Chapter 32: stress and coping 1128

Identify what problem is manifested with the following patient: The patient is sitting alone, displaying a flat affect. She has expressed an inability to fall asleep, malaise, and lack of energy her outward appearance is untidy.

The patient appears to be depressed.

Maladaptive coping responses

can lead to physical and/or psychosocial problems

What is a stress appraisal?

Stress appraisal is the individuals determination of the meaning of a stressful event. In the first stage, the intimacy of the threat and degree of ambiguity of the threat or factors. The person measures what is at stake in the stressful encounter. In the second stage, coping options are evaluated. Primary and secondary appraisals determine whether the stressful situation or transaction is a threat or challenge.

How is stressed defined?

Stress is an autonomic physiological or emotional response to an internal or external environment challenge that is automatically and typically beyond a persons resource or ability to respond. " a non-specific response of the body to any demand made upon it"

Stress- induced hyperglycemia may result from:

Stress related hyperglycemia may result from pregnancy, acute Myocardial infarction, and postoperative state

Identify at least five examples of stress management strategies

Strategies for stress management include progressive relaxation, mindfulness, nutrition, adequate sleep and rest, exercise, yoga, bio feedback, guided imagery, therapeutic touch, REIKI, massage therapy, and eastern medicine.

Negative outcomes of poor coping

-Depression -Suicide -Stress Related Illness -Lack of Self Care -Unsuccessful Relationships -Increased Absenteeism from Work

Which of the following interventions requires a referral to a therapist with specialized training? A. Guided imagery B. Biofeedback C. Time management D. Progressive relaxation

B. Biofeedback

Patients undergoing stress may undergo periods of aggression. The nurse assesses this progressive behavior in the situation where in: A adult patient exercises to the point of fatigue B. Eight year old child sucks his thumb and wets his bed C. Adult patient avoids speaking about health concerns D. 11-year-old child experiences stomach cramps and headaches

B. Eight year old child sucks his thumb and wets his bed

The patient demonstrates unrealistic levels of worry intention without identifiable causes. This is termed: A. Social anxiety disorder B. Generalized anxiety disorder C. Obsessive compulsive disorder D. Post traumatic stress disorder

B. Generalized anxiety disorder

Which of the following are most specifically associated with the local adaptation syndrome. Select all that apply A. palpitations B. Inflammation C.Hypoxia D. Decreased gastric mobility E. Hypertension F. Reflects response to pain

B. Inflammation C. Hypoxia F. Reflects response to pain

A child and his mother have gone to the playroom on the pediatric unit. His mother tells him he cannot have a toy another child is playing with. The child cries, throws a block, and runs over to kick the door. This child is using a mechanism known as: A. Denial B. Conversation C. Displacement D. Compensation

C. Displacement

An individual who is overwhelmed with distraught over the new diagnosis of heart disease will most likely use which strategy to relieve stress? A. Direct action B. Problem focused C. Emotion focused D. Physiological

C. Emotion focused

The patient is assessed by the nurse as experiencing a crisis. The nurse plans to: A. Complete an in-depth evaluation of stressors in response to the situation B. Allow the patient to work through independent problem-solving C. Focus on immediate stress reduction D. Recommend ongoing therapy

C. Focused on immediate stress reduction

Which of the following questions by the nurse will specifically assess information on stress related physical symptoms? Select all that apply A. How have you dealt with stressful situations in the past B. Have you experienced any changes in your life recently? C. Whom do you talk to about your feelings and problems? D. Have you experienced episodes of hyper ventilating? E. Does your cultural or spiritual backgrounds provide you with certain beliefs that are helpful in times of stress? F. Do you have any experience in muscle tension in your neck, back, and head?

D. Have you experienced an episode of hyper ventilating F. Do you have any experience in muscle tension in your neck, back, and head?

The nurse is involved in a crisis intervention with a family where the father has just lost his job and his experience periods of depression. The mother has a chronic debilitating illness that has added responsibility on the adolescent child, who is having behavioral problems. The nurse intervened to specifically focus on the family on their feelings by: A. Discussing past experiences B. Working on time management skills C. Encouraging the use of the families current coping skills D. Pointing out the connections between the situation and the responses

D. Pointing out the connections between situation and responses

While working with patients who are experiencing a significant degree of stress, the nurse is aware that a priority assessment area is: A. The patient's primary activities of daily living needs B. What else is happening in the patient's life C. How the stress has influence the patient's activities of daily living D. Whether the patient is thinking about harming himself, herself, or others

D. Whether the patient is thinking about harming himself, her self, or others

reasons for Maladaptive coping responses

Highly variable: •Type and number of stressors •Perception of stressors •Length of time that stressor occurs •Type of coping mechanism implemented •Resilience of individual •Previous experiences •State of health •Available resources

What foods should the nurse encourage the patient to include in a diet to facilitate stress reduction and improve well-being?

Increasing the intakes of fruit, vegetables, legumes, fish, poultry, and whole-grain enhances both psychological and physical responses to stress. Stress reduction may also be facilitated by taking multivitamins and herbal substance

What are antecedents of coping

Individual Perceptions Life Experiences which Lead to the Ability to Cognitively and Emotionally Appraise and Manage Internal or External Situations Availability of Adequate Resources and Support Systems

Describe the following levels of anxiety. Mild- Moderate- Severe- Panic-

Mild anxiety- can be motivational, foster creativity, and actually increase a persons ability to think clearly. Moderate anxiety-Narrows a persons focus, does perception, and may change a person to pay attention or use appropriate problem-solving skills. Severe anxiety- results in the inability to make decisions or solve problems. Panic (highest level of anxiety)-is associated with a multitude of physiological symptoms, as well as feelings of extreme dread or terror.

For a patient with a different cultural background, the nurse should be alert to which signs or behaviors that may indicate stress?

Nonverbal behaviors may be indicative of stress, including irritability, agitation, anxiety and poor iContact.

If I at least two examples of how prolong stress can affect an individual

Prolong stress can result in irritable bowel syndrome, asthma, exacerbation of multiple sclerosis and other autoimmune disease, decreased immune response, and organ failure.

Which personality factors reduce the negative consequences of stress?

Resilience (flexibility resourcefulness),hardiness and sense of coherence can buffer the impact of stress

Determine whether the following individuals appear to have a strong or low sense of coherence. Mr. beep. Has had a lot of extra responsibilities at work that have kept him late in his office. On his way home, he stops at a nearby park and walks around to gather his thoughts. When he gets home, he takes time to speak with his wife and two children. During his free time, Mr. B. Enjoys working outside and reading.

This individual appears to have a strong sense of coherence

What are some of the principles of affective time management?

Time management principles are prioritizing tasks, setting goals, increasing concentration skills, decreasing distractions, avoiding procrastination, setting boundaries, and maintaining self discipline.

Unresolved and chronically suppressed anger can lead to:

Unresolved anger can lead to violent, abusive behavior and physiological changes, such as hypertension, G.I. distress, or depression.

Nursing Diagnoses for poor coping

•Ineffective/Maladaptive Coping •Compromised Family Coping •Ineffective Community Coping •Readiness for Enhanced Coping

The patient was recently told that he has a serious renal disorder that may need a transplant. He's experiencing a lack of sleep, anxiety, and a poor outlook. A. Identify a possible nursing diagnosis for the patient and a goal/outcome. B. indicate what nursing interventions are appropriate.

A. A possible nursing diagnosis is insufficient coping related to information about medical diagnosis as manifested by insomnia, nervous behavior, and negative attitude. Possible goal, outcomes are patient will discuss possible coping strategies. Patient will participate in a support group. Patient will use relaxation techniques to focus on necessary activities. Patient will identify support network at home. B. Nursing interventions include discussing the patient's feelings about the diagnosis, providing information on support groups or development of these in support network, instructing the patient on ways to reduce anxiety via a holistic approach, and referring the patient to other members of the healthcare team(dietitian, social worker, mental health therapist/advanced practice psychiatric nurse, clergy)

A corporate executive work 60 to 80 hours/week. Patient is experiencing some physical signs of stress. The practitioner teaches the patient to direct her attention to positive memories, such as her favorite vacation spot. This is example of which of the following health promotion interventions? A. Guided imagery B. Time management C. Regular exercise D. Progressive relaxation

A. Guided imagery

Which of the following are accurate statements regarding stress? Select all that apply A. Most stressors for adults involves loss and grieving B. Young adults experience more interpersonal stressors C. Children are able to deal with multiple stressors for a long time D. Culture has a little impact on response to stress E. The arrival of a sibling can become a stressor for a child F. Cognitive changes can influence an Individual's ability to cope

A. Moststressors for adult involve loss and grieving and B. Young adults experience more interpersonal stressors E. The arrival of a sibling can become a stressor for a child F. Cognitive changes and can influence an individual's ability to cope

For stress: A. Negative stress is termed B. Positive stress is termed

A. Negative stress- distress B. Positive stress- eustress

A recommended intervention for a lifestyle stress indicator and reduction in the incident of heart disease is: A. Regular physical exercise B. Attendance to a support groupC.Self awareness skills development D. Time management

A. Regular exercise

What issues has progressive relaxation therapy been used to treat and stressed patients?

Aggressive relaxation has been effectively used to treat nausea and vomiting, pain, depression and anxiety, and sleep disturbances

Briefly explain what happens at each stage of general adaptation syndrome: A. Alarm reaction B. Resistance C. Exhaustion

Alarm reaction stage- hypothalamic pituitary adrenal and autonomic nervous system's are activated, successfully triggering responses in the sympathetic nervous system and in the endocrine and immune system Resistance stage- The body attempts to adapt the stressor, and some of the initial responses or attenuated as the parasympathetic nervous system reverses The sympathetic stimulation stabilization occurs. The body begins to repair damage and restore resources Exhaustion stage- when the stress is not relieved or the resources are inadequate to meet persistent demands

An alternate term for the stress response is:

Allostasis is an alternate term for the stress response and how homeostasis is reestablished

Coping

An ever-changing process involving cognitive means and behavioral actions to manage internal and/or external situations that are perceived as difficult and/or beyond the individual's current resources.

How do fear and anxiety differ?

Anxiety is a response to stress that causes apprehension or uncertainty. Fear has a identifibe source of impending danger.

During the end of shift report, the nurse notes that a postoperative patient has been nervous and preoccupied during the evening and that no family has visited him. To determine the amount of anxiety that the patient is experiencing, the nurse should ask: A. How serious do you think your illness is? B. You seem worried about some thing. Would it help to talk about it? C. Would you like me to call family member to come support you? D. Would you like to go down the hall and talk with another patient who has had the same surgery?

B. You seem worried about some thing. Would it help to talk about it?

Which one of the following is not a consequence of maladaptive coping? A.Sue scores 74 on her biology exam after studying all night and forgoing sleep. B.John's heartburn rarely occurs now even though his workload stayed the same. C.Wes is living on the street after he argued with his parents D.Mary is still with her boyfriend even though she no longer loves him.

B.John's heartburn rarely occurs now even though his workload stayed the same. Johns health is improving

A 72 year old patient is in a long-term care facility after having had a cerebrovascular accident. The patient is non-communicative, the intro feeding tube or not being absorbed, and respirations are becoming labored. Which sign of GAS has the patient experienced? A. Alarm reaction B. Resistance stage C. Exhaustion stage D. Reflects pain response

C. Exhaustion stage

For the fight or flight response, identify the there's a logical responses. Select all that apply A. bradycardia B. People construction C. Increased blood pressure D. Palpitation E. Decreased gastric mobility F. Bradypnea

C. Increased blood pressure D. Palpitation E. Decreased gastric mobility

Nurses in the medical care center are working with a patient experiencing post traumatic stress disorder after a natural disaster. An approach that is appropriate and should be incorporated into the plan of care is: A. Suppression of anxiety producing memories B. Reinforcement that PTSD is short term C. Promotion of relaxation strategies D. Focus on physical needs

C. Promotion of relaxation strategies

What are attributes of coping?

Calm Affect Effective & Appropriate Communication ability to Perform ADLs and IADLs as Needed Appropriate Use of Available Resources and Support Systems

A hazard for nurses and caregivers who are overwhelmed by patient's needs is:

Compassion fatigue

Identify the three general types of stress.

Physiological stress is the body's potentially harmful reaction to a stimulus. Psychological stress comprises the emotional and cognitive fears involved in the appraisal of threat. When an individual interprets an event as a threat, the psychological stress response is activated. A third form of stress is sociocultural stress, occurs when social systems are challenged by factors such as racism, economic hardship, or political upheaval.

According to sister Calista Roy's approach, management of stressors involve:

Sister Castiglia Roy's model provides a solid theoretical foundation for nursing care of patients facing stressful situation. people adapt to stress by meeting there physiological needs, developing a positive identity, performing social functions, and balancing dependency and independently. The nurses role to help the patient adapt to illness or develop positive adaptive behaviors

Provide examples of different stressors that may be encountered by individuals.

Some examples of stressors are the amount of work, situations at school, family responsibilities, financial concerns, and health issues

Nursing Interventions for coping

•Accept patients where they are •Assist with ADLs and IADLs •Provide an environment of acceptance •Quiet and safe environment •Utilize therapeutic communication •Encourage verbalization of feelings, perceptions, and fears •Assist patient to recognize his or her own anxiety •Reinforce that shame and guilt are self-imposed •Identify stressors related to the present physical condition •Identify ways to modify or eliminate the stressors •Improve psychological and physiologic comfort •Anxiolytics •Assist in the development of effective coping skills •Interactive therapies •Behavioral modifications •Acknowledge the patient's spiritual/cultural background •Discourage decision making when the patient is under severe stress

Consequences of Poor Coping

•Decline in physical health: Peptic ulcer disease, Hypertension •Decline in mental health: Isolation, Depression •Alteration in functional ability: Job loss, Poor hygiene •Alteration in family dynamics: Separation/divorce, Poor communication

Outcomes/Patient Goals for coping

•Patient will display Effective/Adaptive Coping •Patient will display Readiness for Enhanced Coping •Patient will use Effective/Adaptive Family Coping •Patient will use Effective/Adaptive Community Coping •Patient will attend counseling bi-weekly •Patient will follow medication regime •Patient will state improvement in mood Patient's blood pressure will be normalized