7. 3 Stages of Stress When stressors are threatening or perceived to be threatening, the body activates physiological changes that ready it for FIGHT OR FLIGHT . The fight-or-flight response occurs. Long-term coping with stressors depletes adaptive energy, resulting in exhaustion. When the body has used up its adaptive energy & can no longer cope with stressors, it breaks down in disease, collapse, or death Stage One: ALARM Stage Two: RESISTANCE Stage Three: EXHAUSTION

11. SLEEP CYCLE REM Sleep NREM Stage 2 NREM Stage 3 NREM Stage 4 NREM Stage 3 NREM Stage 2 The Sleep Cycle NREM Stage 1

12. Adequate high quality sleep is essential for health & for physiological & psychological healing to occur It is believed that during " REM " sleep, adjustment are made that are necessary for learning & memory Need 20 hours of sleep Need 5 - 6 hours

20. 6. Treatment Nasal CPAP --Continuous positive airway pressure ( CPAP ) --lose weight (only 50% successful) -- Uvulopalatopharyngoplasty to remove excess tissue from soft palate, uvula, & pharynx

23. Relief I need help because I’m lonely.

24. Ease I feel totally peaceful.

25. Transcendence I did it! (with the help of my coach…)

26. What do we, as nurses, do to promote physical comfort? positioning Pain & sleep meds Quiet room Comfortable lighting Limit visitors

27. But physical comfort and positioning isn’t the only important type of comfort There are three more comfort themes that need to be addressed: 1. Comfort theme of self-esteem (psychospiritual)

28. 2. Comfort theme of approach and attitudes of staff (sociocultural)

29. 3. Comfort theme of hospital life (environment).

39. Pain Scale

43. Areas of Referred Pain Liver Appendix Ureter Liver Heart Stomach Gallbladder Small intestines Ovary Kidney Colon Bladder

49. Example : Jack injured his left leg, which caused an impairment in his ability to flex his knee 50%. Since he was a school bus driver, this handicap made him no longer able to operate the bus safely.

50. Case Study Mr. Thompson, age 72, suffered a left-sided brain hemorrhage 3 weeks earlier. Because of this, he was unable to speak or use his right arm or leg. He was also incontinent of urine and exhibited some right-sided facial paralysis. After 5 days in the hospital, it was determined that Mr. Thompson’s condition had stabilized, and he was transferred to a rehabilitation facility to continue the rehabilitation process. At this time, his speech had returned, but was slurred and halting.

51. He had minimal movement in his right arm and leg but was still unable to walk or feed himself. The incontinence of urine persisted, and he had several reddened areas on his right hip and coccyx. Before his injury Mr. Thompson had been living with only his wife of 50 years, who also was in poor health. They had no family living in the state, and she was quite concerned about how she would care for him once he was sent home.

52. To comprehend all that is involved in helping Mr. Thompson’s return to full functioning (if that is possible), first you need to imagine a typical day in the Thompson household and to identify all the ADL and IADL competencies required to get through the day. Next, think about all the people and services that may be necessary to prevent further injury and to increase functioning.

54. PATIENT & FAMILY Rehab Team NUTRITIONIST NURSE PSYCHOLOGIST PHYSICAL THERAPIST OCCUPATIONAL THERAPIST SOCIAL WORKER PHYSICIAN RECREATIONAL THERAPIST SPEECH THERAPIST