Chapter 43: Stress and Adaptation

A nurse in a long-term care facility is caring for patient with a spinal cord injury affecting their sensory and motor reflexes below the waist. Based on the patient's condition, what would be a priority intervention for this patient? a. Taking care with hot beverages to prevent burns b. Providing adequate pain relief measures to reduce stress c. Monitoring for depression related to social isolation d. Offering meals high in carbohydrates to promote healing

A A patient with a damaged neurologic reflex arc has a diminished pain reflex response. This diminished sensation and motor response places the patient at risk for burns. All patients should be provided adequate pain relief, but this is not a priority. Monitoring for depression would be an intervention for this patient but is not related to the damaged neurologic reflex arc. A patient who is immobile should eat a well-balanced diet.

A college student visits the school's health center reporting extreme fatigue and slight restlessness. The student states, "Exams are right around the corner, and all I feel like doing is sleeping." There are no abnormal physical assessment findings. How does the nurse best help the student frame their desire to sleep? a. Asking the student if they are worried about failing exams b. Telling them they must strive to sleep 7 to 9 hours nightly c. Evaluating their use of recreational drugs d. Explaining that some people use sleep as a coping mechanism

A Fatigue and mild anxiety are often handled without conscious thought through the use of coping mechanisms, such as sleeping. These coping mechanisms are protective behaviors used to decrease stress and anxiety.

Define fear:

A feeling of dread; a cognitive response to a known threat

What occurs during the alarm stage?

A person perceives a specific stressor and various defense mechanisms are activated and the sympathetic nervous system initiates the Fight-or-flight response, preparing the body to either fight off the stressor or to run away from it

What is the General Adaptation Syndrome (GAS)?

A three-stage physiological response that appears regardless of the stressor that is encountered (body's general response to stress)

A nurse is assessing a patient who reports their migraines have become "unbearable." The patient states, "I got laid off from my job last week, and I have two kids in college. I don't know how I'm going to pay for it all." Which effects of physiologic effects of stress would the nurse expect to find in this patient? Select all that apply. a. Increased or decreased appetite b. Changes in elimination patterns c. Decreased pulse and respirations d. Use of ineffective coping mechanisms e. Withdrawal f. Attention-seeking behaviors

A, B Physiologic effects of stress include changes in appetite and elimination patterns as well as increased pulse and respirations. Using ineffective coping mechanisms, becoming withdrawn and isolated, and exhibiting attention-seeking behaviors are psychological effects of stress.

A nurse in a medical practice has assessed a patient reporting abdominal pain, diarrhea, and anxiety. When the health care provider finds no identifiable cause for the symptoms, which actions would the nurse recommend? Select all that apply. a. Keeping a diary identifying sources of stress b. Sleeping 4 hours per night c. Considering previous strengths and coping d. Asking whom the patient relies on for support e. Asking if the patient's partner is abusive f. Assessing for prior psychiatric conditions

A, C, D The sympathetic nervous system reacts to stress with the fight-or-flight response. This response causes increased the heart rate, muscle strength, cardiac output, blood glucose levels, and mental alertness. Increased peristalsis is brought on by the parasympathetic nervous system under normal conditions and at rest.

A nurse in the emergency department receives a patient rescued from a building fire. The firefighter giving the handoff report tells the nurse the building collapsed immediately after they removed the patient from the building. The nurse notes the patient is experiencing the alarm phase of the fight-or-flight response. What assessment findings support the nurse's observation? Select all that apply. a. Rapid breathing b. Hypotension c. Restlessness d. Withdrawn demeanor e. Tachycardia

A, C, E The sympathetic nervous system initiates the fight-or-flight response, preparing the body to fight a stressor or run from it. This phase of the alarm reaction, called the shock phase, is characterized by an increase in energy levels, oxygen intake, cardiac output, blood pressure, and mental alertness. During the second phase, called the countershock phase, there is a reversal of body changes. Hypotension and withdrawn demeanor represent the countershock phase.

GAS Phase characterized by an increase in energy levels, oxygen intake, cardiac output, blood pressure, and mental alertness. A. Alert B. Resistance C. Exhaustion

A. Alert

Local response to injury or infection. It serves to localize and prevent the spread of infection and promote wound healing. A. Inflammatory Response B. Reflex Pain Response C. Local adaptation syndrome D. General adaptation syndrome

A. Inflammatory Response

Crisis ________________ is a short-term management technique focused on reducing damage to an individual or group affected by a crisis, often a mental or medical health emergency. The crisis may require community resources, such as a local mobile crisis team, to diffuse. A. Intervention B. Consultation C. Recovery D. Interjection

A. Intervention

Actions that cause psychological or physical damage, can be perpetrated by: (1) someone who has no relationship with the victim (crime-based); (2) a customer, client, or patient; (3) a co-worker, who may or may not be a peer; or (4) someone involved in a personal relationship with the victim: A. Workplace violence B. Bullying C. Incivility

A. Workplace violence

Which part of the SAFERR model involves taking note of the precipitating event and the reactions of the individual?

Acknowledgement

An ongoing process as a person strives to maintain balance in the internal and external environments; The change that takes place as a result of the response to a stressor is referred to? A. Stress B. Stressor C. Adaptation D. Homeostasis

Adaptation

What kind of crisis includes accidental and unexpected events resulting in multiple losses, and major environmental changes—such as fires, earthquakes, and floods—that involve not only individuals but also entire communities.

Adventitious

List the 3 stages of General Adaptation Syndrome:

Alarm, resistance, exhaustion

Nurses use what technique when they teach patients about procedures and the surgical experience? When patients know what to expect, their anxiety is reduced and their coping mechanisms are more effective.

Anticipatory guidance

____________________ behavior occurs when a person attempts to overcome obstacles to satisfy a need; it may be constructive, with assertive problem solving, or destructive, with feelings and actions of aggression and hostility.

Attack

What are the 3 kinds of task-oriented reactions?

Attack, withdrawal, compromise

Which body systems primarily control the homeostatic mechanisms?

Autonomic nervous system and endocrine system

Response of the central nervous system to pain. It is rapid and automatic, serving as a protective mechanism to prevent injury; depends on an intact, functioning neurologic reflex arc and involves both sensory and motor neurons: A. Inflammatory Response B. Reflex Pain Response C. Local adaptation syndrome D. General adaptation syndrome

B. Reflex Pain Response

GAS Phase characterized by vital signs, hormone levels, and energy production returning to normal. A. Alert B. Resistance C. Exhaustion

B. Resistance

Anything that is perceived as challenging, threatening, or demanding that triggers a stress reaction; may be internal (e.g., an illness, a hormonal change, or fear) or external (e.g., loud noise or cold temperature) A. Stress B. Stressor C. Adaptation D. Homeostasis

B. Stressor

What occurs during the resistance stage?

Body is coping with stress in order to return to homeostasis. Hormone levels, heart rate, blood pressure, and cardiac output return to normal, and the body begins to repair damage

Most nurses and student nurses enjoy their education and work, coping with physical and emotional demands effectively. Some, however, become overwhelmed and develop symptoms of stress, or a complex set of behaviors and emotions called?

Burnout

A nurse who performs preoperative assessments and teaching prepares patients for postoperative discomfort using anticipatory guidance. What interventions would this nurse use to decrease postoperative stress? a. Teaching rhythmic breathing to perform prior to the procedure b. Telling the patient to mentally place themselves in a pleasant place and breathe in and out slowly c. Explaining about expected incisional discomfort or nausea and describing relief methods d. Suggesting the patient create and focus on a mental image during the procedure to be less responsive to the pain

C Anticipatory guidance focuses on psychologically preparing a person for an unfamiliar or painful event. When the patient knows what to expect through advanced explanation about discomfort, nausea, or pain and available relief measures, the patient's anxiety can be reduced. Rhythmic breathing is a relaxation technique, focusing on a pleasant place and breathing slowly in and out is a meditation technique, and focusing on a mental image to reduce responses to stimuli is a guided imagery technique. While these might be addressed, the other options do not reflect anticipatory guidance or focus on postoperative discomfort.

A nurse is assessing the developmental levels of patients in a pediatric office. Which person would a nurse document as experiencing developmental stress? a. Infant who learns to turn over b. School-aged child learning to add and subtract c. Adolescent who is a "loner" d. Young adult who has a variety of friends

C The adolescent who is a loner is not meeting a major task (being a part of a peer group) for that level of growth and development.

Rude or discourteous actions that negatively affect other and can escalate to bullying, which can be defined as repeated, ongoing actions that intend to harm another person, such as humiliation, offensive speech or actions, or other methods of causing distress: A. Workplace violence B. Bullying C. Incivility

C. Incivility

Localized response of the body to stress. It involves only a specific body part (such as a tissue or organ) instead of the whole body. A. Inflammatory Response B. Reflex Pain Response C. Local adaptation syndrome D. General adaptation syndrome

C. Local adaptation syndrome

Caring for a family member at home for long periods can also cause prolonged stress that includes chronic fatigue, sleep problems, and an increased incidence of stress-related illnesses, such as high blood pressure and heart disease. This is known as?

Caregiver burden

*Types of Defense Mechanisms:* A person attempts to overcome a perceived weakness by emphasizing a more desirable trait or overachieving in a more comfortable area.

Compensation

______________________ behavior is usually constructive, often involving the substitution of goals or negotiation to partially fulfill needs.

Compromise

Define stress:

Condition in which the human system responds to change in its normal balanced state

- Crying, laughing, sleeping, cursing - Physical activity, exercise - Taking a deep breath, using practiced mindfulness/centering exercises - Verbally debriefing with another person, journaling - Engage in an enjoyable activity as a distraction - Smoking, drinking - Lack of eye contact, ignoring the stressor, withdrawal - Limiting relationships to those with similar values and interests' These are all variations of what?

Coping mechanisms

What is a task-oriented reaction?

Coping mechanisms often used at higher levels of anxiety

Nurses working in a trauma intensive care unit state they experience a high level of stress. Which stressor are they likely to encounter? a. Nurse manager support for equitable assignments b. Health care benefits c. Debriefings after the death of a patient d. Incivility by team members or bullying

D Incivility encompasses rude or discourteous actions that negatively affect others. Incivility can escalate to bullying, which is defined as repeated, ongoing actions that intend to harm another person. This includes humiliation, offensive speech or actions, or other methods of causing distress. The other options exist in a positive work environment.

The use of various mechanisms to regulate and maintain a state of balance within the body is? A. Stress B. Stressor C. Adaptation D. Homeostasis

D. Homeostasis

The autonomic nervous system and endocrine system are important regulators of the body. What are the two sub-categories of the autonomic nervous system? A. Automatic and manual B. Peripheral and central C. Fight and rest D. Parasympathetic and sympathetic

D. Parasympathetic and sympathetic

Mechanisms that protect a person's self-esteem and are useful in mild to moderate anxiety are called _____________________ mechanisms.

Defense

*Types of Defense Mechanisms:* A person refuses to acknowledge the presence of a condition that is disturbing.

Denial

The middle-aged adult accepting physical signs of aging is an example of ______________ stress Developmental or Situational?

Developmental

Although there are an almost infinite number of sources of stress, they can be categorized into two broad areas: ______________ stress and ______________ stress. Both require adaptive responses.

Developmental and situational

*Types of Defense Mechanisms:* A person transfers an emotional reaction from one object or person to another object or person.

Displacement

*Types of Defense Mechanisms:* A person subconsciously protects themself from the memories of a horrific or painful event by allowing the mind to forget the incident.

Dissociation

A ____________ is a disturbance caused by a precipitating event, such as a perceived loss, a threat of loss, or a challenge, that is interpreted as a threat to self. A. Stressor B. Problem C. Traumatic event D. Midlife crisis E. Crisis

E. Crisis

Which part of the SAFERR model involves tapping into their existing coping tools and resources and identify external sources of support to facilitate coping.

Encourage effective coping

Stress can either be the problem or the source of the problem, called the ______________.

Etiology

Which part of the SAFERR model involves paraphrasing and reflecting back to the individual what they are experiencing. Normalize their reaction to a stressful event and work to minimize feelings of personal weakness.

Facilitation of understanding

*True or False?:* The stress of a person only affects them, not those around them.

False. When the family is viewed as a system, the behavior of the individual is influenced by family, and any alterations in the individual's behavior affect the family.

Sympathetic nervous system:

Fight or flight; the division of the autonomic nervous system that arouses the body, mobilizing its energy in stressful situations

__________________ tasks (as in the case of any situational stress) involve maintaining self-esteem and personal relationships while preparing for an uncertain future.

General

Adaptation to acute and chronic illness or to traumatic injury involves two sets of adaptive tasks what are they?

General tasks and Illness-related tasks.

______________ influences the number and availability of adaptive responses and the ability to choose the most effective response. For example, although the sickle cell gene is prevalent in some communities in Africa, the gene provides some resistance to malaria, which may be adaptive for those communities

Genetics

The nurse sits by the patient and reads a description of a scene or an experience that the patient has described as happy, pleasant, or peaceful. "You are floating in your swimming pool. The water is cool and comfortable. Birds are singing in the trees. The roses are perfuming the air." As the patient becomes more and more focused on the scene, the nurse needs only to verbally "paint the picture" at intervals. This is a technique called?

Guided imagery

________________________ tasks include such stressors as losing independence and control, managing pain and disability, and carrying out the prescribed medical regimen.

Illness-related

*Types of Defense Mechanisms:* A person incorporates qualities or values of another person into their own ego structure. This mechanism is important in the formation of conscience during childhood.

Introjection

The ability to adapt is *lower/higher* in the very young, the very old, and those with altered physical health who do not have the necessary physiologic reserves to cope with physical changes such as dehydration or fluid excess.

Lower

What kind of crisis occurs during developmental events that require role change, such as when a teenager transitions into adulthood.

Maturational

Crises may be _____________, _____________, or _________________.

Maturational, situational or adventitious

_______________ anxiety is present in day-to-day living. It increases alertness and perceptual fields (e.g., vision and hearing) and motivates learning and growth.

Mild

What are the four levels to anxiety?

Mild, moderate, severe, panic

______________ anxiety narrows a person's perceptual fields so that the focus is on immediate concerns, with inattention to other communications and details; manifested by a quavering voice, tremors, increased muscle tension, a report of "butterflies in the stomach," and slight increases in respirations and pulse.

Moderate

Are a person's usual methods of coping always effective during a crisis?

No

Is stress always a bad thing?

No, short term stress creates positive stress. It is when that positive stress is prolonged does it create negative and chronic stress. Ex. Fear of getting lung cancer can prevent someone from starting smoking

________________ causes the person to lose control and experience dread and terror. The resulting disorganized state is characterized by increased physical activity, distorted perception of events, and loss of rational thought.

Panic

Which division of the autonomic nervous system: - Regulates heart rate - Stimulates secretion of digestive juices and digestive tract smooth muscle - Stimulates insulin secretion

Parasympathetic

Which person has a higher chance at *adapting* to stressors? Why? *Person A*: Has a chronic illness, has a strong support system, access to community programs. *Person B*: Lives alone, is considered a "workaholic", incorporates a healthy diet into daily life

Person A, because people who have strong support systems and relationships are better able to adapt to stress and remain healthy.

Primary _______________ stressors include chemical agents (drugs, poisons), physical agents (heat, cold, trauma), infectious agents (viruses, bacteria), nutritional imbalances, hypoxia, and genetic or immune disorders.

Physiologic

What is a psychosomatic disorder?

Physiological medical problems caused by the interaction of psychological, emotional, and physical difficulties

Define Allostasis:

Process of achieving stability or homeostasis through physiologic or behavioral change.

*Types of Defense Mechanisms:* A person attributes thoughts or impulses to someone else.

Projection

__________________ stressors can include accidents, traumatic experiences, fear of aggression, historical horrors, worldly changes, social isolation, political divides, environmental events that bring up memories of traumatic past, etc.

Psychosocial

*Types of Defense Mechanisms:* A person tries to give a logical or socially acceptable explanation for questionable behavior ("behavior justification").

Rationalization

*Types of Defense Mechanisms:* A person develops conscious attitudes and behavior patterns that are opposite to what they would really like to do.

Reaction formation

Which part of the SAFERR model assesses and establishes the person's ability to function safety?

Recovery

Which part of the SAFERR model involves making any necessary references?

Referral

*Types of Defense Mechanisms:* A person returns to an earlier method of behaving.

Regression

*Types of Defense Mechanisms:* A person voluntarily excludes an anxiety-producing event from conscious awareness.

Repression

Parasympathetic nervous system:

Rest and digest; the division of the autonomic nervous system that calms the body, conserving its energy

_______________ anxiety creates a very narrow focus on specific details, causing all behavior to be geared toward getting relief. The person has impaired learning ability and is easily distracted; characterized by extreme fear of a danger that is not real, emotional distress that interferes with everyday life, and avoidance of situations that cause anxiety.

Severe

A couple begins the process of divorce. This is an example of _______________ stress. Developmental or Situational?

Situational

What kind of crisis occurs when a life event disrupts a person's psychological equilibrium, such as loss of a job or death of a loved family member.

Situational

Which part of the SAFERR model involves introducing yourself and establishing your role and that of the other people involved. Meet basic needs, consider safety of all parties, and mitigate any acute stressors if possible.

Stabilization

What does the SAFERR model stand for?

Stabilization, acknowledgment, facilitation of understanding, encouragement of effective coping, recovery and referral

- "Caregiver stress related to the long-term stress of caring for a parent with dementia, as evidenced by the statement," "I am just at my wits ends trying to keep mom safe!" - "Impaired spiritual status related to the stress of a new terminal diagnosis, as evidenced by the statement," "God has forsaken me" - Hopelessness related to presence of disabling physical injuries, as evidenced by statement, "I give up . . . it's just not worth it," apathy, visible lack of engagement *This identifies stress as the problem or etiology?*

Stress as the etiology

- Stress overload related to single parenthood, inadequate economic resources, and chronic illness - Moral distress related to cultural conflicts, end-of-life decisions, conflicting information about ethical decision making, or treatment decisions *This identifies stress as the problem or etiology?*

Stress as the problem

What are the four basic concepts of stress and adaptation?

Stress, stressors, adaptation, and homeostasis.

*Types of Defense Mechanisms:* A person substitutes a socially acceptable goal for one whose normal channel of expression is blocked.

Sublimation

Which division of the autonomic nervous system: - Stimulates heart rate and force - Dilates skeletal muscle blood vessels - Dilates blood vessels to the brain - Stimulates release of glycogen stores

Sympathetic

_____________ ______________________ involve consciously thinking about the stress situation and then acting to solve problems, resolve conflicts, or satisfy needs.

Task-oriented reactions

What occurs during the exhaustion phase?

The adaptive mechanisms can no longer provide defense. Without defense against the stressor, the body may either rest and mobilize its defenses to return to normal or reach total exhaustion and die.

What is the allostatic load?

The long-term negative impact of the stress response on the body Ex. Person had a high workload and is experiencing extreme fatigue.

Define anticipatory guidance:

The process of psychologically preparing a person for an upcoming, unfamiliar or painful event

*Types of Defense Mechanisms:* A person uses an act or communication to negate a previous act or communication.

Undoing

Define anxiety:

Vague sense of impending doom or apprehension precipitated by new and unknown experiences; "worry"

__________________ behavior involves physical withdrawal from the threat, or emotional reactions such as admitting defeat, becoming apathetic, or feeling guilty and isolated.

Withdrawal

Under normal circumstances, ______________, an anti-inflammatory hormone released by the adrenal glands, regulates the inflammatory response, but prolonged stress may decrease its effectiveness, or the immune cells may be resistant to its effect.

cortisol

In all people, the failure to meet needs results in an _________________ in homeostatic mechanisms and, eventually, illness

imbalance

People who were neglected or abused as children are more vulnerable to __________ as adults.

stress

Potential __________________ for the family include changes in family structure and roles, anger and feelings of helplessness and guilt, loss of control over normal routines, and concern for financial stability.

stressors