allow adaptive denial.
3. Encourage or assist client to
reach out for and accept support.
4. Encourage the client to examine
the patterns of coping in past and
present situation of loss.
5. Encourage client to
review personal strengths
and personal power.
6. Encourage client to
care for him self or her
self.
7. Offer client food
without pressure to eat.
8. Use effective
communication.
9. Establish and maintain
interpersonal skills
A normal human emotion involving
a strong, uncomfortable, emotional
response to a real or perceived
provocation.

Physical Aggression is a
behavior in which a persons
attacks or injures another person
or that involves destruction of
property.
 1. Triggering phase: the stress-
producing event occurs, initiating the
stress responses.
2. Escalating phase: responses
represent escalating behaviors that
indicate a movement toward the loss
of control.
3. Crisis phase: a period of emotional
and physical crisis in which loss of
control occurs.
4. Recovery phase: a period of cooling
down in which the persons slows down and
returns to normal responses.

5. Post crisis depression phase: a period in

which a person attempts reconciliation with
others.
ETIOLOGY:
1.Neurobiological Theories: low serotonin
level.
2. Psychosocial Theories:

Dysfunctional families can result in a

person who is impulsive, easily frustrated
and prone to aggressive behavior.
Wishes are not granted from toddlers.
Rejection hat causes the individual
emotional pain or frustrations, or is a threat
to self esteem.
TREATMENT:

Focuses on treating the underlying or

comorbid psychiatric diagnosis such as
schizophrenia or bipolar disorder.
ASSESSMENT:
1. Assess the factors that influence aggression
in the psychiatric environment or unit milieu.
2. Assess the individual client carefully how
the client with history of aggression handless
anger and what clients believes is important
for him in assisting him to control aggression.
3. Assess the clients behavior to determine
which phase of aggression cycle he or she for
appropriate intervention.
NURSING DIAGNOSIS:

1. Risk for other-

directed violence
2. Ineffective coping
OUTCOME IDENTIFICATION/ GOAL:
1. The client will not harm or threaten others.
2. The client will refrain from behaviors that
are intimidating or frightening to others.

3. The client will described his or her feelings

and concerns without aggression.
4. The client will comply with treatment
NURSING INTERVENTIONS:
1. Build trust ASAP.
2. Be aware of the factors that increase the
likelihood of violent behaviors.
3. Decrease environmental stimulation.
4. Help the client express feelings in
nondestructive ways.
5. Calmly and respectfully assure the client that
you will provide control if he or she cannot
control himself or herself, but do not
threaten the client.
6.Be aware of PRN medication and procedures
for obtaining seclusion or restraint orders.
7. Remain aware of clients feelings (including
fear), dignity and rights.
8. Carefully observe the client, and promptly
complete documentation in keeping with
hospital policy.
9. Administer medications safely.
10. Monitor client for effects of medications.
A vague feeling of
dread or
apprehension.
1. MILD restlessness, difficulty in sleeping.

NURSING INTERVENTION: Discuss the source of

anxiety. Problem solving, accept anxiety as
natural.
2. MODERATE
headache, high voice
pitch, fast rate
Of speech. GI upset,
frequent urination

NURSING INTERVENTION:
1.Decrease anxiety.
2.Use problem solving.
3. Oral medication if
needed.
 3. SEVERE severe
headache, tachycardia,
chest pain, diarrhea

NURSING INTERVENTION:
1.Decrease anxiety, stimuli, and pressure.
2. Use kind, firm, simple directions.
3. Use time out (seclusion).
4. Intramuscular medications if needed.
4. PANIC may bolt and run or totally
immobile and mute, dilated pupils,
increased BP & pulse, fight, flight or
freeze.

NURSING INTERVENTION:
1.Guide firmly or physically take
control.
2.Intramuscular medication
3.Restrain if needed.
ETIOLOGY:
1. Hereditary
2. Neurochemical Theories: decrease in
Gamma- aminobutyric acid (GABA)
3. Intrapsychic/Psychoanalytic
Theories: too much use of defense
mechanisms. Conflict between ID & SE.
4. Interpersonal Theories: problems in
interpersonal relationships.
5. Behavioral Theory: anxiety learned
through experiences
Restlessness and inability to relax
Episodes of trembling and shakiness
Chronic muscular tension
Dizziness
Inability to concentrate
Chronic fatigue and sleep problems
Inability to recognize the connection
between the anxiety and physical
symptoms
The client is focused on the physical
discomfort
1. Ineffective individual coping
2. Anxiety

Nursing Care:
C-calm
A- administer drug
L- Listen to patients concern
M- Minimize environmental stimuli
TREATMENT:
1.Medication
2.Cognitive-behavioral therapy

DSM IV-TR diagnostic Criteria:

Symptoms of Anxiety Disorder
1. Panic disorder
characterized by recurrent,
unexpected panic attacks
that cause constant concern.

PANIC ATTACK
is the sudden onset of
intense apprehension,
fearfulness, or terror
associated with feelings
of impending doom.
2. Specific phobia characterized by
significant anxiety provoked by a specific
feared object or situation which often leads
to avoidance behavior.
* Agoraphobia anxiety
about or avoidance of
places or situations
from which escapes
might be difficult or
help might be unavailable.
* Social phobia
characterized by anxiety
provoked by certain types
of social or performance
situations, which often
leads to avoidance behavior
3. Obsessive-Compulsive
disorder-

involves obsessions (thoughts,

impulses or images) that cause
marked anxiety and /or
compulsion (repetitive behaviors
or mental acts) that attempt to
neutralize anxiety.
4. General Anxiety Disorder
- Characterized by at least 6 months of
persistent and excessive worry and anxiety.
5. Acute Stress Disorder-

Development of anxiety
dissociation and other
symptoms with in 1
month of exposure to
an extremely
traumatic stressor,
It lasts 2 days to 4 weeks.
6. Post Traumatic Stress Disorder-
Characterized by the re-experiencing of
an extremely traumatic event, avoidance of
stimuli associated with the event, numbing
or responsiveness and persistent increased
arousal after the event and may last few
months or years.
1.Anxiety related to general
medical condition.
2.Substance-induced
anxiety disorder.
3.Separation anxiety
disorder.
4.Adjustment disorder.