Counseling and Stress Management in Pre and Post Anesthesia

Counseling and Stress Management in Pre and Post Anesthesia

Overview

Stress is a condition in which the human system responds to change in its normal balance state. It is the collective physiological and emotional responses to any stimulus that disturbs an individual homeostasis.

Homeostasis refers to a steady state within the body. When a change or stress occurs that causes a body function to deviate from its stable range, processes are initiated to restore and maintain dynamic balance. When these adjust- ment processes or compensatory mechanisms are not adequate, steady state is threatened, function becomes disordered, and dysfunctional responses occur. This can lead to disease, which is a threat to steady state.

Causes of Stress

We experience stress when there is imbalance between personal resource and demands/or stressors/ that interferes body's natural balance/homeostasis. If personal resources and demands are in balance everything is ok.

Stress occurs as soon as external /internal demands become greater than the personal resource. In other words, we perceived stress when use are faced with a :

i) Challenge: task that tests our ability and focuses on potential gain growth or mastery rather the possible risks. For example o taking examination

• When someone approaches you with a raised fist
  
• Fearing serious errors
• Being responsible for someone's life

ii) Harm/loss:- that is anticipated or that has already occurred

• Sever traumatic injury such as amputations
• Surgery - loss of body function
• Loss of job
• Death of a loved person

Stressors: A stressor may be defined as an internal or external event or situation that creates the potential for physiologic, emotional, cognitive, or behavioral changes in an individual.

Types of Stressors

Stressors exist in many forms and categories. They may be described as physical, physiologic, or psychosocial. Physical stressors include cold, heat, and chemical agents; physiologic stressors include pain and fatigue. An example of a psychosocial stressor is fear (eg, fear of failing an examination, losing a job, and waiting for a diagnostic test result). Stressors can also occur as normal life transitions that require some adjustment, such as going from childhood into puberty, getting married, or giving birth.

Client Response to Stress

When stress occurs a person uses physiological and psychological energy to respond and adapt. The amount of energy required and effectiveness of the attempt to respond on intensity scope duration and number and nature of stressors

The Physiological Responses to Stress

With the release of the stress hormones into the bloodstream the body is in an elevated state of arousal and additional physiological responses take place.

• The heart rate increases and the heartbeat gets stronger resulting in an increased cardiac output. This supplies the body with more oxygenated blood as quickly as possible.
• The respiratory rate increases to get more oxygen out of the air and into the bloodstream.
• Blood is shunted away from the gastrointestinal tract, spleen and other non vital organs. It is rerouted to more vital organs such as the heart, lungs and brain. Additional blood is also sent to the muscles and limbs.
• Blood pressure increases supplying the body with blood more efficiently.
• Stress hormones affect the limbic system in the brain which controls emotions.
• The areas of the brain related to short and long-term memory are affected causing possible problems with memory.
• Glycerin stored in the liver breaks down to supply the body with more glucose.
• The body makes additional glucose from sources other than carbohydrates.
• Skin becomes clammy and cold.
• The immune system becomes suppressed resulting in an increased possibility of infection.
• There is a diminished perception of pain.
• The pupils of the eye dilate and vision becomes sharper.

Stress Management

Stress or the potential for stress is ubiquitous; that is, it is both everywhere and anywhere. Anxiety, frustration, anger, and feelings of inadequacy, helplessness, or powerlessness are emotions often associated with stress. In the presence of these emotions, the customary activities of daily living may be disrupted; for example, a sleep disturbance may occur, eating and activity patterns may be altered and family processes or role performance may be disrupted

Stress management is directed toward reducing and controlling stress and improving coping

Bulechek, Butcher, and Dochterman (2008,) identified "coping enhancement" as a nursing intervention and defined it as "assisting a patient to adapt to perceived stressors, changes, or threats that interfere with meeting life demands and roles". The nurse can build on the patient's

existing coping strategies, as identified in the health appraisal, or teach new strategies for coping if necessary.

The five predominant ways of coping with illness identified in a review of 57 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 situation or over feelings
• Trying to accept the situation

Other ways of coping included seeking information, reprioritizing needs and roles, lowering expectations, making compromises, comparing oneself to others, planning activities

to conserve energy, taking things one step at a time, listening to one's body, and using self-talk for encouragement.

Anxiety

All people experience some degree of anxiety (a tense emotional state) as they face new, challenging, or threatening life situations. In clinical settings, fear of the unknown, unexpected news about one's health, and impairment of bodily functions engenders anxiety. Although a mild level of anxiety can mobilize a person to take a position, act on the task that needs to be done, or learn to alter lifestyle habits, more severe anxiety can be paralyzing. Anxiety that escalates to a near panic state can be incapacitating. When patients receive unwelcome news about results of diagnostic studies, or they need surgery they are certain to experience anxiety.

Different patients manifest physiologic, emotional, and behavioral signs and symptoms of anxiety in different ways.

Physiologic manifestations include: appetite change, headaches, muscle tension, Fatigue or lethargy, weight change, digestive upsets, grinding teeth, palpitations, hypertension, restlessness, difficulty sleeping and increased use of any alcohol or drugs

Emotional manifestations include: Forgetfulness, low productivity, feeling dull, poor concentration, negative attitude, confusion, boredom, negative self-talk, frustration, depression, crying periods, irritability, worrying, feeling discouraged and nervous laughter

Relational manifestations may include: isolation, intolerance resentment, loneliness and distrust

Spiritual manifestations include: emptiness, loss of meaning, doubt, unforgiving attitude and loss of direction

In the management of anxiety of clients the following techniques are recommended.

• Listen actively and focus on having the patient discuss personal feelings.
• Use positive remarks and focus on the positive aspects of life in the "here and now."
• Use appropriate touch (with patient permission) to demonstrate support.
• Discuss the importance of safety and the patient's overall sense of well-being.
• Explain all procedures, policies, diagnostic studies, medications, treatments, or protocols for care.
• Explore coping strategies and work with the patient to practice and use them effectively (eg, breathing, progressive relaxation, visualization, imagery).
• Use distraction as indicated to relax and prevent self from being overwhelmed

Relief From Anxiety in Anesthesia

Surgical patients have a high incidence of anxiety and there is a significant inverse relationship between anxiety and smoothness of induction of anaesthesia.

Relief from anxiety is accomplished most effectively by non-pharmacological means, which may be termed psychotherapy. This is effected at the preoperative visit by establishment of rapport, explanation of events which occur in the perioperative period and reassurance regarding the patient's anxieties and fears. There is good evidence that this approach has a significant calming effect.

In some patients, reassurance and explanation may be insufficient to allay anxiety. In these patients, it is appropriate to offer anxiolytic medication; the benzodiazepine drugs are the most effective for this purpose.

Counseling the Patient

As we have seen above provision pertinent and relevant way of reducing stress and anxiety for a patient undergoing surgery. Therefore the anesthetist informs the patient the following:

Counseling for Consent

Obtaining informed consent -involves discussing the anesthesia management plan, alternatives, and potential complications in terms understandable to the lay person