Gidden's Chapter 31: Stress

During the first meeting of a therapy group, the members become quite uncomfortable. The nurse notes frequent periods of silence, tense laughter, and nervous movement in the group. What does the nurse conclude about these responses?

They are expected group behaviors because relationships are not yet established.

During labor a client tells the nurse that she and her husband are very concerned because the baby will be born 2 months early. How should the nurse respond?

"If you're concerned, let's talk about it."

A client with multiple sclerosis is admitted to the hospital. The client's exacerbations have become more frequent and more severe. One day, the client's partner confides to the nurse, "Life is getting very hard and depressing, and I am upset with myself for thinking about a nursing home." After listening to the partner's concerns, which is the best response by the nurse?

"Joining a support group of people who are coping with this problem may be helpful."

A nurse is assessing a client who has come to a walk-in mental health clinic. Which statement supports the assessment that the client is experiencing a crisis?

"Nothing I try works. Everything just keeps getting worse."

A client exhibits blurred and double vision and muscular weakness, and diagnostic tests are prescribed. The client is informed that a diagnosis of multiple sclerosis (MS) has been made. The client becomes visibly upset. How should the nurse respond?

"That must have really shocked you. Tell me what the healthcare provider told you about it."

Episodic acute stress

-"self-inflicted" stress or in regular chaos and is common among type A personalities -often occurs by taking on unrealistic assignments beyond what is typically or reasonably expected -individuals may always be in a hurry and irritable -constant worry is another form of episodic acute stress

Pharmacological agents:

-Drugs that act on the central and peripheral nervous systems: anxiolytics and hypnotics, antidepressants, antianxiety agents, psychotherapeutics, muscle relaxants, antimigraine agents, and narcotic pain medications, selective serotonin reuptake inhibitors and tricyclic antidepressants

therapeutic lifestyle change (TLC)

-aimed at promoting adaptation, coping, and support to promote positive changes that lead to checking of stress or of decreasing severity levels -involves exercise, dietary, and counseling professionals -topics and skills include: self-talk; muscle relaxation; exercise; dietary approaches avoiding tobacco, alcohol, and drugs; motivational interviewing

Which areas are sources of stress in four-year-old children?

-attention -insecurity -activity level

People at risk for stress:

-brain disease/impaired cognition -adults who overload their working memory

Eczema

-chronic condition associated with chronic inflammation of the skin -erythema, scaling, itching, and weeping sores -autoimmune condition that is exacerbated by stress -not caused by stress, but the condition is made worse by stress -occurs among individuals of all ages and affects men and women equally

Sources of stress in 3-year-olds:

-confusion -stranger anxiety -separation anxiety

Chronic stress affect on the immune system:

-decrease white blood cells, leading to stress-induced immunosuppression placing the individual at greater risk for bacterial and viral infections -correlation between stress and immune-based conditions such as: rheumatoid arthritis, multiple sclerosis, asthma, and cancer

Fight-or-flight

-due to the release of catecholamines epinephrine and norepinephrine -lead to increased heart rate, blood pressure, and cardiac output; dilation of bronchial airways; pupil dilation; increased blood flow to the skeletal muscles; and increased blood glucose; decrease in blood flow to nonessential organs

Chronic stress affect on the integumentary system:

-excessive hair loss -acne -eczema -psoriasis -stress-related ulcers in the mouth from dry mouth and cold sores

Chronic stress affect on the gastrointestinal system:

-gastritis -ulcerative colitis -irritable colon -diarrhea -obesity -eating disorders

Insomnia

-inability to fall asleep or stay asleep -effects include daytime sleepiness, generalized fatigue, irritability, and cognitive problems -common in adults and older adults

Chronic stress affect on cardiovascular system:

-increases heart rate and blood pressure -cardiovascular disease -hypertension -atherosclerosis -cardiac arrhythmias -myocardial infarction -stroke

common symptoms of stress include:

-irritability -nervousness/anxiousness -fa -feeling overwhelmed -feeling depressed -unexplained abdominal pain or indigestion -headaches -insomnia -fatigue -restlessness -lack of concentration -dizziness -excessive sweating -sweaty palms -back pain -tight shoulders or neck -skin eruptions -hair loss -hyperventilation -palpitations -tightening of the chest

Chronic stress affect on sexuality and the reproduction system (women):

-menstrual cycle disorders -dysmenorrhea -exacerbation of menstrual symptoms (cramping, fluid retention and bloating, and irritability) -menopausal symptoms (irritability, mood swings, and hot flashes)

Tension headaches

-most common type of headache among adults -it is described as a bilateral, dull, bandlike or pressing pain that builds up gradually and has a prolonged duration -can occur periodically or for several days in a row, lasting from 30 minutes to days -worsened by noise and light

Chronic stress affect on the musculoskeletal system:

-overly taut muscle over a long period of time, leading to pain and discomfort, particularly in the head, neck, and shoulders -migraine headaches -nervous tics

Nurses should ask when conducting a history:

-past medical history -current conditions -current medications -family history -psychosocial history -past or current conditions or life events associated with psychological stress, such as a death, loss of job, or illness -demands and recent life events and the individual's perception of the event or demand

Chronic stress affect on sexuality and the reproduction system (men):

-reduced sex drive -reduced testosterone production -reduced sperm production -maturation -erectile dysfunction -impotence

Irritable bowel syndrome (IBS)

-refers to a group of symptoms associated with discomfort in the large intestine, including cramping pain, bloating, gas, diarrhea, and/or constipation -not considered a disease but, rather, a functional syndrome with no known cause -stress has been identified as a common trigger -most commonly affects adults and older adults and affects women more often than men

Chronic stress

-represents a perpetual or sustained demand, threat, or pressure that is harmful to health because it wears on individuals continuously -can stem from long-term stressors such as chronic occupational stress, relationship stress, and financial stress -associated with a loss of hope that the situation can improve

Acute stress

-the most common type of stress -typically occurs for a short period of time -usually occurs in reaction to a real or perceived demand, threat, or pressure -resolution of the stressor leads to elimination of the stress response

Interrelated concepts to stress

1. Coping 2. Anxiety 3. Functional ability 4. Family dynamics 5. Cognition 6. Mood and affect 7. Perfusion 8. Sexuality 9. Sleep 10. Immunity

populations with the greatest level of general stress:

1. Lower-income Americans 2. Young adults (particularly those with children) 3. Women

Populations reporting the highest amount of serious psychological distress:

1. Middle-aged adults (45-64) 2. Hispanics 3. Women

A nurse is planning care for a group of hospitalized children. Which age group does the nurse anticipate will have the most problem with separation anxiety?

6 to 30 months

A client with chronic renal failure has been on hemodialysis for 2 years. The client communicates with the nurse in the dialysis unit in an angry, critical manner and is frequently noncompliant with medications and diet. The nurse can best intervene by first considering that the client's behavior is most likely for which reason?

A defense against underlying depression and fear

Stressor

A stressor is any stimuli that can produce tension and cause instability within the system.

Anxiety

An adaptive response to stress that stretches on a continuum from mild anxiety to a panic disorder

Chronic stress affect on central nervous system:

Affects cognitive function including: -headaches -nervousness -irritability -problems with decision making -insomnia -memory problems -confusion -anxiety disorders -depression -prolonged release of corticosteroids can also lead to stress-induced damage to the hippocampus, which can affect long-term memory

Female Athlete Triad

Amenorrhea, an eating disorder, and osteoporosis

A client experiencing a tremendously stressful situation says, "My baby was diagnosed with terminal cancer 2 months ago. I'm either crying or walking around like I'm in a dream. I can't believe this is happening. What did we do to deserve something so horrible? The doctors can transplant almost every human organ, but they can't stop my baby from dying. I'm so angry. Most days I just want to take my child and run away." The nurse determines that the client is mainly expressing what?

Anticipatory grief

Signs and symptoms of psychological/emotional stress:

Anxiety, anger, depression, irritability, frustration, overreaction, memory loss, lack of concentration

Which statement is true about Betty Neuman's theory?

Betty Neuman's theory is based on stress and the client's reaction to the stressor.

Interventions for physiological stress:

Biofeedback Muscle relaxation Therapeutic touch/massage Exercise

Chronic stress leads to:

Cognitive imparement

Interventions for psychological/emotional stress:

Cognitive-behavioral skills training Meditation Stress inoculation Time management

A client who recently was told by her primary healthcare provider that she has extensive terminal metastatic carcinoma of the breast tells the nurse that she believes an error has been made. She states that she does not have breast cancer, and she is not going to die. The nurse determines that the client is experiencing which stage of death and dying?

Denial

A community health nurse makes a home visit to a disabled 13-year-old client who has a 6-month-old infant sister. The infant lies quietly in her crib and rarely smiles or vocalizes; it appears that the infant barely has her basic needs met. What is the nurse's most appropriate intervention?

Determine whether there is anyone who can help with chores and the infant's care.

The nurse is preparing discharge instructions for a client who was prescribed enalapril for treatment of hypertension. Which instruction is appropriate for the nurse to include in the client's teaching?

Do not change standing position suddenly.

A client is diagnosed with cancer of the pancreas and is apprehensive and restless. Which nursing action should be included in the plan of care?

Encouraging expression of concern

A client is to be transferred from the coronary care unit to a progressive care unit. The client asks the nurse, "Are you sure I'm ready for this move?" What should the nurse determine that the client most likely is experiencing based on this statement?

Fear

The pediatric nurse compares the sources of stress in preschoolers of different ages. Which source creates stress in both 3-year-olds and 4-year-olds?

Fears

Most common source of stress:

Financial strain

Interventions for behavioral stress:

Health education Smoking cessation Counseling

A 30-year-old woman is scheduled for a total abdominal hysterectomy because of noninvasive endometrial cancer. The nurse anticipates the client may have difficulty adjusting emotionally to this type of surgery. What is the most common reason for this difficulty?

Loss of femininity

Physychological/emotional stressors

More common stressors encounterd on a regular basis and generate a state of unpleasant arousal

Signs and symptoms of physiological stress:

Muscle tension, headache, stomachache, acid reflux, tachycardia, hyperventilation, elevated BP

Anxiety is the most common mental health disorder among:

Pediatric, adolescent, and adult populations

Which psychosocial change is least likely to be seen in preschoolers?

Preschoolers feel happy if there is a newborn in the family.

What should the nurse do when a disaster survivor receives a high score on one of the Impact of Event Scale-Revised (IES-R) subscales?

Refer for further evaluation

Three days after a stressful incident a client can no longer remember why it was stressful. The nurse, in relating to this client, can be most therapeutic by identifying that the inability to recall the situation is an example of what defense mechanism?

Repression

What is the most appropriate long-term goal for a client experiencing dysfunctional grieving after the death of a spouse?

Resuming previously enjoyed activities

A client who has been battling cancer of the ovary for 7 years is admitted to the hospital in a debilitated state. The healthcare provider tells the client that she is too frail for surgery or further chemotherapy. When making rounds during the night, the nurse enters the client's room and finds her crying. Which is the most appropriate intervention by the nurse?

Sit down quietly next to the bed and allow her to cry

A 44-year-old single woman loses her job and has been unable to find a job for 8 months. She has exhausted her savings and is overwhelmed. She comes to the crisis intervention center because she is despondent and feels hopeless. What type of crisis does the nurse identify?

Situational

A nurse is caring for an anxious, fearful client. Which client response indicates sympathetic nervous system control?

Skin pallor

Signs and symptoms of behavioral stress:

Smoking, overeating, substance abuse

An executive busy at work receives a phone call from a friend relating bad news. The executive makes a conscious effort to put this information out of mind and continues to work at the task at hand. The next day executive remembers that the friend telephoned but is unable to recall the message. Which defense mechanism does this behavior represent?

Suppression

Age-related differences are primarily associated with:

cognitive appraisal of events that determine if a situation is a threat or not

Which action would the nurse think should be excluded to prevent staff from having posttraumatic stress disorder (PTSD) during a mass casualty assessment?

To work continuously without any breaks

Reaction formation

a conscious behavior that is the opposite of an unconscious feeling

Regression

a person returns to an earlier and more comfortable developmental level

Nursing has further conceptualized stress as:

a subjective experience involving cognitive appraisal, with potential for positive or negative effects on health and well-being.

Complementary and alternative medicine strategies:

acupuncture, herbals/botanicals, aromatherapy, and massage

Factors that effect the variation of stress:

age developmental level maturation environment life experiences the individual's general mental and physical health status environment is important

Macro level stress

an environmental event such as a natural disaster or a large-scale terroristic attack

Ineffective coping

associated with a challenged appraisal of stress, inadequate or inappropriate stress responses, and insufficient resources to resolve the stressor

Hypertension

chronic elevation of blood pressure -catecholamines cause peripheral vasoconstriction and an increased rate and force of cardiac contraction, leading to the elevation of blood pressure -most common in adults but is on the rise among young adults and children

A client with chronic renal failure has been on hemodialysis for 2 years. The client communicates with the nurse in the dialysis unit in an angry, critical manner and is frequently noncompliant with medications and diet. The nurse can best intervene by first considering that the client's behavior is most likely for which reason?

defense against underlying depression and fear

Cognitive appraisal and coping strategies are associated with:

development and life experiences

Micro level stress

focuses on the way a stressor affects an individual, specifically on the internal localized context (cells, organs, or body systems)

Adventitious crisis

involves natural (e.g., hurricane, tsunami) or man-made (e.g., arson, terrorist attack) traumatic events. These crises often involve numerous losses.

Relaxation activities

meditation, breathing, walking, stretching, and yoga

Suppression

the voluntary exclusion from awareness of anxiety-producing feelings, ideas, and situation

Subjective (internal) crisis

threatens a person's well-being but is not obvious to others. Examples of subjective crises include aging, lack of independence, and loss of faith

Maturational crisis

occurs in response to stress as a person experiences a predictable change. Examples of maturational crises include adolescence, marriage, parenthood, and retirement.

Stress neutral

perceived as an event that is easy to manage and easy to mobilize resources

Challenge-manageable

perceived as requiring new ordinary resources that are currently available or can be easily accessed

Relaxation techniques include:

progressive relaxation, guided imagery, biofeedback, self-hypnosis, and deep breathing exercises

Physiologic stress

refers to a stressor that originates as a physiological trigger and usually is specifically associated with an injury or illness

Stress

refers to an internal or external event or demand of life experienced by the individual that is perceived and appraised for scope and meaning on a continuum to determine whether resources and abilities for management are available, exceeded, or exhausted.

Some of the most common drugs are for:

relief of muscle tension and pain associated with stress

Benefits of exercise therapy:

relief of tension, reduction of stress, relaxation, and enhanced sense of well-being

Threat-not manageable

represents a situation perceived as requiring extraordinary resources, support, mobilization of resources that do not currently exist, or the exhaustion of existing resources and abilities

Coping

represents how an individual perceives and responds to the stressor and is a determinant of the magnitude of response

Chronic stress results in:

the continuous activation of the nervous system and eventually produces negative outcomes across multiple body systems

Passive aggression

use of behaviors such as passivity, procrastination, and inefficiency that negatively affect others

Exemplars of stress-related disorders:

• Acne • Anxiety disorders • Autoimmune disorders • Cardiac arrhythmias • Coronary artery disease • Depression • Dysmenorrhea • Dyspepsia • Eating disorders • Eczema • Erectile dysfunction • Fatigue • Fibromyalgia • Hypertension • Immunodeficiency • Insomnia • Irritable bowel syndrome • Low back pain • Stroke • Tension headaches

Examples of psychological/emotional stressors:

• Birth of child • Caregiving • Change in health status • Death of close family member or friend • Diagnosis of terminal illness • Divorce • Environmental emergencies • Failing an examination • Loss of job • Marriage • Moral distress • Moving • Parenting • Physical disability • Relationship problems • Social unrest • Spiritual distress

Examples of physiological stressors:

• Cancer • Chronic obstructive pulmonary disease • Dementia • Diabetes • Organ Failure (such as Heart, Renal, or Respiratory Failure) • Myocardial infarction • Acute and chronic pain • Traumatic injury