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Clinical scenario Gary Powers is a 22-year-old who order super avana 160 mg on-line erectile dysfunction liver cirrhosis, whilst working in construction buy super avana pills in toronto erectile dysfunction 5k, sustained a crush injury to his chest and head injury when a wall collapsed on top of him purchase super avana amex erectile dysfunction doctors buffalo ny. Chest X-ray has revealed flail chest with multiple rib fractures buy super avana 160mg lowest price erectile dysfunction treatment doctors in hyderabad, haemothoraxcis and lung contusions. When drug therapies cannot support cardiac failure, surgery is needed either to repair or replace damaged tissue. Hospitals not performing open heart surgery may still transfer patients to or receive patients from specialist centres. This chapter describes most open heart procedures, percutaneous (‘closed’) alternatives, means to support failing hearts (intra-aortic balloon pumps, ventricular assist devices), and transplant surgery. Much nursing care follows from problems and potential problems caused by surgical procedures; this chapter begins by briefly describing intraoperative procedures. Aortic dissection and aortic root repair, although not discussed in this text, share many of the approaches and problems of open heart surgery. In this chapter, ‘bypass’ refers to grafts; in practice, contexts often clarify intended meanings. The heart is isolated and either arrested (with cardioplegia) or slowed (with β-blockers, usually to about 40 bpm). Sternotomy repair with permanent wire loops (usually five—visible on X-rays) leaves a distinctive permanent skin scar. Sternal wounds and chest drain tubing can cause considerable postoperative pain, making patients reluctant to breathe deeply (predisposing to chest infection). Disconnection and reconnection of major vessels, together with surgery on heart tissue, exposes patients to possible air (micro)emboli, causing possible postoperative neurological and coronary dysfunction. Traditionally, cold cardioplegia (4–10°C) was used to reduce metabolism, but hypothermia causes ■ myocardial depression (‘stunning’) ■ ventricular dysrhythmias ■ increased blood viscosity ■ reduced cerebral blood flow ■ increased systemic and pulmonary vascular resistance ■ cell dysfunction and many other complications (Price & Donahue 1994; Barden & Hansen 1995). To prevent hypervolaemia, 2 units of blood are usually removed for postoperative autologous transfusion. Postoperative rewarming causes vasodilation, necessitating fluid monitoring and replacement. Intensive care nursing 292 Postoperative complications Common postoperative complications therefore include: ■ pain ■ neurological dysfunction ■ multiple and various dysrhythmias ■ hypothermia and hypervolaemia ■ hypovolaemia on rewarming ■ initial polyuria causing hypokalaemia ■ haemodilution ■ anxiety Infection is a potential problem, but postoperative infection can usually be prevented through infection control and active care. Nurses should follow infection control guidelines and observe and report any signs of infection. Valve surgery Mitral valvotomy, a ‘closed’ or ‘open’ procedure, dilates encrusted mitral valves. However, valvotomy merely replaces incompetent semiclosed valves with incompetent dilated ones; valve replacement has largely usurped valvotomy in First World countries. Replacement valves ■ tissue (human cadaver, xenografts: porcine, bovine, baboon) ■ prosthetic (e. Bjork-Shirley®, Starr Edwards®) Tissue valves avoid the need for long-term anticoagulation (Grotte & Rowlands 1992), but usually fail within 6–10 years (Hudak et al. Prosthetic valves last longer (often for 10–12 years) but require lifelong anticoagulation to prevent embolisation. Failure is usually sudden (Grotte & Rowlands 1992), valve fracture causing incompetence. Valve surgery causes greater cardiovascular and pulmonary dysfunction, especially dysrhythmias) than bypass grafts (Unsworth-White et al. However, many postoperative risks remain, including: ■ tamponade ■ infarction ■ emboli Cardiac surgery 293 ■ dysrhythmias (from oedema and manipulation) ■ chest pain (Lamerton & Albarren 1997) Coronary artery bypass grafts Occluded coronary arteries can be bypassed by grafts to restore myocardial blood supply. Percutaneous coronary angioplasty dilates stenosed arteries through inflation of a balloon-tipped catheter. Endothelial damage from angioplasty may leave a flap of intima, which can cause sudden occlusion (Brady & Buller 1996). Implanting coronary stents widens the lumen, reducing severity of restenosis (Brady and Buller 1995). Perioperative acute vessel closure requires urgent graft surgery, causing debate about whether on-site facilities are essential (Rowlands 1996b). Minimally invasive cardiac surgery Minimally invasive surgery exposes patients to fewer complications from wound healing and tissue repair; median sternotomy can be replaced by thoracotomy (Suen et al. Intensive care nursing 294 Transmyocardial laser revascularisation can supplement or replace bypass surgery or angioplasty, especially for patients with diffuse coronary artery disease or at high risk from conventional cardiac surgery (Trehan et al. Minimally invasive saphenous vein harvest significantly reduces postoperative pain (Horvath et al. Alarms should sound before reserve gas in cylinders is exhausted, but nurses should still check cylinder volume and know how to replace them. Unlike intra-aortic balloon pumps, they replace, rather than support, a failing heart. This enables survival, but exposes severely immunocompromised patients to highly invasive equipment, infection and thromboembolism (Tsui & Large 1998). Tsui and Large (1998) describe cardiomyoplasty as the biological equivalent to artificial hearts, but long-term benefits and risks have not yet been clarified. Insufficient supply (approximately 6,000 waiting (MacLean & Dunning 1997)) and preoperative mortality (21–30 per cent on waiting lists (Tsui & Large 1998)), has encouraged interest in xenograft (including genetically engineered) and artificial alternatives, despite continuing problems with each alternative. Postoperative nursing In addition to the needs of any postoperative patient, cardiac surgery creates specialised needs. Preparation Any surgery is likely to be daunting for patients, but long-standing heart disease and traditional emotional connotations of the heart can heighten anxieties of patients undergoing cardiac surgery. Recovery is improved through preoperative information (Hayward 1975), and patients (and families) can find preoperative visits useful (Lynn- McHale et al. Cardiac surgery 297 Most patients undergoing cardiac surgery have only single organ failure and so recovery is usually rapid, patients usually being transferred to step-down units the following day. Emphasis should therefore focus on normalisation, promoting homeostasis and encouraging patients to resume normal activities of living. Ventilation Traditionally, postoperative ventilation was routinely used until normothermia and homeostasis were restored. Fluid shifts, hypovolaemia, infusion of large volumes of intravenous fluids, and myocardial surgery (forming oedema and dysrhythmias from irritation) make cardiovascular status volatile in the immediate postoperative period. Artificial ventilation therefore ensures adequate ventilation and oxygenation while cardiovascular stability and pulmonary blood flow are restored. Extubation exposes patients to risks from atelectasis and hypoventilation, while pain or fear of pain cause reluctance to breathe. Auscultation may detect possible atelectasis (a major risk given the area of surgery) or accumulation of secretions. Suction is necessary to remove secretions and secretions may accumulate without obvious sounds to indicate their presence but, like any other aspect of care, suction should not become routine; trauma from excessive endotracheal suction may delay recovery. Hypoventilation and impaired cough may be caused by ■ pain ■ fear ■ impaired respiratory centre function Pulmonary complications delay discharge for 25 per cent of patients following coronary artery bypass grafts (Johnson & McMahan 1997). With adequate analgesic cover, patients should be encouraged to breathe deeply and cough. Following cardiac surgery, patients are traditionally ventilated until stable; increasingly, centres encourage early extubation (often in theatre).
Or it might involve changing the way a person thinks about the problem or learning to tolerate and accept it discount super avana 160 mg with visa erectile dysfunction treatment dallas. For example purchase super avana 160 mg overnight delivery xyzal erectile dysfunction, coping with relationship conﬂict could involve leaving the relationship or developing strategies to make the relationship better order 160 mg super avana with visa erectile dysfunction rates age. In contrast it could involve lowering one’s expectations of what a relationship should be like order online super avana erectile dysfunction shake drink. Lazarus and Folkman (1984) emphasized the dynamic nature of coping which involves appraisal and reappraisal, evaluation and re-evaluation. Likewise, coping is also seen as a similar interaction between the person and the stressor. Further, in the same way that Lazarus and colleagues described responses to stress as involving primary appraisal of the external stressor and secondary appraisal of the person’s internal resources coping is seen to involve regulation of the external stressor and regulation of the internal emotional response. To reduce stressful environmental conditions and maximize the chance of recovery; 2. Styles, processes and strategies When discussing coping, some research focuses on ‘styles’, some on ‘processes’ and some on ‘strategies’. However, it also reﬂects an ongoing debate within the coping literature concerning whether coping should be considered a ‘trait’ similar to personality, or whether it should be considered a ‘state’ which is responsive to time and situation. The notion of a ‘style’ tends to reﬂect the ‘trait’ perspective and suggests that people are quite consistent in the way that they cope. The notions of ‘process’ or ‘strategy’ tends to reﬂect a ‘state’ perspective suggesting that people cope in diﬀerent ways depending upon the time of their life and the demands of the situation. Some diﬀerentiate between approach and avoidance coping, whilst others describe emotion focused and problem focused coping. Approach versus avoidance Roth and Cohen (1986) deﬁned two basic modes of coping, approach and avoidance. Approach coping involves confronting the problem, gathering information and taking direct action. People tend to show one form of coping or the other although it is possible for someone to manage one type of problem by denying it and other by making speciﬁc plans. Some researchers have argued that approach coping is consistently more adaptive than avoidant coping. However, research indicates that the eﬀectiveness of the coping style depends upon the nature of the stressor. For example, avoidant coping might be more eﬀective for short-term stressors (Wong and Kaloupek 1986), but less eﬀective for longer-term stressors (Holahan and Moos 1986). Some researchers have also explored repressive coping (Myers 2000) and emotional (non) expression (Solano et al. Problem focused versus emotion focused (also known as instrumentality – emotionality) In contrast to the dichotomy between approach and avoidant coping, the problem and emotion focused dimensions reﬂect types of coping strategies rather than opposing styles. People can show both problem focused coping and emotional focused coping when facing a stressful event. Problem focused coping: This involves attempts to take action to either reduce the demands of the stressor or to increase the resources available to manage it. Examples of problem focused coping include devising a revision plan and sticking to it, setting an agenda for a busy day, studying for extra qualiﬁcations to enable a career change and organizing counselling for a failing relationship. Emotion focused coping: This involves attempts to manage the emotions evoked by the stressful event. Examples of behavioural strategies include talking to friends about a problem, turning to drink or smoking more or getting distracted by shopping or watching a ﬁlm. Examples of cognitive strategies include denying the importance of the problem and trying to think about the problem in a positive way. Several factors have been shown to inﬂuence which coping strategy is used: Type of problem: Work problems seem to evoke more problem focused coping whereas health and relationship problems tend to evoke emotion focused coping (Vitaliano et al. Age: Children tend to use more problem focused coping strategies whereas emotion focused strategies seems to develop in adolescence (Compas et al. Gender: It is generally believed that women use more emotion focused coping and that men are more problem focused. For example, Stone and Neale (1984) considered coping with daily events and reported that men were more likely to direct action than women. However, Folkman and Lazarus (1980) and Hamilton and Fagot (1988) found no gender diﬀerences. In contrast they use more emotion focused coping if the problem is perceived as being out of their control (Lazarus and Folkman 1987). Available resources: Coping is inﬂuenced by external resources such as time, money, education, children, family and education (Terry 1994). Poor resources may make people feel that the stressor is less controllable by them resulting in a tendency not to use problem focused coping. Measuring coping The diﬀerent styles of coping have been operationalized in several measures which have described a range of speciﬁc coping strategies. The most commonly used measures are the Ways of Coping checklist (Folkman and Lazarus 1988) and Cope (Carver et al. The coping strategies described by these measures include the following: s Active coping (e. Some of these strategies are clearly problem focused coping such as active coping and planning. For example, positive reframing involves thinking about the problem in a diﬀerent way as a means to alter the emotional response to it. Some strategies can also be considered approach coping such as using emotional support and planning whereas others reﬂect a more avoidance coping style such as denial and substance use. Therefore eﬀective coping can be classiﬁed as that which reduces the stressor and minimizes the negative outcomes. In addition, recent research has shifted the emphasis away from just the absence of illness towards positive outcomes. Much research has addressed the impact of coping on the physiological and self-report dimensions of the stress response. Coping and the stress illness link: Some research indicates that coping styles may moderate the association between stress and illness. For some studies the outcome vari- able has been more psychological in its emphasis and has taken the form of well-being, psychological distress or adjustment. For example, Kneebone and Martin (2003) critic- ally reviewed the research exploring coping in carers of persons with dementia. They examined both cross-sectional and longitudinal studies and concluded that problem- solving and acceptance styles of coping seemed to be more eﬀective at reducing stress and distress. In a similar vein, research exploring coping with rheumatoid arthritis sug- gests that active and problem-solving coping are associated with better outcomes whereas passive avoidant coping is associated with poorer outcomes (Manne and Zautra 1992; Young 1992; Newman et al. Similarly, research exploring stress and psoriasis shows that avoidant coping is least useful (e.
Specify: (a) behaviours (adaptive/maladaptive) discount 160 mg super avana overnight delivery erectile dysfunction treatment with viagra, emotions (positive/negative) and thoughts (b) verbal comments (c) typical coping mechanisms (effective/ineffective purchase super avana 160 mg without prescription facts on erectile dysfunction, beneficial/ harmful) 160mg super avana with mastercard impotence vacuum pumps. Chapter 47 Complementary therapies Introduction The recent growth of interest in complementary therapies is reflected in their increasing use in nursing and healthcare buy super avana with mastercard impotence zinc. The literature varies between introductory and anecdotal texts to substantive studies. The placebo effect is also discussed, before concluding with practical application and professional perspectives. Although discussed under separate headings, the use of various complementary therapies may be mixed, just as orthodox medicine may use combination therapy; thus essential oils may be used for massage, with benefits potentially being gained from both the massage and the oil itself. While research studies need to specify causal relationships, for clinical practice the end results to patients is (from utilitarian perspectives) more important than precisely how results are achieved. Concepts and terminology The term ‘complementary therapy’ is increasingly replacing ‘alternative therapy’. Both supporters and opponents of complementary therapies have used ‘alternative’, usually to try and devalue the other approach. This text follows Rankin-Box (1988) in using the term ‘complementary’ rather than ‘alternative’. Many complementary therapies are derived from traditional Chinese medicine, and conflicts can occur from the differing cultural contexts and translation. Yin and Yang, which are popularly and often over-simplistically assimilated into Western culture, involve balances between the various kinds of energy necessary for health (Downey 1995)—this carries similar connotations to orthodox medicine’s concept of ‘homeostasis’. In Chinese medicine, Ki (Qi or Chi), the universal energy which links people to their environment, is dispersed through twelve main channels (meridians) that connect the internal organs to the skin (Downey 1995). Intensive care nursing 440 Orthodox medicine Many complementary therapies are very old; reflexology is depicted in pyramids of c. Since knowledge of the therapies has been mainly transmitted through oral traditions and folklore, the lack of regulation led some practices into disrepute, while the Cartesian focus on atoms largely replaced European folklore medicine with an ‘orthodox’ (and increasingly regulated) medical profession. Orthodox medicine has adopted some of the tried and tested remedies, such as foxglove (digitalis— digoxin) for dropsy (oedema) and willow bark (aspirin) for analgesia, so that, refined and analysed, ‘orthodox medicine’ has preserved elements of herbal medicine. Orthodox medicine’s pursuit of diagnosing anatomically specific problems led to targeting specific problems with specific drugs (e. Complementary therapies focus attention on the whole person, and recognise the complex interactions contributing to disease (literally, dis-ease). Such holistic and humanist perspectives make complementary therapies attractive to many nurses; the absence of regulation (compared with orthodox medicine) enables nurses to initiate complementary therapies. The resurgence of interest in complementary therapies therefore parallels the growth of the nursing profession’s autonomy and advocacy of therapeutic nursing. Until recently, the knowledge bases of most complementary therapies was largely limited to anecdotes and unsupported assertions. Complementary therapies are often sought when orthodox medicine fails to resolve chronic problems, although some people seek interventions purely for pleasure (e. Therapeutic touch This intervention, conceptualised into nursing by Krieger (1975), develops the traditional laying-on of hands, and is included here mainly because its name can create confusion. Neither the laying-on of hands nor Krieger’s Therapeutic Touch involve skin-to-skin contact. Building on Martha Rogers’ philosophy that humans are made up of energy, and that humans and their environments are continuously, simultaneously and mutually exchanging energy with each other (Sayre-Adams 1994), Therapeutic Touch attempts to touch the energy or force field of the person. Any intervention that increases qualitative staff-patient interaction is potentially beneficial. Qualitative touch (skin- to-skin contact) is much underused by nurses, and can significantly reduce sensory imbalance (see Chapter 3): touch can be therapeutic. Labelling Krieger’s intervention Complementary therapies 441 ‘Therapeutic Touch’ may imply that other nursing touch is not therapeutic—an erroneous presumption. Therefore, when discussing therapeutic touch nurses should clarify whether they mean it in Krieger’s sense or in the broader humane sense. Nursing without touch is a contradiction, but where ordinary touch becomes massage is unclear: washing patients arguably fulfils Feltham’s definition. Where guidelines and professional practice limit the use of massage, nurses should defend the value of touch (especially qualitative). Nineteenth century attempts to regulate masseurs (many with nursing backgrounds) within medicine eventually led to the Chartered Society of Physiotherapists, so that dilemmas of professional boundaries with massage are not new. Although physiological differences were insignificant, patients receiving aromatherapy described feeling better and less anxious. Hill (1993) justifiably questions how critically ill these patients were (over three-quarters could report effects), but such benefits on less critically ill patients are presumably transferable to those more sick. If nursing itself is therapeutic (person-to-person interaction, ‘presence’) then Dunn’s use of a number of nurses to measure the effects of specific interventions (e. Stevensen (1992) used twenty-minute foot massage on patients following cardiac surgery, both with and without neroli oil (relaxant). Other than relaxing respiratory rates, no physiological benefits were observed, but, when interviewed five days later, patients who had received the neroli oil massage reported psychological benefits. Likely (but unproven) physiological benefits include improved lymphatic drainage, returning plasma proteins to the circulation. Reflexology Although there are ancient precedents, modern Western reflexology derives from the work of William Fitzgerald, a nineteenth-century doctor who accidentally found that the Intensive care nursing 442 use of pressure could replace anaesthesia during minor operations (Griffiths 1995). Fitzgerald believed that organ malfunction resulted in tiny crystalline deposits of calcium and uric acid on the nerve endings of the feet, and that breaking down these deposits with massage would heal the organ (Griffiths 1995). Fitzgerald identified ten energy zones of life-force running longitudinally through the body (not too dissimilar to the twelve meridians of Ki), reflecting the organs in specific parts of the feet (and hands). Reflexologists can therefore treat any part of the body using specialised foot massage that breaks down the crystalline deposits. If reflexology’s assumptions are correct, it is possible that nurses manipulating feet and hands (e. Griffiths (1995) warns that reflexology initiates a ‘healing crisis’ which can last up to 24 hours, although this is less likely to occur with the gentler Western approaches than the more vigorous approaches used in the East. The absence of any reported complications suggests this may not be an actual problem, but it leaves a (currently) unanswered question. Shiatsu Although derived from the Japanese for ‘finger pressure’, Shiatsu practice has gained wider connotations; it usually treats the whole meridian system (of vital energy/life force) in order to harmonise Ki (Stevensen 1995). Like other variants of massage, shiatsu is best left to those with specialist knowledge. Aromatherapy Aromatherapy implies the use of essential oils with direct chemical effects, not just burning something which emits pleasant smells (although boundaries between pleasure and therapy can become blurred when evaluating psychological benefit): burning neroli (see Massage above) can reduce anxiety. As active chemicals, essential oils can be considered to be drugs, albeit not restricted by regulations governing traditional medicines. Because of the nature of this therapy, the effects of aromatherapy may affect anyone (staff, other patients) in the immediate environment, so although relaxation may help some patients, it could be harmful to others, while possibly reducing staff efficiency. Complementary therapies 443 Placebo effect Throughout history significant minorities of people have benefited from inactive medicines (placebos); Hippocrates was familiar with the problems of patients who had been given unhelpful (and often harmful) treatments.
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Helping him or her recognize this in a nonthreatening manner may help reveal unresolved issues so that they may be confronted buy super avana paypal impotence vs impotence. Help client recognize the signs that tension is increasing and ways in which violence can be averted best purchase for super avana best erectile dysfunction doctors nyc. Activities that require physical exertion are helpful in relieving pent-up tension purchase discount super avana online erectile dysfunction treatment san francisco. Explain to the client that should explosive behavior occur best purchase super avana erectile dysfunction drugs levitra, staff will intervene in whatever way is required (e. This conveys to the client evidence of control over the situation and provides a feeling of safety and security. The client is able to verbalize the symptoms of increasing tension and adaptive ways of coping with it. Related/Risk Factors (“related to”) [Central nervous system trauma] [Mental retardation] [Early emotional deprivation] [Parental rejection or abandonment] [Child abuse or neglect] [History of self-mutilative behaviors in response to increasing anxiety: hair-pulling, biting, head-banging, scratching] Goals/Objectives Short-term Goals 1. Client will cooperate with plan of behavior modiﬁcation in an effort to respond more adaptively to stress (time dimen- sion ongoing). Intervene to protect client when self-mutilative behaviors, such as head-banging or hair-pulling, become evident. A helmet may be used to protect against head-banging, hand mittsto prevent hair-pulling, and appropriate padding to pro- tect extremities from injury during hysterical movements. Try to determine if self-mutilative behaviors occur in re- sponse to increasing anxiety, and if so, to what the anxiety may be attributed. Assist with plan for behavior modiﬁcation in an effort to teach the client more adaptive ways of responding to stress. Encourage client to discuss feelings, particularly anger, in an effort to confront unresolved issues and expose internalized rage that may be triggering self-mutilative behaviors. Offer self to client during times of increasing anxiety, to pro- vide feelings of security and decrease need for self-mutilative behaviors. Anxiety is maintained at a level at which client feels no need for self-mutilation. Client demonstrates ability to use adaptive coping strategies in the face of stressful situations. Long-term Goal Client will be able to delay gratiﬁcation and use adaptive coping strategies in response to stress (time dimension to be individu- ally determined). Often these individuals rationalize to such an extent that they deny that what they have done is wrong. Client must come to under- stand that certain behaviors will not be tolerated within the society and that severe consequences will be imposed on those individuals who refuse to comply. Encourage client to explore how he or she would feel if the circumstances were reversed. An attempt may be made to enlighten the client to the sensitivity of others by promoting self-awareness in an effort to assist the client gain insight into his or her own behavior. Throughout relationship with client, maintain attitude of “It is not you, but your behavior, that is unacceptable. Rewards and positive feedback enhance self-esteem and encourage repetition of desirable behaviors. Help client identify and practice more adaptive strategies for coping with stressful life situations. The impulse to perform the maladaptive behavior may be so great that the client is unable to see any other alternatives to relieve stress. Client is able to demonstrate techniques that may be used in response to stress to prevent resorting to maladaptive impul- sive behaviors. Client verbalizes understanding that behavior is unaccept- able and accepts responsibility for own behavior. This category differs from somatoform disorders and conversion disorders in that there is evidence of either de- monstrable organic pathology (e. Selye (1956) believed that psychophysi- ological disorders can occur when the body is exposed to prolonged stress, producing a number of physiological effects under direct control of the pituitary-adrenal axis. He also suggests that genetic predisposition inﬂuences which organ system will be affected and determines the type of psychophysiological disorder the individual will develop. It has been hypothesized that individuals exhibit speciﬁc physiological responses to certain emotions. For example, in response to the emo- tion of anger, one person may experience peripheral va- soconstriction, resulting in an increase in blood pressure. The same emotion, in another individual, may evoke the response of cerebral vasodilation, manifesting a migraine headache. Various studies have suggested that individuals with speciﬁc personality traits are predisposed to certain disease processes. A third psychosocial theory considers the role of learning in the psychophysiological response to stress. If a child grows up observing the attention, increased dependency, or other secondary gain an indi- vidual receives because of the illness, such behaviors may be viewed as desirable responses and subsequently imi- tated by the child. This theory relates to the predisposition of those individuals who are members of dysfunctional family systems to use psychophysiological problems to cover up interpersonal conﬂicts. The anxi- ety in a dysfunctional family situation is shifted from the conﬂict to the ailing individual. Anxiety decreases, the conﬂict is avoided, and the person receives positive reinforcement for his or her symptoms. Complaints of physical illness that can be substantiated by objective evidence of physical pathology or known patho- physiological process 2. Denial of emotional problems; client is unable to see a relationship between physical problems and response to stress 4. Use of physical illness as excuse for noncompliance with psychiatric treatment plan 5. Report (or other evidence) of numerous stressors occurring in person’s life Psychological Factors Affecting Medical Condition ● 267 Common Nursing Diagnoses and Interventions* (Interventions are applicable to various health-care settings, such as inpatient and partial hospitalization, community outpatient clinic, home health, and private practice. Possible Etiologies (“related to”) [Repressed anxiety] [Inadequate support systems] [Inadequate coping methods] [Low self-esteem] [Unmet dependency needs] [Negative role modeling] [Dysfunctional family system] Deﬁning Characteristics (“evidenced by”) [Initiation or exacerbation of physical illness (specify)] [Denial of relationship between physical symptoms and emo- tional problems] [Use of sick role for secondary gains] Inability to meet role expectations Inadequate problem-solving Goals/Objectives Short-term Goals 1. Within 1 week, client will verbalize understanding of correlation between emotional problems and physical symptoms. Within 1 week, client will verbalize adaptive ways of coping with stressful situations. For purposes of this chapter, only nursing diagnoses common to the general category are presented. Perform thorough physical assessment in order to deter- mine speciﬁc care required for client’s physical condition.