powerpoint presentation on psychodynamics

1. Psychodynamics
 Psychodynamics is the theory and systematic study of the
psychological forces that underlie human behavior,
especially the dynamic relations between conscious
motivation and unconscious motivation.
 In general, psychodynamics, also known as dynamic
psychology, is the study of the interrelationship of various
parts of the mind, personality, or psyche as they relate to
mental, emotional, or motivational forces especially at the
unconscious level

2. Stress
 Stress results from a change in the environment that is
perceived as challenge, a threat, or a danger, & can
have both positive & negative effects.
Types of stress
 Distress –damaging stress
 Eustress –stress that protects the health, eustress is
motivating energy, such as happiness, hopefulness &
purposeful movement .

3. Stressor
 A stressor is anything that is perceived as challenging,
threatening, or demanding.
 Stressor may be
 Internal-e.g.an illness, a hormonal change or fear
 External –e.g. loud, noise or cold temperature

4. Adaptation
 When a person is in a threatening situation, immediate
responses, which are often involuntary, are called
coping responses .the change that take place as a
result of the response to a stressor is adaptation
perception of source coping
stressor for support mechanisms

5. Dynamic balance & homeostasis
 When a change or stress occurs that causes body
functions to deviate from its stable range. Processes
are initiated to restore & maintain dynamic balance.
 Three of the major mechanism used in adapting the
stressors is controlled by
medulla oblongata,
 the reticular formation
 pituitary gland

6. Medulla oblongata
 The medulla oblongata controls vital functions
necessary to survival. These include heart rate, blood
pressure & respiration. Impulses traveling to and from
the medulla oblongata can increase or decrease these
vital functions.
 Example:- regulation of the heart beat is the result of
sympathetic or parasympathetic nervous system
impulses traveling from the medulla oblongata to the
heart. The heart rate increases in response to pulse
from sympathetic fibers and decreases with impulse
from parasympathetic fibers.

7. Reticular formation:-
 the reticular formation is a small cluster of neurons in
the brain stem and spinal cord. It also control vital
functions and continuously monitors the physiological
status of the body through connections with sensory &
motors tracts.
 For example-certain cells within the reticular
formation can cause a sleeping person to regain
consciousness or increase the level of consciousness
when a need arises.

8. Pituitary Gland
 The pituitary gland, a small gland attached to
hypothalamus supplies hormones that control vital
functions. The pituitary gland produces hormone
necessary for adaptation to stress such as
adrenocorticotrphic hormone, which in turn produce
cortisol. In addition pituitary gland regulates the
secretion of thyroid, gonadal, &parathyroid hormones.
 When hormone level drop, the pituitary gland receives
a message to increase hormone secretion. When
hormone level s rise, the pituitary gland decreases
hormone production

9. Maintaining physiological &
psychological homeostasis
The effect of physiologic & psychological stress are
interrelated, as are the mechanisms that are
consciously used to maintain homeostasis in response
to illness
1)Physiological homeostasis
-general adaptation syndrome
-local adaptation syndrome
2) Psychological homeostasis

11. 1)General Adaptation Syndrome
The GAS can be triggered either directly by physical
event or indirectly by a psychological event (Lazarus
1999) The GAS is an immediate Physiological response
of the body to stress & involves several body systems,
especially the autonomic nervous system & the
endocrine system
Three Stages of Stress
 Alarm Reaction
 Resistance Stage
 Exhaustion Stage

12. THE IMMEDIATE
RESPONSE:
 The hypothalamus stimulates the sympathetic nervous
system, which results in the following physical effects-
 The adrenal medulla releases norepinephrine and
epinephrine into the bloodstream
 The pupils of the eye dilate
 Secretion from the lacrimal gland is increased
 In the lungs, the bronchioles dilate the respiration rate
is increased
 The cardiac contraction increases, as do cardiac
output, heart rate, and blood pressure

13.  Gastrointestinal motility and secretions decrease, and
sphincters contract
 In the liver, there is increased glucogenolysis and
gluconeogenesis, and decreased glycogen synthesis
 Secretion from the sweat gland is increased
 Lipolysis occurs in the fat cells

14. Sustained stress response
 When an individual experiences stress over a long
time, the hypothalamus stimulate the pituitary gland
to release hormones that produce effects:
 Adrenocorticotrophic hormone stimulates the adrenal
cortex to release glucocorticoids and
mineralocorticoids, resulting in increased
gluconeogenesis and retention of sodium and water
and decreased immune and inflammatory responses.

15.  Vasopressin increases blood pressure through
constriction of blood vessels and also increases fluid
retention
 Thyrotrophic hormone stimulates the thyroid gland to
increase the basal metabolic rate
 Gonadotropins cause a decrease in secretion of sex
hormones, resulting in decreased libido and
impotence

16. Resistance Stage:-
 In the resistance stage the body stabilizes and
hormone level, heart rate, B.P and cardiac output
returns to normal. The person is attempting to adapt
to the stressor. If the stress can be resolved, the body
repairs damage that may have occurred.

17. Exhausation Stage:-
 Exhaustion stage occurs when the body can no longer
resist stress and when the energy necessary to
maintain adaptation is depleted.

18. 2)Local Adaptation Syndrome
 LAS :- the body produces localized response to stress.
the response is localized, it does not involve entire
body system
 Two localized responses are
The Reflex Pain Response
Inflammatory Response

19. Reflex Pain Response
The response is a localized response of the CNS to
pain. It is an adaptive response and protects tissues
from further damage. The response involves a sensory,
motor receptor.
e.g reflex removal of hand from a hot surface.

20. Inflammatory Response
 The inflammatory response is stimulated by trauma or
infection. This response localizes the inflammation.
This preventing its spread and promote healing. The
inflammatory response may produce localized pain,
swelling, heat, redness, changes in functioning. It
occur in three phases.

21.  First Phase involves changes in cells and circulatory
system. Initially narrowing of blood vessels at the injury
site to control bleeding. The histamine is released at the
injury, increasing blood flow to the area and increasing the
number of WBC to combat infection.
 The Second Phase is characterized by release of exudates
from the wound, exudates is a combination of fluid, cell
other substances produce in the area of injury.
 The Third Phase is repair of tissues by regeneration or
scar formation. Regeneration replaces damaged cells with
similar cells.

22. Psychological homeostasis
 To maintain mental well being, humans also must
need psychological homeostasis. Each person needs to
feel loved & a sense of belonging ,to feel safe & secure
&to have a self esteem.

23. Stress coping model-
 Perception of the stressor is coor-dinated by
structures of the brain and may be conscious &
unconscious process

24. Environmental
change /demands
Internal
external
Perception
Non stressor
Stressor
Physiologic
Psychologic
social
Equilibrium
Disturbed
Equilibrium
stress
Psychoneuroendocrine
activation
Emotional response
Physiologic response
Behaviours
Circular
process
reapraisal
Coping
mechanism

25. Nursing Management
 Numerous methods for reducing stress are available, each person
develops a different pattern of stress response
Promoting A Healthy Lifestyle
 Individual personal resources that aid in coping include health &
energy. A health promoting life style provides these resources
and buffers or cushions the impact of stressors, lifestyles or
habits that contribute to the risk of illness can be identifies
through a health risk appraisal.
 A health risk appraisal is an assessment method that is designed
to promote health by examining an individual personal habits
risk to identify. Health risk questionnaires estimate the like hood
that a person with a given set of characteristics will become ill. It
is hoped that if people are provided with their information. They
will alter their activities (stop smoking, have periodic screening
examinations) to improve their health.

26. Enhancing coping strategies
The five predominant ways of coping with illness identifies
in a review of 51 nursing research studies were as follows
(Jalowiec 1993)
 Trying to be optimistic about the outcome
 Using social support
 Using spiritual resources
 Trying to maintain control either over the situations or over
feelings
 Trying to accept the situation
 Others ways of coping included seeking information,
reprioritizing needs and roles, making compromises,
comparing oneself to others, planning activities to
conserve energy, taking one step at a time, listening to
one’s body and using self talk for encouragement

27. Teaching Relaxation Techniques
 Relaxation techniques are major method used to relieve
stress. Commonly used techniques include progressive
muscle relaxation, the Benson relaxation response. T he
goal of relaxation training is to produce a response that
counters stress response. With this goal is achieved, the
action of the hypothalamus adjust and decreased activity of
the sympathetic and parasympathetic nervous system.
 The different relaxations technique share four similar
elements
 quiet environment
 comfortable position
 passive attitude
 mental device ( something on which focus the attention,
such as a word, phrase, or sound)

28. Enhancing Social Support
 Emotional support from family & significant others
provide a person with love and sense of sharing the
burden This social network assists with management
of stress by providing the individual with
 a positive social identify
 emotional support
 maternal aid & tangible services
 access to information
 access to new social contacts and new social studies

29. Path physiology of disease causation
Health
According to World Health Organization (WHO) health is "a state of
complete physical, mental, and social well-being and not merely the
absence of disease or infirmity.
Disease
Any deviation from or interruption of the normal structure or function of any
body part, organ, or system that is manifested by a characteristic set of
symptoms and signs and whose etiology, pathology, and prognosis may be
known or unknown.
In general, disease is a dynamic process & it is just opposite of health.
Health denotes perfect harmony & normal functioning of all body systems
i.e. state of complete wellbeing, whereas disease denotes disharmony &
deviations from the normal functioning of various body systems i.e. state of
illness.

30.  Physiology
Physiology is the study of functional activities of the
living organisms.
 Path -physiology
Path -physiology is the study of disordered functions
of the body.
 Mechanisms
Each different body system performs specific
functions to sustain optimal life for the organism.
These mechanisms are compensatory in nature & work
to restore balance in the body .e.g. development of
rapid breathing after intense exercise to compensate
for an oxygen deficit

31. Classification of disease
 Acute: a disease that has sudden onset, that is of short
duration, & self limiting.
 Chronic illness: A chronic illness is one lasting 3
months or more. It has following characteristics-
Causes non –reversible path physiology
Requires special training of client for rehabilitation
Requires a long period of care

32. Dynamic Balance
 The person as a living system has both internal and
external environment between which information and
matter are continually exchanged. Within the internal
environment each organ, tissue, cell is also a system or
subsystem of the body which exchanging information and
matter. The goal of interaction of the body’s subsystem is to
produce a dynamic balance or steady state so that all
subsystem are in harmony with each other.
 Four concept : - constancy, homeostasis, stress and
adaptation enhances the nurse understanding of steady
state. The internal environment constantly changes and
the body’s adaptive mechanism continually functions to
adjust these changes and these to maintain equilibrium or
homeostasis.

33. Path physiologic processes at
cellular level
 If the cell is considered the smallest unit or subsystem, the
processes of health or disease or adaptation or mal adaptation
may all occur at cellular level.
-Nature of changes
Cell is described as existing on a continuum of function &
structure, ranging from normal cell to adapted cell, to injured or
diseased cell, to the dead cell .changes from one state to another
state occur rapidly &may not be detectable as, each state does
not have distinct boundaries & disease represents an extension &
distortion of normal processes. At cellular level, changes are not
easily detectable, not until structures are altered.
-Response to stimuli/stressors
Different cells &tissues respond to stimuli when different pattern
& rates of response. Thus cardiac muscle cells respond to hypoxia
more quickly than smooth muscle cells.

34. Cellular adaptation & injury
Cells are the complex units dynamically responding to
the changing demands & stressors of daily life. They
possess maintenance function & specialized function.
Common adaptations
Cells can adapt to environmental stress by the
structural & functional changes. some of these
adaptations include-
 Hypertrophy
 Atrophy
 Hyperplasia
 Metaplasia
 Dysplasia

35. Hypertrophy
 Increase in cell size & hence size of organs.
Compensatory hypertrophy resulting in enlarged
muscle mass commonly occurs in skeletal & cardiac
muscles under prolonged, increased workloads

36. Atrophy
 There is decrease in cell size and that effects skeletal
muscle mainly heart, brain, & sex organs

37.  Hyperplasia
It is increase in number of cells, as cells multiply,
volume increases. It is mitotic response but it is
reversible when stimulus or stressor is decreased or
removed.
 Metaplasia
It is a cell transformation in which a highly specialized
cell changes to less specialized cell. This serves as a
protective function, because less specialized cell is
more resistant to stress that stimulates the change.

38. Injury
It is defined as disorder in steady state regulation, any
stressor that alters the ability of the cell or system to
maintain optimal balance of its adjustment processes will
lead to injury. Structural & functional damage,then occurs
which may reversible or irreversible. The most common
causes are-
 Hypoxia
 Chemical injury
 Infectious agents
 Nutritional agents
 Physical agents
 Genetic disorders
 Psychogenic disorders

39. Concept of health
 Biomedical concept
Founded on the development of the microbial theory of
disease ,The development of this concept is based on the
understanding that every disease occurs as a result of the
presence of a certain agent in the host.
 Ecological concept
it is based on the hypothesis, that health represents a
dynamic equilibrium between man and his environment .
Health means … a continuous adaptation to environment
with the purpose of achieving optimal functioning”
(Dubos,R., 1965).

40.  Psychosocial concept
Health is effected by social, psychological , cultural,
economic,& political factors. These factors must be
taken into consideration in defining & measuring
health.
 Holistic concept
It synthesis of all the above concepts. it is
multidimensional process involving the well being of
whole person in context of his environment

41. Dimensions of Health
Physical Dimension
Physical health refers to the state of the body; its
compositions, development, functions and maintenance.
Following are a few ways to ensure good physical health.
 Eat nutritious food, to keep the body and mind energized.
 Never skip meals or overeat.
 Water is essential for cleansing the body.
 Fitness through exercise will increase immunity and
endurance levels of the body.
 Regular medical checkups can help in arresting an illness,
in its early stages.
 Sleep at least for 7 uninterrupted hours daily.
 Avoid addictive substances.

42. Intellectual dimension
This is a cognitive ability to develop skills and
knowledge to enhance one's life. Our intellectual
capacity helps to stimulate our creativity and insight in
decision making.
 Setting realistic goals will go a long way in life
planning.
 Explore every opportunity with an open mind.
 Be aware of the demands and expectations from you.
 A positive outlook, especially when dealing with
conflicts.

43. Emotional dimensions
 Our ability to accept and cope with our own and others
feelings is defined as emotional well-being. Emotions
contribute to almost all aspects of our life, at times, even
setting course of actions. Symptoms of emotional
problems; as hopelessness, depression, anxiety and even
suicidal tendencies are not always easily detectable, but can
lead to dire consequences.
 Awareness and acceptance of our strength and
shortcoming, is essential for our emotional well-being.
 Ability to handle stress and seek help, if needed.
 Build strong communication networks among family,
friends and peers.

44. Social dimensions
To build and maintain satisfying relationships, comes
naturally to us, as we are social animals. Being socially
accepted, is also connected to our emotional well-
being.
 We should increase our ability to interact with people
and their ideas.
 Accept and understand diverse cultural norms.
 Build networks among different kinds of people.
 Adopt a positive self image.
 Enhance your interpersonal communication skills.

45. Spiritual dimensions
 Our good health is incomplete without being
spiritually healthy. To seek meaning and purpose of
life is termed as being spiritual. Spiritual health
dimension, refers to our personal belief and value, our
own acceptance or rejection of the creation. There are
no prescribed ways, to attain spiritual well-being, it's
more a matter of looking inwards, at our own depth of
understanding, our existence and creation.

46. GERM THEORY
 Microbes (germs) were found to be the cause for many
known diseases. Pasteur, Henle, Koch were the strong
proponents of microbial theory after they discovered
the micro-organisms in the patients’ secretions or
excretions
 This theory refers to as a one to one relationship
between causal agent & disease. The disease model
accordingly is
Disease agent man Disease
 For example –Tuberculosis due to Mycobacterium
tuberculosis
Mycobacterium tuberculosis man tuberculosis

47. Epidemiological Triad
 The most familiar disease model, the epidemiologic triad,
depicts relationship among three key factors in the
occurrence of disease or injury: Agent, environment, and
host.
 An agent is a factor whose presence or absence, excess or
deficit, is necessary for a particular disease or injury to
occur. Such as bacteria, viruses, fungi, and protozoa
 The host is the actual or potential recipient or victim of
disease or injury. Host susceptibility is affected by personal
characteristics such as age, occupation, income, education,
personality, behavior, and gender and other genetic traits
 The environment includes all external factors, other than
the agent, That can influence health interaction between
agent & host

49. Multi -factorial causation
The concept that disease is due to multiple factors , For
example coronary heart disease associated with certain
life style activities such as smoking ,ingestion of food
containing high levels of cholesterol, lack of exercise,
increased mental & emotional stress & environmental
stress etc.
It has two models –
-multi cause, single effect model
- multi cause ,multiple effect model

50. 1. Multi cause, single effect model-in these several causes produce single
disease
Cause
Cause
Cause Effect
2.Multi cause ,multiple effect model-in this several causative factors produce
many observed effects ,e.g. air pollution ,smoking & specific forms of
radiation produce lung cancer ,emphysema ,bronchitis.
Cause Effect
Cause Effect
Cause Effect

51. Web of causation
 A later and more sophisticated, but rather generalized,
web of causation was developed by Stallones (1966) to
describe some of the interrelationships among the
three major types of cardiovascular disease. While this
web does not attempt to provide a step-by-step
description of the mechanisms by which the causal
factors operate, it does give a clear view of how
different factors may work together to produce one
form or another of cardiovascular disease.

52. Change in life style stress genetic inheritance
Ageing &
Other factors
Overeating smoking
Obesity hypertension
Hyperlipidaemia increased thrombotic changes in walls of
Tendency arteries
Coronary arteriosclerosis
Cardio vascular
Diseases
Web of disease causation

53. Natural History of Disease
 Natural history of disease refers to the process of
disease/condition progression from the time it affects
an individual to the time the individual recovers or
dies, if appropriate measures are not instituted.
 The process of disease progression has two distinct
periods: pre-pathogenesis period and pathogenesis
period.

54. Natural history of disease
Pre- pathogenesis
There is no
disease
yet
•The 3 factors in
Interaction
•If host fights off
agent- no disease
Agent
Host environment
.
Pathogenesis period
The course of disease in man
Early
pathogenesis
Late pathogenesis
Clinical
Horizon
Early
disease
stage
Advanced
disease.
Convalescence
Chronic state
Disability
Death