Unit 2 - Ch. 10 | Stress Responses + Stress Management

Other Relaxation Techniques for Stress Management

Physical exercise, cognitive reframing, journaling, humor

Eustress

Positive beneficial energy that motivates and results in feelings of happiness, hopefulness, and purposeful movement (much-needed vacation, playing favorite sport, birth of baby, challenge of a new job)

The Nurse's Role in Reducing Stress

Promote a healing environment, facilitate successful coping, and develop future coping strategies

A recent immigrant from Honduras comes to the clinic with a family member who has been a U.S. resident for 10 years. The family member says, The immigration to America has been very difficult. Considering cultural background, which expression of stress by this patient would the nurse expect? a. Motor restlessness b. Somatic complaints c. Memory deficiencies d. Sensory perceptual alterations

B (Honduras is in Central America. Many people from Central American cultures express distress in somatic terms. The other options are not specific to this patients cultural background and are less likely to be observed in persons from Central America.)

Relaxation Techniques for Stress Management

Biofeedback, deep breathing exercises, guided imagery, progressive relaxations, meditation

Fight-or-Flight Response

Body prepares for situation that the individual perceives as a threat to survival

A patient tells the nurse, I know that I should reduce the stress in my life, but I have no idea where to start. What would be the best initial nursing response? a. Physical exercise works to elevate mood and reduce anxiety. b. Reading about stress and how to manage it might be a good place to start. c. Why not start by learning to meditate? That technique will cover everything. d. Lets talk about what is going on in your life and then look at possible options.

D (In this case, the nurse lacks information about what stressors the patient is coping with or about what coping skills are already possessed. Further assessment is indicated before potential solutions can be explored. Suggesting exploration of the stress facing the patient is the only option that involves further assessment rather than suggesting a particular intervention.)

Short Term Effects (Hypothalamus-Pituitary-Adrenal Cortex HYPAC) of the Stress Response

Decreased fluid loss, increased glucose, decreased inflammation, decreased brain norepinephrine

Physiological Stressors

Environmental conditions (trauma, excessive cold or heat), physical conditions (infection, hunger, pain)

Psychological Stressors

Events such as loss of a job, divorce, unmanageable debt, death of a loved one

Long Term (Chronic) Effects of the Stress Response

Immune system compromise, atherosclerosis, depression, hypertension, insulin insensitivity, obesity, high blood lipids, protein breakdown, heart disease, stroke, arthritis, diabetes, cancer, ulcers, high HR, high cholesterol, glucose intolerance, digestive problems, chronic anxiety, etc.

Distress

Negative draining energy that results in anxiety, depression, confusion, helplessness, hopelessness, and fatigue (death in family, financial overload, school/work demands)

Stress

The brain's natural response to any demand

A patient who had been experiencing significant stress learned to use progressive muscle relaxation and deep breathing exercises. When the patient returns to the clinic 2 weeks later, which finding most clearly shows the patient is coping more effectively with stress? a. The patients systolic blood pressure has changed from the 140s to the 120s mm Hg. b. The patient reports, I feel better, and that things are not bothering me as much. c. The patient reports, I spend more time napping or sitting quietly at home. d. The patients weight decreased by 3 pounds.

A (Objective measures tend to be the most reliable means of gauging progress. In this case, the patients elevated blood pressure, an indication of the bodys physiological response to stress, has diminished. The patients report regarding activity level is subjective; sitting quietly could reflect depression rather than improvement. Appetite, mood, and energy levels are also subjective reports that do not necessarily reflect physiological changes from stress and may not reflect improved coping with stress. The patients weight change could be a positive or negative indicator; the blood pressure change is the best answer.)

Which changes reflect short-term physiological responses to stress? Select all that apply. a. Muscular tension, blood pressure, and triglycerides increase. b. Epinephrine is released, increasing heart and respiratory rates. c. Corticosteroid release increases stamina and impedes digestion. d. Cortisol is released, increasing glucogenesis and reducing fluid loss. e. Immune system functioning decreases, and risk of cancer increases. f. Risk of depression, autoimmune disorders, and heart disease increases.

ABCD (The correct answers are all short-term physiological responses to stress. Increased risk of immune system dysfunction, cancer, cardiovascular disease, depression, and autoimmune disease are all long-term (chronic) effects of stress.)

An individual says to the nurse, I feel so stressed out lately. I think the stress is affecting my body also. Which somatic complaints are most likely to accompany this feeling? Select all that apply. a. Headache b. Neck pain c. Insomnia d. Anorexia e. Myopia

ABCD (When individuals feel stressed-out, they often have accompanying somatic complaints, especially associated with sleep, eating, and headache or back pain. Changes in vision, such as myopia, would not be expected.)

Which nursing comments are likely to help a patient to cope by addressing the mediators of stress? Select all that apply. a. A divorce, while stressful, can be the beginning of a new, better phase of life. b. You said you used to jog; getting back to aerobic exercise could be helpful. c. Journaling often promotes awareness of how experiences have affected people. d. Slowing your breathing by counting to three between breaths will calm you. e. Would a short-term loan make your finances less stressful? f. There is a support group for newly divorced persons in your neighborhood.

ACEF (Stress mediators are factors that can help persons cope by influencing how they perceive and respond to stressors; they include personality, social support, perceptions, and culture. Suggesting that a divorce may have positive as well as negative aspects helps the patient to alter perceptions of the stressor. Journaling increases self-awareness regarding how life experiences may have shaped how we perceive and respond to stress (or how our personality affects how we respond to stressors). A loan could help the patient by reducing the financial pressures. Participation in support groups is an excellent way to expand ones support network relative to specific issues. However, neither aerobic exercise nor breathing-control exercises, while helpful in other ways, affect stress mediators.)

What factors affect the way we perceive stressors?

Age, gender, culture, life experiences, lifestyle

Which scenario best demonstrates an example of eustress? An individual: a. loses a beloved family pet. b. prepares to take a one-week vacation to a tropical island with a group of close friends. c. receives a bank notice there were insufficient funds in their account for a recent rent payment. d. receives notification their current employer is experiencing financial problems and some workers will be terminated.

B (Eustress is beneficial stress; it motivates people to develop skills they need to solve problems and meet personal goals. Positive life experiences produce eustress. Going on a tropical vacation is an exciting, relaxing experience and is an example of eustress. Losing the family pet, worrying about employment security, and having financial problems are examples of distress, a negative experience that drains energy and can lead to significant emotional problems. See related audience response question.)

A patient tells the nurse, I will never be happy until Im as successful as my older sister. The nurse asks the patient to reassess this statement and reframe it. Which reframed statement by the patient is most likely to promote coping? a. People should treat me as well as they treat my sister. b. I can find contentment in succeeding at my own job level. c. I wont be happy until I make as much money as my sister. d. Being as smart or clever as my sister isnt really important.

B (Finding contentment within ones own work, even when it does not involve success as others might define it, is likely to lead to a reduced sense of distress about achievement level. It speaks to finding satisfaction and happiness without measuring the self against another person. Focusing on salary is simply a more specific way of being as successful as the sister, which would not promote coping. Expecting others to treat her as they do her sister is beyond her control. Dismissing the sisters cleverness as unimportant indicates that the patient continues to feel inferior to the sibling.)

A patient nervously says, Financial problems are stressing my marriage. Ive heard rumors about cutbacks at work; I am afraid I might get laid off. The patients pulse is 112/minute; respirations are 26/minute; and blood pressure is 166/88. Which nursing intervention will the nurse implement? a. Advise the patient, Go to sleep 30 to 60 minutes earlier each night to increase rest. b. Direct the patient in slow and deep breathing via use of a positive, repeated word. c. Suggest the patient consider that a new job might be better than the present one. d. Tell the patient, Relax by spending more time playing with your pet.

B (The patient is responding to stress with increased arousal of the sympathetic nervous system, as evident by elevated vital signs. These will have a negative effect on his health and increase his perception of being anxious and stressed. Stimulating the parasympathetic nervous system will counter the sympathetic nervous systems arousal, normalizing these vital-sign changes and reducing the physiological demands stress is placing on his body. Other options do not address his physiological response pattern as directly or immediately.)

The nurse wishes to use guided imagery to help a patient relax. Which comments would be appropriate to include in the guided imagery script? Select all that apply. a. Imagine others treating you the way they should, the way you want to be treated b. With each breath, you feel calmer, more relaxed, almost as if you are floating c. You are alone on a beach, the sun is warm, and you hear only the sound of the surf d. You have taken control, nothing can hurt you now. Everything is going your way e. You have grown calm, your mind is still, there is nothing to disturb your well-being f. You will feel better as work calms down, as your boss becomes more understanding

BCE (The intent of guided imagery to assist patients manage stress is to lead the patient to envision images that are calming and health-enhancing. Statements that involve the patient calming progressively with breathing, feeling increasingly relaxed, being in a calm and pleasant location, being away from stressors, and having a peaceful and calm mind are therapeutic and should be included in the script. However, items that raise stressful images or memories or that involve unrealistic expectations or elements beyond the patients control (e.g., that others will treat the patient as he desires, that everything is going the patients way, that bosses are understanding) interfere with relaxation and/or do not promote effective coping. Thus these are not health-promoting and should not be included in the script.)

A patient reports, I am overwhelmed by stress. Which question by the nurse would be most important to use in the initial assessment of this the patient? a. Tell me about your family history. Do you have any relatives who have problems with stress? b. Tell me about your exercise. How much activity do you typically get in a day? c. Tell me about the kinds of things you do to reduce or cope with your stress. d. Stress can interfere with sleep. How much did you sleep last night?

C (The most important data to collect during an initial assessment is that which reflects how stress is affecting the patient and how he is coping with stress at present. This data would indicate whether or not his distress is placing him in danger (e.g., by elevating his blood pressure dangerously or via maladaptive responses, such as drinking) and would help the nurse understand how he copes and how well his coping strategies and resources serve him. Of the choices presented, the highest priority would be to determine what he is doing to cope at present, preferably via an open-ended inquiry. Family history, the extent of his use of exercise, and how much sleep he is getting are all helpful but seek data that is less of a priority. Also, the manner in which such data is sought here is likely to provide only brief responses (e.g., how much sleep he got on one particular night is probably less important than how much he is sleeping in general).)

A patient diagnosed with emphysema has severe shortness of breath and needs portable oxygen when leaving home. Recently the patient has reduced activity because of fear that breathing difficulty will occur. A nurse suggests using guided imagery. Which image should the patient be encouraged to visualize? a. Engaging in activity without using any supplemental oxygen b. Sleeping comfortably and soundly, without respiratory distress c. Feeling relaxed and taking regular deep breaths when leaving home d. Having a younger, healthier body that knows no exercise limitations

C (The patient has dysfunctional images of dyspnea. Guided imagery can help replace the dysfunctional image with a positive coping image. Athletes have found that picturing successful images can enhance performance. Encouraging the patient to imagine a regular breathing depth and rate will help improve oxygencarbon dioxide exchange and help achieve further relaxation. Other options focus on unrealistic goals (being younger, not needing supplemental oxygen) or restrict her quality of life.)

When a nurse asks a newly admitted patient to describe social supports, the patient says, My parents died last year and I have no family. I am newly divorced, and my former in-laws blame me. I dont have many friends because most people my age just want to go out drinking. Which action will the nurse apply? a. Advise the patient that being so particular about potential friends reduces social contact. b. Suggest using the Internet as a way to find supportive others with similar values. c. Encourage the patient to begin dating again, perhaps with members of the church. d. Discuss how divorce support groups could increase coping and social support.

D (High-quality social support enhances mental and physical health and acts as a significant buffer against distress. Low-quality support relationships affect a persons coping negatively. Resuming dating soon after a divorce could place additional stress on the patient rather than helping her cope with existing stressors. Developing relationships on the Internet probably would not substitute fully for direct contact with other humans and could expose her to predators misrepresenting themselves to take advantage of vulnerable persons.)

The adult child of a patient diagnosed with major depression asks, Do you think depression and physical illness are connected? Since my fathers death, my mother has had shingles and the flu, but shes usually not one who gets sick. Which answer by the nurse best reflects current knowledge about psychoneuroimmunology? a. It is probably a coincidence. Emotions and physical responses travel on different tracts of the nervous system. b. You may be paying more attention to your mother since your father died and noticing more things such as minor illnesses. c. So far, research on emotions or stress and becoming ill more easily is unclear. We do not know for sure if there is a link. d. Negative emotions and stress may interfere with the bodys ability to protect itself and can increase the likelihood of infection.

D (The correct answer best explains the research. Research supports a link between negative emotions and/or prolonged stress and impaired immune system functioning. Activation of the immune system sends proinflammatory cytokines to the brain, and the brain in turn releases its own cytokines that signal the central nervous system to initiate myriad responses to stress. Prolonged stress suppresses the immune system and lowers resistance to infections. Although the adult child may be more aware of issues involving the mother, the pattern of illnesses described may be an increase from the mothers baseline)

A patient is brought to the Emergency Department after a motorcycle accident. The patient is alert, responsive, and diagnosed with a broken leg. The patients vital signs are pulse (P) 72 and respiration (R) 16. After being informed surgery is required for the broken leg, which vital sign readings would be expected? a. P 64, R 14 b. P 68, R 12 c. P 72, R 16 d. P 80, R 20

D (The patient would experience stress associated with anticipation of surgery. In times of stress, the sympathetic nervous system takes over (fight or flight response) and sends signals to the adrenal glands, thereby releasing norepinephrine. The circulating norepinephrine increases the heart rate. Respirations increase, bringing more oxygen to the lungs.)

4 Coping Categories

Health sustaining habits (proper diet, medical compliance, relaxation), life satisfactions (work, family, hobbies, humor, nature), social supports (support groups, culture), effective and healthy responses to stress

Short Term Effects (Sympathetic-Adrenal Medulla SAM) of the Stress Response

Increased heart rate, increased respiration, increased triglycerides, decreased kidney clearance, increased muscular tension, increased blood to skeletal muscles

How do males and females responses to stress differ?

Males usually use fight or flight response whereas women use tending and befriending strategy

Effects of Stress on the Body

Malfunctions of the immune system, headaches, anxiety, depression, increased risk of CVA, increased BP, increased HR, increased blood glucose, changes in appetite, rapid breathing, insomnia, digestive problems, decreased labido, ED, irregular menstrual cycle, infertility, back aches

Nursing Management of Stress Responses

Measuring stress, assessing coping styles, developing healthy and effective responses to stress

General Adaptation Syndrome (GAS)

Occurs in 3 stages - alarm stage (initial brief and adaptive response, fight or flight), resistance stage (sustained and optimal resistance to stressor - stressors are usually successfully overcome here), exhaustion stage (attempts to resist the stressor prove futile - resources are depleted)