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Terms in this set (96)
The mother of a 38 year old female recently died due to complications from a surgery which required an unexpected colostomy. After her mother's death, the daughter states "My mother would have never wanted to live with a colostomy." The daughter is exhibiting which defense mechanism?
evading the emotional response that would normally accompany an uncomfortable or painful incident by using rational explanations that remove incident from personal significance or feeling
1. During a community visit, volunteer nurses teach stress management to the participants. The nurses will most likely advocate which belief as a method of coping with stressful life events?
a. Avoidance of stress is an important goal for living
b. Control over one's response to stress is possible
c. Most people have no control over their level of stress
d. Family and friends can often provide more additional stress than support.
B - Control over one's response to stress is possible. When learning to manage stress, clients find it helpful to believe that they have the ability to control their response to it. It is impossible to avoid stress, which is a normal life experience.
1. A nurse feels vulnerable after a child dies following a lengthy resuscitation effort. A positive coping strategy for the nurse is to:
a. Take a sedative when getting home
b. Accept it as part of a day's work
c. Review the resuscitation until mistakes are found to explain the child's death
d. Meet with others who participated in the resuscitation to debrief the experience
debriefing does offer a chance to manage the situation through problem based coping and emotion-based coping
1. A nurse is teaching students about anxiety medications; The nurse explains that benzodiazepines affect which brain chemical?
b. Gamma-aminobutyric acid (GABA)
Antianxiety medications stimulate the neurotransmitter GABA, which is a chemical associated with relaxation. The other options are not affected by benzodiazepines
1. Mandy, a nurse who works at the Rehabilitation Center is assessing a client for recent stressful life events. She recognizes that stressful life events are both:
a. Desirable and growth-promoting
b. Positive and negative
c. Undesirable and harmful.
d. Predictable and controllable.
B- The concept of stressful life event is based on the research of Holmes and Rahe, who found that both positive and negative changes result in stress
1. In a natural disaster relief facility, the nurse observes that an elderly man has a recovery plan, while a 25-year-old man is still overwhelmed by the disaster situation. These different reactions to the same situation would be explained best by which of the following?
a. Restorative care
b. Strong financial resources
c. Maturational and sociocultural factors
d. Immaturity and intelligence factors
C - Maturational factors and sociocultural factors can affect people differently depending on their life experiences. An older individual would have more life experiences to draw from and to analyze on why he was successful, whereas a younger individual would have fewer life experiences based on chronological age to analyze for patterns of previous success
1. Which of the following accurately describes stress?
a. Stress is an objective response to stimuli, and some stressors are universally stressful
b. Stress results when demands exceed ability to cope
c. Eustressors result in inability to cope
1. Which of the following is an example of a chronic-intermittent duration stressor?
a. Long term disability
b. A job interview
c. Arguments with spouse over course of relationship
d. Death of a loved one
C - Arguments with a spouse (intermittent) over the course of a relationship (Chronic
1. Cortisol affects with the following biological processes:
c. Immune suppression
d. Increased healing ability
e. Increased inflammatory response
B, C, E - Cortisol effects are hyperglycemia, immune suppression, and inflammatory response
1. Negative consequences of long-term stress include
a. Nitrogen imbalance
b. Increased muscle mass
c. Cardiac wear and tear
C, E - long term stress does not alter nitrogen levels, increase muscle mass or cause hypoglycemia, but does cause cardiac wear and tear and hyperglycemia
General adaptation syndrome: G.A.S
Alarm phase (fight or flight) getting body ready
Resistance phase (fight or flight - reserves) fighting stress
Exhaustion - if resistance phase isn't followed by recovery it leads to exhaustion and decreases immune system.
increase glucose in the blood, enhances brain's use of glucose, increase availability of substances to repair tissue
increases heart rate + blood pressure, causes bronchial
dilation, which allows for increased oxygen uptake
mental sorting, assessing, categorizing, evaluating, and framing of the significance after exposure to a stressor with regards to one's own wellbeing
Condition in which all competing elements are in balance
describes the body's short-term and long-term reactions to stress; "the body's ability to maintain a state of physiologic balance in the presence of constantly changing conditions"
changes necessary to achieve the characteristic stability of homeostasis
physiologic changes triggered by stress include activation of the neural,
neuroendocrine, and endocrine systems as well as activation of target organs
hormones (glucocorticoids, catecholamines) intended to promote adaptation (increase BP and HR) when faced with danger
What are individual risk factors for stress reactions?
• Impaired cognition
• Financial strain, Socioeconomic status (e.g., poor, homeless)
• Chronic health conditions including mental health issues
• Multiple significant life changes
• Caregiver role
Individual in a foreign country—especially with language/cultural barrier
What are some examples of acute
What are some examples of acute Psychologic/emotional stressors?
What are some examples of chronic
chronic Psychologic/emotional stressors?
Why does chronic stress cause different symptoms than acute stress?
Resistance to other stressors is diminished, no down regulation of inflammatory response
What are symptoms of chronic stress?
Can lead to disease
Could be fatal
Glucocorticoid receptor resistance
Unhealthy coping behaviors
Name several primary prevention interventions for managing stress (think of both individual and population level interventions)
1. Stress management and reduction techniques
3. Maintenance of positive relationships- family, friends, social networks
4. Maintenance of optimal health- nutrition, wellness programs, health education
Name several secondary prevention interventions (think both for individuals and for populations)
3. Overall assessment
How does a collaborative intervention differ from other interventions for managing stress?
Collaborative interventions are geared toward restoring the person to optimal function by initiating prompt interventions, follow-up, and education.
four main categories of collaborative interventions for managing stress:
· Those that directly impact prevention or reduction of stress are therapeutic lifestyle change
· Relaxation/exercise therapy
· Pharmacologic agents
· Complementary and alternative therapies
sensory response to stress
- Pupillary dilation -> entrance of light to enhance perception
- Enhanced awareness in response to severe threats
endocrine response to stress
- Increased release of glucocorticoids and glycogenesis -> risk of hyperglycemia
Urinary response to stress
- Aldosterone release from endocrine -> Increased Na+ and H2O retention
- Decreased UO
- Increased Blood Volume
Musculoskeletal response to stress
- Increased muscular tension in preparation for fight or flight
Integumentary response to stress
- Diaphoresis to offset increased body temperature secondary to increased metabolism
- Skin pallor secondary to vasoconstrictive effects of NorEpi
Reproductive response to stress
- Damages and disrupts reproductive capacity in women
- Erectile dysfunction in men
Respiratory response to stress
- Increased respiratory rate and depth of respirations
- Dilation of bronchioles to facilitate increased oxygenation
Cardiovascular response to stress
Increased HR & CO
GI response to stress
Inhibition of parasympathetic NS:
- Decreased peristalsis and possible constipation
- Increased flatus
- Decreased salivation
- Increased serotonin levels in gut -> feelings of nausea
Other Disorders that are a response to stress
- Accident Proneness
- Decreased immune response
The nurse is planning to teach a client how to use relaxation techniques to prevent elevation of blood pressure and heart rate. The nurse is teaching the patient to control which physiological function?
a.Replace stress-producing thoughts and activities with daily stress-reducing thoughts and activities.
b. Switch from the sympathetic mode of the autonomic nervous system to the parasympathetic mode.
c. Reduce catecholamine production and promote the production of additional beta-endorphins.
d. Alter the internal state by modifying electronic signals related to physiologic processes
Switch from the sympathetic mode of the autonomic nervous system to the parasympathetic mode.
A client tells the nurse, "I'm told that I should reduce the stress in my life, but I have no idea where to start." Which would be the best initial nursing response?
Select one or more
a. "Let's talk about what is going on in your life and then look at possible options."
b. "Reading about stress and how to manage it might be a good place to
c. "Why not start by learning to meditate? That technique will cover
d. "In cases like yours, physical exercise works to elevate mood and reduce anxiety."
Let's talk about what is going on in your life and then look at possible options
Which of the following statements is true about stress?
Select one or more:
a. Stress occurs only at the individual level.
b. Stress occurs only in individuals with pathology.
c. An internal event experienced by the body
d. Stressful events are seldom identifiable
An internal event experienced by the body
Which action should the nurse take to monitor the effects of an acute stressor on a hospitalized patient? (Select all that apply.)
Select one or more:
a. Monitor for a decrease in respiratory rate.
b. Ask about epigastric pain.
c. Assess for bradycardia.
d. Observe for increased appetite
e. Check for elevated blood glucose levels.
: Ask about epigastric pain. ; Observe for increased appetite ; Check for elevated blood glucose levels
Which of the following is an example of types of primary prevention of stress? (Select all that apply)
Select one or more:
a. Maintenance of positive relationships
b. Screening for stress.
c. Providing medication for anxiety.
d. Stress management and reduction techniques
e. Nutrition counseling.
Maintenance of positive relationships ; Stress management and reduction techniques ; Nutrition counseling.
Nursing Interventions During Cognitive Appraisal Phase
•create a safe space - limit unnecessary noise and bright lights, limit distractions
•demonstrate respect and empathy
•validate feelings "You seem to be uncomfortable, we will do everything we can to help you feel better"
•Address immediate concerns "what can I do right now to help you?"
•Listen actively - lean forward, make eye contact, paraphrase to show understanding, brief verbal affirmations
•Support problem solving and decision making by asking clarifying questions
•Avoid providing your opinion, instead statements such as "tell me more about..." and "how did that make you feel?" can be asked to clarify feelings
•Provide education and additional information as requested
The transactional model of stress and coping
emphasizes the individual's perception, or cognitive appraisal, of a given threat as being the most significant factor in the process
•is the stressor irrelevant, positive with pleasurable emotions, or stressful (harm, loss) and viewed as a threat or challenge?
•Believe can control events in life
•Believe in benevolent world
judgment of the situation in terms of significance to one's well-being, and how one can manage the situation. This is determined by how much control one feels they have. If feel inadequate or high-stakes, experience stress as high due to perception that they cannot control the outcome
The ability to bounce back, cope, and/ or adjust successfully despite substantial adversity.
is coping inherit or learned?
what determines how a person will cope with a stressor
how they appraise it
Types of coping strategies
problem focused coping
Evaluating the problem or stressor
Action taken to reduce or eliminate the underlying cause of the stressor
emotion focused coping
Emphasizes the regulation of emotional response
No attempt is made to address the situation or stressor
Focus is on controlling the emotional response resulting from stressor
meaning focused coping
Persons or communities draw on values, beliefs, and goals to modify the personal interpretation and response to a problem or stressor
maladaptive coping risk factors
Inability to accurately assess stressor
Denial or avoidance
Actual or perceived lack of control
Actual or perceived lack of support
No experience or poor past experiences in managing stressful situations
mental health exam
a method of screening for Alzheimer's and other kinds of dementia
mental status exam acronym
always send mail through the post office
No highs—decrease abuse potential
No cross tolerance with alcohol, sedatives
Takes up to 6 weeks for full effect - lag of 10-14 days
No dependence, withdrawal, tolerance
Take with food
Few drug-drug interactions
blocks symptoms of anxiety (↓ HR, ↓ BP, ↓ Flushing)
•Will work quickly. Doesn't address feelings of anxiety, only physical response
(↑neurotransmitter GABA, slows down nervous system)
•Tx acute anxiety
•Fast acting 20-30 minutes
•Risk of dependency and tolerance
(Increase available serotonin, ↑ well being)
•Tx chronic anxiety
•Slow onset 3-4 weeks
effect between cortisol and immune system
increased cortisol decreases WBC, immunosuppression
the wear and tear on brain and body resulting from allodynamic overactivity as well as dysregulation of the mediators of allostasis
physical cost of adaptation to physiologic of psychosocial stressors
Which environmental factors increase allostatic load
Environmental stressors - abuse, lead, diesel exhaust, excessive noise, extreme temperature variations, crowding, air pollution (increases inflammation in the body which stimulates cortisol release)
Which social factors increase allostatic load?
Psychosocial stressors - ethnicity, race, income level (financial strain, insecurity, marginalization), abuse, harsh parents, unstable family
How do allostasis and allostatic load differ?
Allostasis: Dynamic regulatory process wherein homeostatic control is maintained by an active process of adaptation during exposure to physical and behavioral stressors
Allostatic Load: The physical cost of adaptation on an individual due to stress
In primary appraisal, which judgments are the brain making and what are the components?
Evaluation of the transaction, which is the event or circumstance, in terms of its potential to harm, benefit, threaten, or challenge the individual
In secondary appraisal, how does the judgment the brain is making differ from primary appraisal and which components are part of that decision-making?
Evaluation of the individual's available coping resources and potential options for responding to the event or circumstance
Which factors increase an individual's likelihood to consider a stressor a challenge rather than a threat?
Believe can control events in life, believe in a benevolent world. High self-esteem.
What is locus of control and how does it relate to coping?
Internal: degree to which people believe that they have control over outcome of events;
External: believe beyond their control, places blame externally
How are Crisis and Panic different? Similar?
Panic: A perceived stressor can overwhelm some and bring about a panic attack
Fear of dying or insanity
Crisis: extreme stress viewed as a threat to one's well being
Often results from fear, unmet needs, and poor coping
people in crisis may revert to aggression or suiuicide
physiological safety is a priority
NRS role: create a safe environment for people and communities so they can better adapt to stress
These mental health concepts apply to all of us
MOA: bind to benzo receptor, Increase GABA, slows down nervous system
inhibits serotonin reuptake
Beta Blockers MOA
binds to b-adrenergic receptors, decreases HR, decreases BP, decreases flushing
Identify several common defense mechanisms used by clients:
Repression (involuntary blocking)
Suppression (voluntary blocking)
covering weakness by emphasizing a more desirable trait
transferring or discharging emotional reactions from one object/person to another. (punching a door rather than a person)
attempt to manage anxiety by imitating the behavior of someone feared/respected. (nurse imitates behavior of nursing instructor)
avoiding emotional response by using rationalization that removes any personal significance or feelings. (pain over a parent's death by saying "she wouldn't have wanted to live disabled")
a form of identification that allows for acceptance of others' norms and values into oneself. (A 7 year old tells sister "don't talk to strangers" introjecting this value from parents)
not acknowledging the significance of one's behavior. ("Don't believe what my wife says. I wasn't so drunk I couldn't drive.")
blaming others/environment for unacceptable desires, thoughts, shortcomings, and mistakes. (a husband forgets to pay the bill and blames his wife for not giving it to him earlier.)
justifying behaviors by faulty logic and ascription of motives that are socially acceptable but did not actually inspire the behavior. (spanking a child but saying they couldn't feel it through the diaper anyway)
acting exactly opposite to how one feels
resorting to an earlier, more comfortable level of functioning that is less demanding and responsible (adult throws a tantrum)
Unconscious mechanism by which threatening thoughts, feelings, and desires, are kept from becoming conscious.
displacing energy associated with primitive sexual or aggressive drives into socially acceptable activities.
replacing a highly valuable, unacceptable, or unavailable object with a less valuable, acceptable, or available object. (a woman wants to marry a man just like her dead father and settles for someone who looks a little bit like him.)
performing an action or using words designed to cancel some disapproved thoughts, impulses, or acts in which the person relieves guilt by making reparation. (A father hits his child and brings home a gift the next day.)
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