Chapter 42
A nurse is assessing the developmental levels of patients in a pediatric office. Which person would a nurse document as experiencing developmental stress? a) An infant who learns to turn over b) A school-aged child who learns how to add and subtract c) An adolescent who is a "loner" d) A young adult who has a variety of friends
C
Which of the following could be considered psychosocial stressors: (SELECT ALL THAT APPLY) A.Asthma B.Heart disease C.Fear of previous stressful event D.Fear of aggression E.Fear of change
C, D, E
What are the 2 main systems that control homeostatic mechanisms? A.cardiovascular B.respiratory C.GI D.endocrine E.autonomic nervous system F.renal
D, E
Which of the following would be included in a teaching plan for healthy activities of daily living? A.exercise B.rest & sleep C.nutrition D.support systems E.stress management F.none of the above G.all of the above
G
Which of the following could be considered a physiologic stressor? A.chemical agents B.physical agents C.infectious agents D.nutritional imbalances E.hypoxia F.genetic or immune disorders G.none of the above H.all of the above
H
A person attempts to overcome a perceived weakness by emphasizing a more desirable trait or overachieving in a more comfortable area. Example: A student who has difficulty with academics may excel in sports.
compensation
Is usually constructive, often involving the substitution of goals or negotiation to partially fulfill needs
compromise behavior
Which emotional response to stress is being described below? Crying and physical activity
coping mechanism
An anti-inflammatory hormone released by the adrenals known as ----, regulates the inflammatory response.
cortisol
*** Which coping strategy is being described below? Compensation Denial Displacement Introjection Projection Rationalization Reaction formation Regression Repression Sublimation Undoing
defense mechanisms
A person refuses to acknowledge the presence of a condition that is disturbing. Example: Despite finding a lump in her breast, a woman does not seek medical treatment.
denial
A person transfers (displaces) an emotional reaction from one object or person to another object or person. Example: An employee who is angry with a coworker kicks a chair.
displacement
A person subconsciously protects him- or herself from the memories of a horrific or painful event by allowing the mind to forget the incident. Example: An adult cannot recall childhood memories surrounding the traumatic death of a sibling.
dissociation
Chemical agents?
drugs, poison
True or False Stress alone can cause autoimmune diseases such as rheumatoid arthritis.
false
True or False When a child who is angry with one's parents kicks a bedroom wall, the child is using the defense mechanism known as introjection.
false
---- is the biochemical model of stress comprised of 3 stages.
general adaptation syndrome
Biochemical model of stress; the bodies general response to stress
general adaptation syndrome
Physical agents?
heat, cold, trauma
---- is a process of maintaining constancy in the internal environment, the balance to maintain health.
homeostasis
The process called ---- refers to the body's use of various physiologic mechanisms to respond to internal changes to maintain relative constancy in the internal environment.
homeostasis
An ---- can occur if the perception of the event is exaggerated or if sources for support or coping mechanisms are inadequate.
imbalance
Which type of pain response is being described below? Redness from a surgical site or wound
inflammatory
A person incorporates qualities or values of another person into his or her own ego structure. This mechanism is important in the formation of conscience during childhood. Example: An older sibling tells his preschool sister not to talk to strangers, expressing his parents' values to his younger sister.
introjection
Involves only one specific body part
local adaptation syndrome (LAS)
What are some examples of external stressors?
loud noises and cold or hot temperatures
Which emotional response to stress is being described below? Present in day-to-day living
mild anxiety
Which emotional response to stress is being described below? Body interaction
mind
Which emotional response to stress is being described below? Immediate concerns
moderate anxiety
Which emotional response to stress is being described below? Loss of control, distorted perception, and loss of rational thoughts
panic anxiety
Stress results from internal or external factors that are perceived as a challenge, threat, or danger. Most stress in our society results from....
performance demands or interpersonal relationships rather than physical threats or danger
Which factor affecting stress and adaptation is being described below? Genetic inheritance, age, nutrition and sleep, mental health, etc.
personal factors
A person attributes thoughts or impulses to someone else. Example: A person who denies any sexual feelings for a coworker accuses him of sexual harassment.
projection
A person tries to give a logical or socially acceptable explanation for questionable behavior ("behavior justification"). Example: A patient who forgot to keep a health care appointment says, "If patients didn't have to wait 3 months to get an appointment, they wouldn't forget them."
rationalization
A person develops conscious attitudes and behavior patterns that are opposite to what he or she would really like to do. Example: A married woman is attracted to her husband's best friend but is constantly rude to him.
reaction formation
Which type of response is being described below? Pulling back from a hot stove
reflex
A person returns to an earlier method of behaving. Example: Children often regress to soiling diapers or demanding a bottle when they are ill.
regression
A person voluntarily excludes an anxiety-producing event from conscious awareness. Example: A father may not remember shaking his crying baby.
repression
The three stages in GAS are the alarm reaction, the stage of ----, and the stage of exhaustion.
resistance
Stress occurs every day and a person's ---- to stress are necessary to life.
responses
Which emotional response to stress is being described below? Specific details; focus on getting relief
severe anxiety
Which factor affecting stress and adaptation is being described below? Developmental and situational stress
sources of stress
Which stage is being described below? •Results when adaptive mechanisms are exhausted •Body either rests and mobilizes its defenses to return to normal or dies/damage to the body
stage of exhaustion
Which stage is being described below? •Body attempts to adapt to stressor •Vital signs, hormone levels, and energy production return to normal •Body regains homeostasis or adaptive mechanisms fail
stage of resistance
A person substitutes a socially acceptable goal for one whose normal channel of expression is blocked. Example: A person who is aggressive toward others may become a star football player.
sublimation
*** Which coping strategy is being described below? Attack behavior Withdrawal behavior Compromise behavior
task-oriented reactions to stress
What does it mean if the 3 components of psychosocial homeostasis are not in tact?
they were never established in childhood, then we cannot reach psychological homeostasis if these basic needs are not met then psychological homeostasis is out of the question
True or False A crisis is a disturbance caused by precipitating event, such as a perceived loss, a threat of loss, or a challenge that is perceived as a threat to self.
true
True or False In the exhaustion stage of general adaptation syndrome (GAS), without defense against the stressor, the body may either rest or mobilize its defense to return to normal or reach total exhaustion and die.
true
True or False The major sources of stress in our society arise from interpersonal relationships and performance demands rather than from actual physical threats.
true
Which factor affecting stress and adaptation is being described below? Marriage, illness, role changes, etc.
types of stressors experienced
A person uses an act or communication to negate a previous act or communication. Example: A husband who was physically abusive to his wife may bring her an expensive present the next day.
undoing
Infectious agents?
virus, bacteria
Involves physical withdrawal from the threat, or emotional reactions such as admitting defeat, becoming apathetic, or feeling guilty and isolated
withdrawal behavior
Within the general adaptation syndrome, describe the stage of exhaustion.
1. vasodilation 2. decreased blood pressure 3. increased pulse and respirations 4. panic, crisis 5. exhaustion
A nurse caring for patients in a hospital setting uses anticipatory guidance to prepare them for painful procedures. Which nursing intervention is an example of this type of stress management? a) The nurse teaches a patient rhythmic breathing to perform prior to the procedure. b) The nurse tells a patient to focus on a pleasant place, mentally place himself in it, and breathe slowly in and out. c) The nurse teaches a patient about the pain involved in the procedure and describes methods to cope with it. d) The nurse teaches a patient to create and focus on a mental image during the procedure in order to be less responsive to the pain.
C
The local adaptation syndrome is composed of two types of responses. What are they?
1. reflex pain response 2. inflammatory response
What are 2 specific ways to cope?
1. task-oriented reactions to stress 2. defense mechanisms
What are the two most common responses to local adaptation syndrome (LAS?
1. reflex pain response 2. inflammatory response
List 5 non-pharmacologic stress management techniques.
1. relaxation 2. meditation 3. anticipatory guidance 4. guided imagery 5. biofeedback 6. crisis intervention
What are 6 stress management techniques?
1. relaxation 2. meditation 3. anticipatory guidance 4. guided imagery 5. biofeedback 6. crisis intervention
What are 3 factors affecting stress and adaptation?
1. sources of stress 2. types of stressors experienced 3. personal factors
What are the 3 emotional responses to stress?
1. mind 2. coping mechanisms 3. anxiety
What are 2 specific types of stressors?
1. physiologic 2. psychosocial
Within the general adaptation syndrome described the stage of resistance.
1. Neuroendocrine activity returns to normal 2. Local adaptation syndrome (LAS) 3. Coping and defense mechanisms
What are 6 psychosocial stressors?
1. accidents 2. stressful or traumatic experiences of family members and friends 3. horrors of history 4. fear of aggression or mutilation 5. events of history that are brought into our homes through television and the internet 6. rapid changes in the world
Long-term stress can...
1. affect physical status 2. increase risk for disease or injury 3. compromises recovery and return to normal functions 4. is associated with specific diseases (alcoholism, drug abuse, depression, suicide, eating disorders) 5. can exacerbate other diseases that are not caused by stress (rheumatoid arthritis)
What are 4 effects of long-term stress?
1. affects physical status 2. impairs and weakens the immune systems and is a causal factor in numerous health conditions and diseases (heart) 3. increases risk for disease or injury 4. compromises recovery and return to normal function
What are the 3 most common responses to the general adaptation syndrome?
1. alarm reaction 2. stage of resistance 3. stage of exhaustion
Describe developmental stress.
1. certain taks must be resolved to reduce stress 2. occurs when a person progresses through stages of growth and development
What are 4 family stressors?
1. changes in family structure and roles 2. anger and feelings of hopelessness and guilt 3. loss of control over normal routines 4. concern for future financial stability
What are 6 physiologic stressors?
1. chemical agents 2. physical agents 3. infectious agents 4. nutritional imbalances 5. hypoxia 6. genetic or immune disorders
What are 5 coping mechanisms and how individuals deal with problems?
1. crying, laughing, sleeping, cursing 2. physical activity, exercise 3. smoking, drinking 4. lack of eye contact, withdrawal 5. limiting relationships to those with similar values and interests
What are 4 factors affecting stress?
1. culture 2. family 3. genetics 4. life experiences
Physiologic homeostasis is controlled by what 2 main systems?
1. endocrine 2. autonomic nervous system
What are 6 ways of teaching healthy activities of daily living?
1. exercise 2. rest and sleep 3. nutrition 4. use of support systems (defined by the client) 5. use of stress management techniques (time management) 6. training to manage stress (journaling)
Describe crisis intervention.
1. identity the problem 2. list alternatives 3. choose from alternatives 4. implement the plan 5. evaluate the outcome
What are some examples of situational stress?
1. illness, traumatic injury 2. marriage or divorce 3. loss (belongings, relationships, family members) 4. new job 5. role change
What are some examples of developmental stress?
1. infant learning to trust others 2. toddler learning toilet training 3. school-age child socializing with peers 4. adolescent striving for independence 5. middle-age adult accepting physical signs of aging 6. older adult reflecting on past experiences with satisfaction
What are the 2 components of physiologic homeostasis?
1. local adaptation syndrome (LAS) 2. general adaptation syndrome
What are the 3 components of psychosocial homeostasis?
1. love and belonging needs 2. safety and security needs 3. self-esteem needs
A nurse is caring for an older adult in a long-term care facility who has a spinal cord injury affecting his neurologic reflex arc. Based on the patient's condition, what would be a priority intervention for this patient? a) Monitoring food and drink temperatures to prevent burns b) Providing adequate pain relief measures to reduce stress c) Monitoring for depression related to social isolation d) Providing meals high in carbohydrates to promote healing
A
A nurse is assessing a patient who complains of migraines that have become "unbearable." The patient tells the nurse, "I just 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 physiologic effects of stress would be expected findings in this patient? Select all that apply. a) Changes in 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
Which are examples of local adaptation syndrome? (SELECT ALL THAT APPLY) A.redness at surgical incision B.pulling hand away from hot stove C.fever D.increased HR
A, B
A nurse witnesses a street robbery and is assessing a patient who is the victim. The patient has minor scrapes and bruises, and tells the nurse, "I've never been so scared in my life!" What other symptoms would the nurse expect to find related to the fight-or-flight response to stress? Select all that apply. a) Increased heart rate b) Decreased muscle strength c) Increased mental alertness d) Increased blood glucose levels e) Decreased cardiac output f) Decreased peristalsis
A, C, D
Which are examples of what may occur initially if psychological homeostasis is not maintained? (SELECT ALL THAT APPLY) A.nothing B.coping mechanisms are activated C.defense mechanisms may occur D.immediate death
B, C
Internal examples of stressors include: (SELECT ALL THAT APPLY) A. loud noises B. illness C. hormone changes D. fear
B, C, D
What effects does long-term stress have on physical and emotional health? (SELECT ALL THAT APPLY) A.nothing B.may promote health & wellness C.may increase risk for illness & disease D.may cause death
B, C, D
The major sources of stress in our society result from: (SELECT ALL THAT APPLY) A. Physical stress B. Situational/performance demands C. Verbal threats D. Developmental/interpersonal relationships
B, D
Describe the local adaptation syndrome.
Localized response of the body to stress Involves only a specific body part (such as a tissue or organ) instead of the whole body Stress precipitating the LAS may be traumatic or pathologic Primarily homeostatic short-term adaptive response
Within the general adaptation syndrome. Describe the alarm reaction.
Neuroendocrine activity 1. increased heart rate 2. increased blood pressure 3. increased peripheral vasoconstriction 4. increased metabolism 5. increased water retention 6. increased glucose 7. dilated pupils 8. dilated bronchi 9. mental alertness Fight-or-flight response
List some outcomes (goals) to create for a care plan related to stress/anxiety.
Patient verbalizes the causes and effects of stress and anxiety Patient identifies and uses sources of support Patient uses problem solving to find a solution to stressors Patient practices healthy lifestyle habits and anxiety-reducing techniques Patient verbalizes a decrease in anxiety and increase in comfort
Which stage is being described below? •Person perceives stressor, defense mechanisms activated •Fight-or-flight response (epi, norepi, cortisol) •Hormone levels rise, body prepares to react •Shock and counter-shock phases
alarm reaction
The most common response to stress is ----, a vague, uneasy feeling of discomfort or dread from an often unknown source.
anxiety
Which is the most common emotional response to stress?
anxiety
As a nursing student, what kind of stressors do you encounter related to nursing / clinical experiences?
assuming responsibilities for which one is not prepared working with unqualified personnel working in an environment in which supervisors are not supportive caring for a patient in cardiac arrest or a dying person experiencing conflict with peers greater stress for new grads and those who work in intense areas (ER, ICU, etc.)
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 behavior
A ---- is achieved when the perception of the stressful event is realistic and support and coping mechanisms are adequate.
balance
A stress management technique known as ---- is a method of gaining mental control of the autonomic nervous system, which regulates body responses such as blood pressure, heart rate, and headaches.
biofeedback
Describe situational stress.
can occur anytime, not predictable patterns