Stress and Adaptation nursing

Psychological Responses to Stress 1. Difficulty learning 2. Preoccupation 3. Rebellion 4. Irritability 5. Forgetfulness 6. Fear 7. Overly confident 8. Depression

1,2,3,4,5,6,8

Stress Management Techniques 1. Exercise 2. Biofeedback 3. Imagery 4. Humor 5. Journal writing 6. Social drinking 7. Massage 8. Meditation

1,2,3,4,5,7,8

Physiological Stressors 1. Tobacco 2. Cold Exposure 3. High-fat diet 4. Bacteria 5. Active Lifestyle 6. Sexual difficulties 7. Obesity 8. Vacation

1,2,3,4,7

The nurse is discussing coping strategies with a client who has generalized anxiety disorder. Which behaviors reported by the client indicate the use of positive coping strategies? Select All That Apply. 1. Jogging 2. Knitting 3. Smoking 4. Counseling 5. Eating binges

1,2,4

Stages of General Adaptation Syndrome 1. Recovery 2. Homeostasis 3. Alarm 4. Inflammatory 5. Reflexive 6. Resistance 7. Exhaustion 8. Multifaceted

1,3,6,7

The hospitalized client states, "I need to know when I'm going to be discharged. I'm so upset and worried that I'm missing work." The nurse knows: 1. This is an example of "eustress" and no intervention is necessary. 2. This is an example of psychological stress and the client should be placed on antidepressants. 3. This is an example of developmental stress and the client should talk to someone his own age. 4. This is an example of distress and could affect the client's health status.

4

Defense Mechanisms - Displacement

"Kick the dog." Transferring emotions, ideas, or wishes from one original object or situation to a substitute inappropriate person or object that is perceived to be less powerful or threatening.

A client was brought into the emergency department and was the victim of a robbery. Upon assessment, his heart rate is 112 bpm, respirations 34 and deep, and he is complaining of nausea and lower abdominal pain. Which stage of general adaptive syndrome (GAS) is this client in? 1. Alarm 2. Resistance 3. Adaptation 4. Recovery

1

A co-worker makes a sarcastic remark when the nurse is late for their shift and "throws" a stack of paperwork and a list of clients who need assessing to them before they can settle in. Why is this co-worker possibly behaving this way? 1. Hostility and resentment of the late nurse 2. Depression related to something occurring outside the workplace. 3. Anger due to being reprimanded earlier in the day. 4. Anxiety about information they just received regarding their health.

1

An older client with a history of congestive heart failure was just admitted to the hospital for chest pain. The patient asks a nurse, "Why did the chest pain begin after I thought someone was trying to break into my house?" What is the nurse's best response? 1. "Fear causes an increase of the body's heart rate and blood pressure, which can place additional stress on your damaged heart and cause chest pain." 2. "Fear causes the parasympathetic system to use all available adrenaline, leaving you so tired that you developed chest pain." 3. "The decrease in the need for oxygen during the fight-or-flight response experienced with fear is most likely the reason that you developed chest pain." 4. "Fear causes an increase in glucose levels, which limits blood flow and causes chest pain."

1

At the end of a meditation session, which physical assessment finding would suggest that the relaxation technique was successful? 1. Decreased blood pressure 2. Decreased peripheral skin temperature 3. Increased respiratory rate 4. Increased bowel motility

1

Evelyn is a 47-year-old who recently lost her husband suddenly in a tragic accident. In addition, she is responsible for the daily care of her elderly mother who is suffering with Alzheimer's and failing health. Evelyn is in the office complaining of chest pain, extreme fatigue, and shortness of breath. Upon assessment, it is discovered she has gained about 10 pounds in a short period of time and has started smoking again after being a non-smoker for 25 years. What should the nurse investigate further in Evelyn? 1. Other issues or stressors suggesting maladaptive coping issues. 2. What is disrupting Evelyn's mother's health to recommend nursing interventions for to help relieve stress? 3. Psychiatric referral to help cope with the death of the spouse. 4. Evelyn's past health history to determine if symptoms are typical for her.

1

A client begins experiencing chest pain off and on for a few days and continues to work without seeking medical attention. Which response to stress is this client demonstrating? 1. Altering the stressor 2. Avoiding the stressor 3. Analyzing the stressor 4. Adapting to the stressor

2

A client is scheduled for a major surgery the next morning and appears anxious that family has not visited. Which question by the nurse would help to determine the level of anxiety that the client is experiencing? 1. "Do you have questions about the surgery tomorrow?" 2. "Would you like for me to call a family member to come support you?" 3. "Would you like to talk with another client who had the same surgery?" 4. "You seem worried about something. Would it help to talk about it?"

2

Which nursing diagnosis related to stress references the behavioral domain? 1. Constipation r/t decreased peristalsis secondary to stress 2. Ineffective coping r/t stress AEB disinterest in present and distancing from support. 3. Anxiety r/t traumatic experience, preoccupation with events AEB fear and withdrawal from support system. 4. Hopelessness r/t perceived lack of support and ability to change the present situation

2

Which behaviors are consistent with adaptive coping behaviors? Select all that apply. 1. Working additional hours to complete a task 2. Exercising each day to relieve tension 3. Going to a movie with friends 4. Seeking a support group 5. Sleeping additional hours each night

2,3,4

What must be present for the nurse to consider a client in crisis? Select All That Apply. 1. Presence of physiological symptoms 2. Event that has drastically changed a client's life 3. Usual coping mechanisms are ineffective 4. Event is perceived as a threat to the client 5. Anxiety and an inability to function 6. Precipitating event causes the client to gain something

2,3,4,5

Factors That Influence Successful Adaptation 1. Exaggerated perception of the stressor 2. Healthy lifestyle 3. Church support group 4. Living alone 5. Age 6. Developmental level 7. Good coping skills 8. Hardiness

2,3,5,6,7,8

A client who was informed of a cancer diagnosis assures the nurse that he is fine. Which of the following is the most indicative physical evidence to the nurse of the client's stress? 1. Constricted pupils 2. Dilated peripheral blood vessels (flush) 3. Hyperventilation 4. Decreased heart rate

3

Defense Mechanisms - Identification

A person takes on the ideas, personality, or characteristics of another person, especially someone whom the person fears or respects.

Styles of Coping Strategies

Adaptive Maladaptive

General adaptation syndrome (GAS) - Stages

Alarm Resistance Exhaustion

Defense Mechanisms - Intellectualization

Cognitive reasoning is used to block or avoid feelings about a painful incident.

Stress

Any disturbance in a person's normal balanced state Unique response by each person to a stressor Can be harmful or motivating

Defense Mechanisms - Undoing

Apologizing excessively Making amends for a behavior one thinks is unacceptable to reduce guilt.

Defense Mechanisms - Sublimation

Unacceptable drives, traits, or behaviors (often sexual or aggressive) are unconsciously diverted to socially accepted traits.

Categories of Stress - Developmental

Associated with life stages (e.g., college graduation)

General adaptation syndrome (GAS) -Parasympathetic Nervous System

Balances sympathetic activity Ho​rmone levels return to normal

Defense Mechanisms - Projection

Blaming others. Attributing one's own personality traits, mistakes, emotions, motives, and thoughts to another; "finger pointing."

Categories of Stress - Distress

Can threaten health (e.g., continual financial worries)

Categories of Stress - Eustress

Good stress

Styles of Coping Strategies - Adaptive

Healthy choices Directly reduce negative effects of stress Examples: Change in lifestyle; problem-solving

Styles of Coping Strategies - Maldaptive

Unhealthy style, temporary fix Possible other harmful effects Examples: Substance abuse; overeating

Psychological Responses to Stress

Includes feelings, thoughts, and behaviors - Anxiety and fear - Ego defense mechanisms (e.g., denial, rationalization, projection) - Anger - Depression

Defense Mechanisms - Compensation

Making up for a perceived inadequacy by developing or emphasizing some other desirable trait.

Defense Mechanisms - Minimization

Not acknowledging or accepting the significance of one's own behavior, making it less important.

Defense Mechanisms - Rationalization

Use of a logical-sounding excuse to cover up or justify true ideas, actions, or feelings. An attempt to preserve self-respect or approval or to conceal a motive for some action by giving a socially acceptable reason. Similar to intellectualization, but uses faulty logic. Excuses

Defense Mechanisms - Regression

Using behavior appropriate in an earlier stage of development to overcome feeling of insecurity in a present situation. "Thumb sucking"

Defense Mechanisms - Dissociation

Painful events are separated or dissociated from the conscious mind.

Categories of Stress - Situational

Random, unpredictable (e.g., hurricane, accident)

Stress as response - Selye

Response based model "The nonspecific response of the body to noxious stimuli" Originator of stress theory and research General Adaptation Syndrome (GAS) / Local Adaptation Syndrome (LAS)

Physical Response to Stressors - Local Adaptation Syndrome

Response to stress involving specific body part, tissue, or organ Short-term attempt to restore homeostasis Localized Types - Reflex pain response - Inflammatory response

General adaptation syndrome (GAS)

Selye's theoretical model of physiological responses to stress Nonspecific bodily responses shared by all people Response to distress as well as eustress Involves three stages

Defense Mechanisms - Reaction Formation

Similar to compensation, except the person develops the opposite trait. The person is aware of her feelings but acts in ways opposite to what she is really feeling. React to form

Stress Theories

Stress as stimulus (Holmes and Rahe) * Stress as response (Selye) Stress as transaction (Lazarus) Stress as a process including internal and external demands and resources (Pearlin)

Consequences of Failed Adaptation

Stress-induced organic responses Somatoform disorders Stress-induced psychological responses

General adaptation syndrome (GAS) - Alarm

Sympathetic Nervous System: Hypothalamus - CRH Poterior Pituitary - Endorphins, ADH Anterior Pituitary - ACTH Adrenal Cortex - Cortisol, Aldosterone Adrenal Medulla - Epi/nor-epinephrine

Categories of Stress - Anticipatory

The future (e.g., upcoming exam)

Dealing With Stress: Coping Strategies

Three general approaches depending on situation: Alter the stressor: Change jobs Adapt to the stressor: Changing thoughts about nursing clinical Avoid the stressor: Ending a relationship

Defense Mechanisms - Denial

Transforming reality by refusing to acknowledge thoughts, feeling, desires, or impulses. This is unconscious; the person is not consciously lying. Usually the first defense learned.

True or False A client who is taking the drug atenolol (Tenormin) may not exhibit the expected rise in blood pressure and pulse during the alarm stage of the general adaptation syndrome.

True

Categories of Stress - Time

Unable to meet demands (e.g., multiple demands, rushing)

Physical Response to Stressors - Inflammatory Process

Vascular response Cellular response Exudate formation Healing

Defense Mechanisms - Substitution

the action of replacing someone or something with another person or thing.

Defense Mechanisms - Introjection

the unconscious adoption of the ideas or attitudes of others.

Defense Mechanisms - Repression

Unconscious "burying" or "forgetting" of painful thoughts, feelings, memories, ideas; pushing them from a conscious to an unconscious level. It is a step deeper than denial.

Ego Defense Mechanisms

Unconscious psychological adaptive mechanisms Unconscious mind working to protect the person from anxiety Precursors to conscious cognitive coping mechanisms

The nurse is working with a client who is dealing with multiple stressors. Which action made by the client indicates a desire to learn from stressors? 1. Beginning a weight loss program after a new diagnosis of type 2 diabetes mellitus 2. Deciding to work from home and rarely leaving the home after becoming a victim of a crime 3. Choosing to become involved in parent activities at his or her child's school 4. Taking a continuing education course on how to garden and grow plants in the yard

1

The nursing manager of an intensive care unit is worried about staff burnout. Which behaviors of the nurses may indicate this problem? Select All That Apply. 1. Increased client acuity 2. Nurses being floated to other units 3. Increased ability to delegate nursing responsibilities 4. Decreased staff nurse-to-client ratio assignments 5. Management bringing in food to help nurses who work through extra shifts

1,2

A 44-year-old female client who was just admitted states, "I must be under too much stress at work and home. I just do not feel well." Which physical findings are consistent with the client's statement? Select all that apply. 1. Blood pressure is 178/96 mm Hg. 2. Palms of her hands are sweaty. 3. Pupils are constricted and reactive to light. 4. Legs are continually moving in the bed. 5. Mucous membranes are dry.

1,2,4,5

An older adult is tearful, shaky, withdrawn, tachycardic, and sleepless. She tells you that she is "worrying herself to death" about losing her aging husband and being "all alone." Which statement can be made about this anxiety reaction? Select all that apply. 1. It concerns future or anticipated events. 2. It concerns anticipation of danger rather than a present danger. 3. Her symptoms are emotional and not physical. 4. There is a psychological rather than a physical threat. 5. She lacks adaptive coping mechanisms.

1,2,4,5

The nurse is caring for a client after abdominal surgery. The client is afraid of having pain and experiences physiological changes when the stressor of pain is introduced. Which changes are a result of this stressor? Select all that apply. Increased blood pressure Vasoconstriction of the skin Increased peristalsis Constriction of the bronchioles Increased glucose in the blood

1,2,5

Which statements about stressors are accurate? Select all that apply. 1. Stressors can be different, depending on the situation. 2. Stressors impact each person the same way. 3. Stressors change throughout the life span. 4. Stressors are measurable for each person. 5. Stressors always impact physiological health.

1,3

Problems That Occur When Adaptation Fails 1. Inability to cope effectively in the workplace 2. Purposefully making a drastic change in routine 3. Anxiety and flashbacks to a traumatic event 4. Physical symptoms with no known organic cause 5. Exposing self to other stable environments 6. Preoccupation with physical illness 7. Pain as the main focus of life without physical cause 8. Perceived threat to self or others

1,3,4,6,7,8

Adaptive Coping Behaviors 1. Seeking advice 2. Overeating 3. Oversleeping 4. Exercising 5. Spending time alone 6. Drinking alcohol 7. Posting on social media 8. Taking a class

1,4,5,8

A middle-aged male client is experiencing job-related stress associated with the fear of layoff, resulting in his accepting projects that require a great deal of travel. Which of the following would be the most important health promotion strategy for this client? 1. Exercise 2. Sleep 3. Nutrition 4. Time management

2

HPI: Evelyn is a 47-year-old who recently lost her husband suddenly in a tragic accident. In addition, she is responsible for the daily care of her elderly mother who is suffering with Alzheimer's and failing health. Evelyn is in the office complaining of chest pain, extreme fatigue, and shortness of breath. Upon assessment, it is discovered she has gained about 10 pounds in a short period of time and has started smoking again after being a non-smoker for 25 years. Vitals: BP 158/90 RA sitting, P 84 beats/min and labored, Temp 99.3 F orally Nurse Assessment: Client appears to be unable to concentrate AEB fragmented thought processes and communication. Client states she has not slept well in the past several months since her husband died and has difficulty focusing on daily decisions. One sister who helps with her mother on the weekends. Denies any church affiliation or specific cultural practice and has a small group of close friends who have been 'in and out' with their support. Admits to smoking one pack of cigarettes/day and has been drinking approximately one bottle of wine each evening to 'calm down.' Denies any consistent exercise routine stating she is 'just too tired.' States she has been eating more fast food and she doesn't want to cook now that her husband is not here to cook for. What type of coping skill can the nurse identify in Evelyn's behavior? 1. Altering the stressor 2. Avoiding the stressor 3. Adapting to the stressor 4. Removing the stressor

2

Martha is stressed from the overwhelming amount of work she is responsible for since her charge nurse quit her position. She has spoken with her director but nothing seems to change. She decides to apply for another position within the hospital. Which coping approach is Martha using? 1. Assigning the stressor 2. Avoiding the stressor 3. Altering the stressor 4. Adapting to the stressor

2

Physiological Responses to Stress 1. Excess saliva 2. Hyperventilation 3. Decreased heart rate 4. Decreased glucose 5. Dilated pupils 6. Headaches 7. Eczema 8. Dysrhythmias

2,5,6,7,8

A patient who is newly diagnosed with cancer is scheduled to consult with an oncologist in several days. What would be the best coping strategy for the nurse to recommend at this time? 1. Go away for a few days to forget about the situation. 2. Talk to family and friends about negative feelings. 3. Seek information about the cancer and treatment options. 4. Wait to see what the oncologist recommends for treatment.

3

The nurse is presenting a workshop on stress and adaptation to a group of teenagers. A teenager approaches the nurse and says, "Sometimes I feel stressed when I have to take a test. I feel my heart is going faster and I have a hard time focusing. I'm scared I'm going to fail. Do you think that is normal?" What is the most appropriate response by the nurse? 1. "As long as you are getting through the test, I think you will be just fine." 2. "A little stress is not necessarily a bad thing. It can help you to focus." 3. "You may need to develop some additional stress-reducing activities." 4. "I think you should talk to your teacher about getting accommodations for testing."

3

The nurse should assess every client to determine if stress reduction interventions should be part of the plan of care. The rationale for this action is that: 1. There are more persons experiencing mental illness now than in the past. 2. Life is so much more stressful than it has ever been. 3. The occurrence of stress in clients is unpredictable. 4. Clients often develop maladaptive coping strategies.

3

Categories of Stress

Distress Eustress Developmental Situational Time Anticipatory

General adaptation syndrome (GAS) - Exhaustion

Energy is depleted, cannot adapt, and dies.