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NURS 112 - TEST 4 - Unite E.2 > EF - Stress and Coping > Flashcards

EF - Stress and Coping Flashcards

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1
Q

SUMMARY

A

SUMMARY

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2
Q

Stress

A

mental, emotional / physical response / adaptation to real/perceived changes/challenges OR
psychological / emotional / physical response / adaptation to real / perceived changes / challenges

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3
Q

economists - stress -social / economic

A

Poverty / unemployment

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4
Q

psychologists - stress - individual life events

A

divorce / job loss

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5
Q

nature or stress is

A

ambiguous -  perceptions of stress often based personal life experiences

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6
Q

stress involves what or\gans / tissues

A

nearly every organ system / tissue human body

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7
Q

Stress affects entire

A

family

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8
Q

All individuals experience

A

stress as a normal part of daily life
health care professionals - may experience stress in own lives / clinical practice
Recognizing signs / symptoms own stress / implementing self-care / stress management techniques

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9
Q

responding to stress is a necessary physiological process for

A

regulation/homeostasis

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10
Q

situation is determined-stressful, nervous/endocrine systems

A

respond by initiating fight-or-flight response

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11
Q

stress reaction

A

when perceived demands (stressors) > individual resources - meet demands

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12
Q

When disrupted by stress

A

body works to maintain equilibrium GAS

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13
Q

stress can be both

A

positive and negative
depending - how individual perceives stress (appraisal)

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14
Q

stress is bodys response to

A

∆s affecting normal balanced state of equilibrium

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15
Q

Selye

A

(early pioneer study of stress) - identified stressor
 Any event / experience / environmental stimulus → causes stress in individual

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16
Q

stressors are inherently

A

neutral
 individual’s perceptions of / responses - determine stressor – positive / pleasant (eustress) / negative / unhealthy (distress)

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17
Q

“eustress”

A

positive / pleasant

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18
Q

Unhealthy / chronically prolonged stress levels

A

→ physical / emotional fatigue / ill health

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19
Q

concept of stress encompasses (2)

A

 effects of stressor
 person’s appraisal / interpretation of stressor

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20
Q

everyday stressors - effectively managed through

A

homeostatic / regulation processes
 ↓ impact on individual / maintain health

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21
Q

When person experiences potential / actual stressor

A

 situation appraised
 limbic system activates anticipatory response

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22
Q

anticipatory response

A

??

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23
Q

stressor perceived as minor

A

 physiological / psychological / behavioral processes compensate for it
 homeostasis maintained

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24
Q

v stressor perceived as more serious threat

A

??CLARIFY

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25
hypothalamus secretes
corticotropin-releasing factor (CRF)
26
corticotropin-releasing factor (CRF) activates
SNS to release norepinephrine / epinephrine / dopamine AKA fight or flight
27
fight-or-flight response
 ↑ in heart rate / blood pressure / cardiac output  dilation of bronchial airways / pupil dilation  ↑ in blood glucose levels body prepared for action
28
CRF also signals
anterior / posterior pituitary glands release adrenocorticotropic hormone (ACTH) from adrenal cortex
29
ACTH stimulates
adrenal glands - release cortisol
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the stress hormone
cortisol
31
cortisol causes what to happen in body
• ↑ mental alertness / focus • ↓ pain receptors immunosuppressive / anti-inflammatory effects
32
clarifiying some questionas
??
33
When individual disrupted by stress - body works to maintain equilibrium →how
initiating general adaptive syndrome (GAS)
34
(GAS), which consists of a three-stage response:
alarm, resistance/ exhaustion
35
alarm
 central nervous system becomes aroused  body defense mechanisms mobilized CLARIFY
36
resistance
 body resists / seeks to counter stress  parasympathetic nervous system - attempts return body to homeostasis  body remains on alert  hormonal / other bodily functions return to normal  body repairs any damage caused by threat
37
exhaustion
body can no longer defend against stressor  chronic exposure - ↑ / fluctuating endocrine / neural responses  causes ↑ wear / tear - body organs  leads to allostatic load
38
ALLOSTATIC LOAD
 Wear and tear on body  Repeated / chronic stress  IE. Cumulative burden of chronic stress / life events
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chronic exposure - ↑ / fluctuating endocrine / neural responses • can cause long-term physiological problems LIKE
• chronic hypertension / depression / autoimmune disorders
40
short spurts - CORTISOL
 cortisol ↑ immunity  ↓ inflammation
41
cortisol levels heightened for prolonged period
 inflammation ↑  may result ↓ immune function  ↑ risk - infection - ↓ lymphocytes (WBC’S - fight off infection)
42
GAS may be triggered
physical / psychological stressors / events
43
physiological changes occur whether
§  perceived stressor considered positive (eustress) / negative (distress)
44
fundamental concept underlying GAS
Ø  body will attempt → return steady state of internal / physical / chemical balance (homeostasis)
45
Chronic inflammation
development / exacerbation - immune-related disorders →  cardiovascular disease / arthritis / psoriasis / inflammatory bowel disease / various cancers
46
As individuals age - immunological responses become
more taxed  Biologically / energetically costly  inflammation related - stress exposure  ↑ likelihood - developing disease / exacerbate preexisting conditions
47
Transactional Theory of Stress / Coping (TTSC)
stress as a dynamic process a transaction between a person / their environment
48
TTSC - HOW MANY STAGES
Primary / secondary - BOTH before responding to stress
49
PRIMARY STAGE
individual evaluates situation  determine whether stressor poses a threat  If stressor determined not - a threat - it is dismissed
50
IF STRESS DETERMINED AS THREAT THEN - SECONDARY STAGE - CONFIRM
 individual assesses whether can cope w/ situation  examining balance of situational demands (risk / uncertainty / difficulty w/ available resources for addressing threat) • including social support / expertise / past successes
51
SEQUENCE OF STEPS TTSC (4)
APPRAISALS RESPONSES CHANGE IN SITUATION RE-APPRAISAL
52
WHY IS TTSC CONSIDERED A TRANSACTIONAL MODEL
 suggests appraisals impact responses  which in turn result in changes in situation / individual  these changes then influence ongoing reappraisals  PROCESS OF REAPPRAISAL REPEATS PRIMARY / SECONDARY APPRAISALS  ongoing endeavor  continually reassesses both • nature of stressor • resources available for responding to stressor
53
POSIBLE OUTCOMES REAPPAISALS - TTSC
 individual may be able to cope effectively w/ stressor or  person may have to ∆ / abandon coping strategy
54
How an individual appraises a stressor determines
how that person will respond to stressor
55
Appraisal of stressor influenced numerous personal / contextual factors
 Cognitive / physiological / affective / psychological / neurologic skills / abilities resources
56
2 CATEGORIES / TYPES OF STRESSORS
Ø  acute or chronic
57
Physiological stressors - generally associated w/
INJURY / ILLNESS →  EX: exposure → extreme temperatures / trauma / injury / illness / pain  body’s reaction – immediate / necessary for survival
58
Psychological stressors - more common / generate
STATE - EMOTIONAL UNEASE • Event / situation / comment / condition / interaction • individual interprets - negative / threatening  EX: Work / academic pressures / financial difficulties / ∆ marital status / victim - natural catastrophe
59
 Chronic physiological stress  →
§  debilitating conditions
60
Stress - three types:
acute stress / episodic acute stress / chronic stress
61
Stress-related disorders may
result of prolonged / heightened levels of stress / anxiety
62
#NAME?
most common / frequent  brief  either positive / negative  causes IMMEDIATE REACTION / BIOLOGICAL response  triggers FIGHT-OR-FLIGHT RESPONSE  EX’s: motor vehicle accident / experiencing loss loved one / victim of crime  Manifestations – irritability / chest tightness / headache / gastrointestinal disturbance / sweaty palms / shortness of breath  Most episodes - NO lingering health effects
63
MOST COMMON / FREQUENT TYPE OF STRESS
ACUTE
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WHICH STRESS STYPE TRIGGERS FLIGHT OR FIGHT
ACUTE
65
DOES ACUTE STRESS NORMALLY HAVE LINGERING HEALTH EFFECTS
NO
66
MAINIFESTATIONS (SIGNS / SYMPTOMS ) ACUTE STRESS
irritability / chest tightness / headache / gastrointestinal disturbance / sweaty palms / shortness of breath
67
POSSIBLE CAUSES ACUTE STRESS
: motor vehicle accident / experiencing loss loved one / victim of crime
68
 Severe / prolonged stress levels  could →
mental health issues → post traumatic stress disorder (PTSD) / acute stress disorder
69
v  Episodic Acute Stress
someone experiences frequent bouts acute stress
70
v  Episodic Acute Stress often associated w/ individuals
responsibility > than can be handled
71
v  Episodic Acute Stress clients often feel
disorganized / rushed
72
MAINIFESTATIONS (SIGNS / SYMPTOMS ) EPISODIC ACUTE STRESS
short-tempered / irritable / anxious  may experience tension headaches / hypertension / migraines
73
v  Clients w/ pattern of episodic acute stress WHAT TYPE OF OUTLOOK
 pessimistic outlook / negative worldview  can negatively impact relationships / work / overall health
74
CHRONIC STRESS
 stress levels – HEIGHTENED / CONSTANT / PROLONGED
75
CHRONIC STRESS CLIENTS OFTEN BELIEVE
little / no control over situation / circumstances
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CHRONIC STRESS PRODUCES CONTINOUS ACTIVATION OF
nervous system
77
MAINIFESTATIONS (SIGNS / SYMPTOMS ) CHRONIC STRESS
 ANXIETY / DEPRESSION / CARDIOVASCULAR DISEASE / CANCER / SUICIDE
78
CHRONIC STRESS OFTEN STEMS FROM
serious life problems →  POVERTY / RACISM / ILLNESS / DISEASE  dysfunctional family system
79
all populations across lifespan - susceptible to
v  stress-related conditions
80
everyone reacts differently TO
stressful situations  stressful for one person ≠ stressful for another
81
common major life events - trigger stress include
 work-related issues / financial pressures / bereavement / family problems / illness / fear of criminal victimization / excessive noise / overcrowding / fear of unknown
82
 Stress-related disorders - result OF
PROLONGED / ↑ LEVELS STRESS / ANXIETY
83
 Onset / severity STRESS RELATED DISORDERS affected by
 Type / frequency / intensity of stressor  person’s perception of stressor  access to support systems  individual’s ability to effectively cope w/ stressor
84
v  common stress-related disorders include
 ACUTE STRESS DISORDER / POSTTRAUMATIC STRESS DISORDER (PTSD) / IRRITABLE BOWEL SYNDROME
85
 Individuals diagnosed w/ ASD  often been exposed
frightening / traumatic event →  death of loved one  threat of serious injury to themselves / others  exposure to war  other acts of violence
86
Individuals diagnosed w/ ASD may experience feelings
numbness / disconnectedness / depersonalization / other dissociative symptoms  Other symptoms –  disrupted sleep / irritability / difficulty concentrating / becoming easily startled
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WHICH STRESS DISODRDER MAY CAUSE PERSON TO MENTALLY REEXPERIENCE TRAUMATIC EVENT
ASD  avoid people / places  things - remind them of traumatic event
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TYPES OF SITUATIONS THAT COULD LEAD TO PTSD
accident / sexual abuse / naturally occurring disaster
89
WHICH STRESS DISORDER IS  among most common mental health disorders in United States
PTSD
90
PTSD ASSOCIATED WITH WHAT TYPE SYMPTOMS
CHRONIC COURSE / DEBILITATING SYMPTOMS
91
 most individuals WILL EXPERIENCE
ome type - traumatic event during lifetime  most will NOT develop PTSD 
92
MANIFIESTATIONS (SIGNS / SYMPTOMS) PTSD
 Recurring / intrusive memories  flashbacks of trauma  nightmares  sweating  ↑heart rate / exaggerated startle response - certain noises  experiences - remind person of trauma  Manifestations vary - individual to individual
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PTSD MANIFESTATIONS MAY BE DELAYED HOW LONG
days / months / years
94
For some – PTSD symptoms CAN LAST
months / years
95
MANIFIESTATIONS (SIGNS / SYMPTOMS) IBS
 abdominal discomfort / cramping / bloating / diarrhea / constipation
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IS IBS CONSIDERED A DISEASE
NO  rather functional syndrome w/ no known cause  significantly impacts individual’s quality of life
97
WHAT IS A COMMON TRIGGER FOR IBS
 Stress  treatment planning should include stress-reducing techniques / activities
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MULTIFACTORIAL DISORDER
condition caused by many contributing factors  approaches to treatment - diverse IS IBS MULTIFACTORIAL - CONFRIM
99
crisis
emotionally significant life event major ∆ in an individual’s life pushes person beyond ability - effectively cope
100
 Crises may include
 Unexpected / unanticipated event w/ insufficient time to prepare / respond  highly threatening incident  disaster  radical ∆ in one’s life  corresponding lack ability to respond effectively
101
EXS OF CRISIS
Ø  traumatic injury / natural disasters / loss of financial security 
102
Crisis severity ranges
Level 1 (least severe) to Level 4 (highest level)
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LEVEL 1 - LOWEST /LEAST SEVERE
?
104
LEVEL 2
?
105
LEVEL 3
?
106
LEVEL 4 - HIGHEST
risk of harm - self (suicide) / others (homicide) is present  providers must swing into action – PREVENT / ADDRESS IMMEDIATELY CONFIRM THIS IS LEVEL 4
107
v  Individuals who commit violence against others may have risk factors →
 history of substance misuse / addiction  history of violence toward animals / people  history of psychiatric illness  Other risk factors associated w/ acts of violence directed toward oneself →  history of depression / suicidal behavior  family history of abuse / neglect  ongoing relationship problems
108
 During a crisis - person may
 threaten suicide  display highly erratic / unusual behavior  misuse alcohol /other substances  refuse intervention
109
Crises arise - various sources - generally categorized as STEMMING FROM
situational / developmental (maturational) / adventitious / socioeconomic / cultural stressors
110
CRISIS -  Situational Stressors
Ø  created by personal / family /work-related issues
111
CRISIS - EX’s: personal stressors →
 Diagnosed / living w/ chronic illness  financial strain  victim - motor vehicle accident
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CRISIS - EX’s: Family stressors →
 death of a loved one  ∆ in marital status  being unable to conceive  experiencing an unwanted pregnancy
113
CRISIS - EX’s: work related issues →
 Downsizing  sheltering in place  changing work roles / responsibilities
114
SIGNS A PERSON IS EXPERIENCING A MENTAL HEALTH EMERGENCY
 acting on suicide threat  displaying hostile / belligerent behaviors  throwing / breaking items  threatening harm
115
Crises - experienced by people
all ages / backgrounds / cultures / environments
116
CRISES CAN BE OBVIOUS OR NOT
→ experiencing death of loved one / dealing w/ a natural disaster → internal fear of being exposed - infectious disease EITHER WAY - sense of imbalance / confusion / situation where usual coping skills may be inadequate
117
 Nurses / health care workers need - particularly alert - potential – work - related stress in themselves  may lead
burnout / compassion fatigue / moral distress
118
Moral distress - nurse
nurse placed in difficult situation - actions taken ≠ nurse feels ethically correct  complicate nurse’s ability balance moral / emotional / professional duties - clients / themselves
119
Moral distress - nurse can lead to feelings of
frustration / guilt / insomnia / fatigue / result in w/drawal / depersonalization of clients
120
moral distress nurse can occur when
anytime during nursing care clients  often heightened during time of crisis / disaster / tragedy
121
crisis - Developmental Stressors also known as
 Developmental (maturational) stressors
122
Developmental (maturational) stressors can occur when
 occur as individual moves through stages of life
123
Children / preadolescents often identify developmental stressors →
physical appearance / family / friends / school
124
Adolescents experience developmental stress →
§  Friendships / belongingness / identity formation / leaving family home
125
Ø  Adults developmental stressors →
§  Marriage / beginning a family / launching career / accepting physical aging
126
 Seniors / older adults developmental stressors →
§  health problems / ∆’s in mobility / cognition
127
CRISIS - Adventitious Stressors AKA
v  DISASTER EVENTS  disaster events - generally rare / unexpected  can result from  natural disasters → • floods / earthquakes / war  interpersonal disasters → • physical / sexual assault  Acts of terrorism - also considered adventitious events  since previous methods coping may not be sufficient - dealing w/ magnitude of stress
128
CRISIS -Socioeconomic Stressors
poverty / lower SES / homelessness
129
low socioeconomic status (SES) / POVERTY CONTRIBUTE TO
 contribute to nearly every measure of mental health  including measures of self-reported distress  diagnoses of clinical disorders
130
potential consequences socioeconomic stressors - not necessarily
fixed / universal  EX: Bridger / Daly concluded cognitive ability may buffer long-term association between childhood socioeconomic disadvantage / poor mental health in adulthood CONFIRM
131
CRISIS -CULTURAL STRESSORS
 live w/in society do not culturally fit  when they receive care - ignores cultural beliefs
132
Leininger’s Transcultural Nursing Theory AKA - _________ INVOLVES KNOWING WHAT
Culture Care Theory knowing / understanding / appreciating different cultures/ beliefs / values that influence nursing care
133
Culture Care Theory advocates
meaningful / effective nursing care in accordance w/  individual’s cultural values / beliefs /patterns of behaviors
134
 Cultural factors → RELATED TO CRISIS CULTURAL STRESSORS
 Beliefs / values that influence how individual perceives / responds to stress • since all individuals appraise stressors w/in context of their own culture
135
stressor that is perceived as highly stressful in one culture - MAY BE
minor stressor w/ in another culture  Coping strategies - vary from culture to culture
136
v  During a crisis - nurse establishes / maintains therapeutic nurse – client relationship
 using effective communication skills  providing safe / calming environment
137
IS Crisis intervention process oriented
NO  action / situation focused goal  to help client identify precipitating events leading up to crisis  utilize skills, resources,/available support systems to effectively deal w/ crises;/formulate a plan of care for current/future critical events CONFIRM
138
goal of crisis intervention
help client identify events leading up to crisis utilize skills / resources / available support systems effectively deal w/ crisis / formulate plan of care for current / future critical events
139
Seven-Stage Model of Crisis Intervention 
1.  biopsychosocial crisis assessment  suicidal / homicidal risk / Drug / alcohol abuse / need medical attention  ineffective coping strategies / Assess resilience / protective factors / support systems 2.  Establish rapport / therapeutic environment by conveying respect / acceptance  Display neutrality / nonjudgmental attitude 3.  Assess dimensions problem / crisis / Identify client issues / challenges / what precipitated crisis → insight into presenting problem 4.  Encourage client to explore / express feelings / emotions / active listening / reflection / paraphrasing / respond w/ encouraging statements 5.  Explore past positive coping strategies / alternatives / View client – resourceful / resilient - as possessing an array of potential resources / alternatives 6.  Implement action plan / Identify supportive individuals / contact referral sources 7.  Establish follow-up plan after initial intervention - determine client’s status - ensure crisis has been resolved
140
Cramer defined - ego defense mechanism
 mental operation - occurs outside conscious awareness  functions to protect individual’s self-esteem  keep person from experiencing excessive anxiety  extreme cases - protect integration of self
141
v  Holland - defense mechanisms
 psychological strategies - help individuals separate from / distance between themselves / unpleasant events / feelings / thoughts
142
Defense mechanisms
psychological strategies / mental operations outside conscious awareness protect individual’s self-esteem keep person from ex periencing excessive anxiety extreme cases - protect integration of self normal / natural part - psychological development useful in protecting human psyche from anxiety / fear
143
Defense mechanisms usually occur outise
conscious awareness
144
Defense mechanisms normal / nautural part of
psychological development
145
Defense mechanisms usefule in protecting human psyche from
anxiety / fear
146
defense mechanisms can be misused / distorted →
 cognitive distortions / thinking errors  Thinking errors - faulty patterns thinking  unhealthy ways - coping that become self-defeating  often occur unconsciously
147
role of nurse FOR CLIENTS EXPERIENCING STRESS
conducting comprehensive assessment - client’s condition
148
evidence-based assessment tools to evaluate physiological, psychological / emotional / behavioral signs / symptoms of stress
Psychological General Well-Being Index (PGWBI) Beck Depression Inventory (BDI) Ways of Coping Questionnaire (WCQ) confirm
149
Ø  Psychological General Well-Being Index (PGWBI)
 measures client’s level of subjective psychological well-being  self-representations of affective / emotional states • reflects client’s sense of subjective well-being • distress full scale provides subscales to assess • anxiety / depression / positive well-being / self-control / general health / vitality
150
Before conducting – assessment - nurse must first
 establish rapport / build trusting nurse / client relationship - provide safe / confidential environment - conducive to sharing personal / sensitive information
151
therapeutic communication techniques - build
TRUSTING RELATIONSHIPS
152
therapeutic communication technique INCLUDE
 active listening / asking open-ended questions / seeking clarification / offering observations
153
Nurses - all areas nursing practices need to recognize
physiological / psychological signs / symptoms of stress in clients implement / evaluate effective interventions provide ongoing client education
154
v  Signs / symptoms – stress associated health alterations MANIFEST HOW
variety of ways / w/ varying levels severity
155
nursing process provides a five-step, systematic approach to
assess client’s condition implement a client-centered individualized / holistic plan of care
156
v  five sequential steps NURSING PROCESS
Ø  assessment / diagnosis / planning / implementation / evaluation
157
v  Assessment
 nursing process begins w/ detailed assessment - client’s condition  Objective / subjective information - obtained through • Interviews / observation / examination • Ideally will take place – private / quiet / uninterrupted setting • free from distractions
158
Ø  During initial assessment – NURSE CONDUCTS
mental status exam  gathers relevant client information → • presenting symptoms • personal / family health history • substance use / abuse history • previous hospitalizations • mental health treatment • coping strategies • health beliefs / practices
159
Ø  EX’s: objective client information →
 vital signs / appearance / behavior / physical exam findings • •
160
Vital signs often vary - depending -
level of anxiety client experiencing
161
client w/ mild anxiety may exhibit – •
minimal / no physiological manifestations – anxiety
162
client w/ moderate anxiety - may appear
animated / have slightly ↑ vital signs •
163
Clients w/ severe anxiety - likely exhibit
↑ vital signs / diaphoresis / heart palpitations / muscle tension
164
Ø  EX’s: subjective client information →
 somatic complaints / current relationship / work situations / client’s perceptions - current stressors / problems • nurse may consult family members / other individuals knowledgeable about client (w/ client’s permission) • health records / assessments conducted - other members mental health care team • fully understand client’s unique situation
165
Analysis
 After conducting comprehensive assessment - nurse analyzes client-related information→  develop statement of client’s problem / health alteration
166
Ø  To analyze actual / potential client concerns / health alterations
 nurses use clinical judgment skills  Analysis may include - actual description of problem (eg, loss of appetite)  as well as assessment of client’s potential risk - developing additional health conditions
167
Nurses use information obtained from analysis TO DETERMINE
client plan of care
168
 Planning  Based on
assessment information  nurse collaborates w/ client / family / members health care team  to establish measurable short / long-term goals (outcomes) • which are used to formulate plan of care • plan of care should take into account – • client’s level of knowledge / available support systems / access to care / personal beliefs / health habits / cultural / spiritual preferences
169
Ø  Plan of care - →
 identified client problems  require priority / immediate attention  treatment goals  nursing actions needed to achieve desired goals  ways to evaluate goal achievement
170
§  EX’s: goals requiring immediate attention →
• client staying w/ a friend/family member to ↓ suicide potential • client identifying at least 2 individuals who can be called if client begins to have suicidal feelings • client identifying at least one goal for future
171
§  EX’s: long-term goals →
• client implementing effective coping strategies - deal w/ stress / anxiety • client identifying personal strengths • client using available resources / support systems
172
 EX’s: nursing actions →
• developing trusting relationship w/ client • through use of therapeutic communication • providing calm presence • acknowledging client’s feelings • helping client determine which situations / events tend to contribute – stress / anxiety • discussing coping mechanisms used in past • which mechanisms - most helpful • teaching client about / encouraging use - new coping skills • → physical activity / progressive relaxation / deep breathing /positive self-affirmations • referring client - community resources - help alleviate situational stressors
173
v  Implementation
 implementing nursing actions / interventions outlined in plan of care  accurately documenting client’s progress / response to treatment • ensure continuity of client care
174
Client outcomes / goals - achieved by
accomplishing nursing interventions detailed in plan of care  designed to prevent / promote / maintain / restore mental / physical health
175
Ø  During implementation phase - nurses may implement / coordinate / delegate
aspects of plan of care
176
v  Evaluation
 Evaluation – ongoing / iterative / thorough assessment - client’s health status / plan of care  step - critical - determine if plan of care - been effective ↑ client’s condition / health status
177
client’s status / effectiveness of plan of care - continuously
evaluated  plan of care modified as needed
178
Ø  When evaluating plan of care - nurse reviews all steps - nursing process
Assesses / reassesses plan - determine whether desired outcomes achieved
179
Coping
strategies an individual adopts to deal w/ a stressor
180
coping strategies are highly influenced by
psychological / sociological /cultural factors
181
Stressors / coping mechanisms - vary across lifespan
 depend on individual’s appraisal of stressor  amount / type of social support available to manage stressor  importance placed upon stressor  severity of stressor  ability to cope effectively / in a healthy manner
182
positive outcome - not necessarily associated w/
v  adequately managed stress
183
individuals might adopt either
problem-focused/emotion-focused coping styles
184
problem-focused approach - involves
Ø  dealing w/ situation itself by trying to ∆ it into something more palatable
185
v  emotion-focused approach - requires
 altering association w/ situation to ↓ stress it may be causing  can include - avoiding situation / reframing its meaning  this approach does not ∆ nature of situation itself  does ∆ how situation affects individual
186
Coping strategies are classified as
adaptive / maladaptive
187
adaptive
help individual manage stress in short / long terms → changing an unhealthy habit
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maladaptive
reduce stress short term often exacerbate problem longer term  EX: → misusing drugs to cope
189
Health promotion is
art / science of helping individuals ∆ their lifestyle to achieve optimal health
190
Health promotion enables people to
↑ control over personal health by addressing / preventing root causes of ill health /not just focusing on treatment / cure
191
how does health promotion help people gain control over their personal health
by addressing / preventing root causes of ill health / not just focusing on treatment / cure
192
 According - World Health Organization - health promotion  focuses on
interventions that support healthy lifestyle
193
 By practicing health promotion
 people can be proactive / take control of personal health  rather than having to respond to illness / disease
194
 Health promotion activities → interventions
 Mitigate / reduce stresss - producing situations  ↑ resistance to stress
195
Strategies / techniques to help individuals cope effectively w/ stressors include
maintaining a healthy diet / nutrition / learning time management / building personal resilience / rest / relaxation / (PROGRESSIVE RELAXATION) practicing complementary / alternative therapies / journaling
196
Healthy Diet/Nutrition
 healthy diet can help offset impact of stress  strengthening immune system  lowering blood pressure  supporting overall good health
197
 According to WebMD - consumption - complex carbohydrates  stimulates production of
serotonin  chemical that ↑s sense of well-being  ↓s stress  stabilizes blood sugar levels
198
v  Good choices - complex carbohydrates
 whole grains / oatmeal / lentils / beans
199
 Oranges - good source vitamin C  can help
↓ stress hormone levels  strengthening immune system
200
omega-3 fatty acids - found in
fish / seafood / nuts / seeds / plant oils  may provide protection against disorders →  heart disease / depression / premenstrual syndrome
201
Drinking black tea - may help individuals recover - FROM
stressful events more quickly
202
Seeds / nuts /avocados - sources of
v  healthy fats
203
v  healthy fats
 help ↓ cholesterol levels  reduce inflammation  protect against effects of stress
204
mechanical effects munching raw vegetables (ie. celery / carrot sticks)
• helps reduce tension • releasing clenched jaw
205
 drink plenty of water  drink two glasses of water WHEN
UPON WAKING
206
Exercise
 One of best stress-reducing strategies – exercise / ↑ physical activity  Cardio (cardiovascular) exercise  boosts oxygen circulation  spurs body - produce feel - good chemicals • endorphins  Exercise programs →  Pilates / yoga / tai chi - effective ↓ stress
207
Ø  According to Mayo Clinic - virtually any form exercise
can act as stress reliever
208
 Exercise ↑s  Regular movement / physical activity
↑s overall health / sense of well-being / reducing stress  Regular movement / physical activity  Can ↑energy  ↑ mood / self-confidence  create sense of relaxation
209
Ø  Exercise - also ↑ sleep
often disrupted by stress / depression / anxiety
210
 Time Management  Managing time well / staying organized - can be
stress ↓ strategy identifying tasks / activities - require immediate attention vs tasks can wait  Starting each day w/ a to-do list / prioritizing list of tasks - high - low  can help ↓ stress levels  lower-priority tasks may be rescheduled / delegated - someone else / or eliminated  Managing multitasking  controlling urge - immediately respond every text / email - helps ↓ stress
211
Building Personal Resilience
 Resilience - ability bounce back - life’s various challenges  adapt well in face of adversity / trauma / stress  can be fostered by practicing mindfulness activities
212
Mindfulness -
state of paying attention / being fully present / alert to your surroundings / environment  means focusing attention - purposeful way - present moment  becoming aware of what is happening in here-and-now  being cognizant of internal / external worlds w/out judgment
213
MINDFULNESS STEPS OR PROCESS
 Stand outdoors  Breathe deeply / notice elements / environment (Is sun shining, etc)  30 to 60 seconds to perform  can be done any time / formidable way - turning brain - mindful / contemplative mode  Throughout day - pause for moment / slow breaths (in through nose / exhale through mouth)  Focus breathing / sensations lungs filling / rib cage falling  Clear your mind/relax as you continue breathing  Handwashing – impressive / uncomplicated mindfulness activity - can be done anywhere  As you wash hands - be mindful of all sensations (temp / friction hands moving along your wrists / suds washing away / enjoy sensation
214
Rest/Relaxation
 Establishing - regular routine - getting adequate rest / sleep  essential - ensuring overall good health / ↓ stress
215
Adequate sleep - necessary –
 body to repair / restore itself  release melatonin • essential hormone - regulating sleep / wake cycles
216
Ø  Sleep quality can be enhanced – by
 going to bed / rising same time each day  avoiding nicotine / caffeine / alcohol before bedtime  unplugging from media devices  keeping a comfortable / cool / dark sleeping space
217
Guided imagery -
helpful technique - ↓ stress –
218
Ø  using combination relaxation / visualization / imagination
 assume relaxed / comfortable position  focus on pleasurable image / experience / event  while practicing progressive relaxation
219
Progressive relaxation →
tensing / releasing each muscle group – body  begin by tensing / relaxing - facial muscles → neck → arms → torso → abdomen → legs  down to toes
220
Ø  positive affirmation →
“Stress is leaving my body; my work as a nurse is very important; I am making a positive difference in lives of my patients; what I do matters”
221
v  Complementary/Alternative Therapies
Ø  aromatherapy / herbal medicine / acupuncture / massage / biofeedback / meditation • offer clients new avenues - may ↑ overall health
222
v  Journaling
 personal journal – thoughts / feelings / emotions  provide meaningful / productive outlet for stress
223
Ø  Expressing gratitude - another way ↓ anxiety
 When stressed / anxious / overwhelmed - individual can reflect upon • Person / experience / event / thing • which they are grateful • record their reflections in journal
224
may be one of most effective strategies – achieving / maintaining contented life
Conveying gratitude -
225
v  acute stress
Ø  The most common type of stress It is usually brief,/triggers fight-or-flight response
226
v  acute stress disorder (ASD)
Ø  An intense/dysfunctional reaction to a traumatic event / SYMPTOMS lasts less than a month
227
v  adventitious stressors
Ø  Stress that results from events of disaster; they are generally rare, unexpected,/can result from natural disasters
228
v  chronic stress
Ø  Occurs when stress is heightened, constant,/prolonged Continuous activation of nervous system can cause/exacerbate health problems
229
v  coping strategies
Ø  The strategies that an individual adopts to deal w/ a stressor, which is highly influenced by psychological, sociological,/cultural factors Adaptive coping strategies include maintaining a healthy diet/nutrition, exercise, time management techniques, building personal resilience, rest/relaxation, mindfulness activities, complementary/alternative therapies,/journaling
230
v  crisis
Ø  threatening situation triggered by a precipitating event whereby an individual experiences a strong behavioral, emotional,/psychiatric response Crises arise from various sources  pushes person beyond ability - effectively cope
231
v  cultural stressors
Ø  Stress that individuals may experience by living w/in a society in which they do not culturally fit and/or receiving care that ignores their cultural beliefs
232
v  developmental (maturational) stressors
Ø  Stress that occurs as an individual moves through stages of life
233
v  ego defense mechanism
Ø  Defense mechanisms are psychological strategies that help individuals separate from/put distance between themselves/unpleasant events, feelings,/thoughts Common ego defense mechanisms include denial, rationalization, projection, repression, regression,/compartmentalization
234
v  episodic acute stress
Ø  Characterized by frequent bouts of acute stress, usually associated w/ taking on too much responsibility
235
v  fight-or-flight response
Ø  When a stressful situation is perceived, hypothalamus secretes corticotropin releasing factor (CRF), which activates sympathetic nervous system/signals anterior pituitary gland to secrete adrenocorticotropic hormone (ACTH) release of ACTH by pituitary stimulates adrenal cortex to release hormone cortisol
236
v  general adaptive syndrome (GAS)
Ø  The body's attempt to maintain equilibrium/homeostasis Consists of three stages: alarm, resistance,/exhaustion
237
v  health promotion
Ø  The process of enabling clients to↑control over/↑ment of all aspects of their general health
238
v  irritable bowel syndrome (IBS)
Ø  A COMMON gastrointestinal condition characterized by abdominal pain/changes to bowel elimination patterns that can include diarrhea and/or constipation
239
v  posttraumatic stress disorder (PTSD)
Ø  A prolonged/heightened stress reaction to a traumatic event /SYMPTOMS that lasts more than a month
240
v  Seven-Stage Model of Crisis Intervention
Ø  An action plan for nurses to help a client identify precipitating events leading up to a crisis, utilize skills, resources,/available support systems to effectively deal w/ crises/to formulate a plan of care for current/future critical events
241
v  situational stressors
Ø  Stress that stems from personal, family,/work-related issues
242
v  socioeconomic stressors
Ø  Stress that occurs from factors → poverty, socioeconomic status (SES),/homelessness
243
v  stress
Ø  The mental, emotional,/physical response/adaptation to real/perceived changes/challenges Stress response: Initiated by nervous/endocrine systems when a stressor is perceived as a serious threat
244
v  stress-related disorders
Ø  Stress-related disorders include acute stress disorder (ASD), posttraumatic stress disorder (PTSD),/irritable bowel syndrome (IBS)
245
v  Transactional Theory of Stress/Coping (TTSC)
Ø  Describes stress as a dynamic process/a transaction between a person/their environment How an individual appraises a stressor determines how they will respod to stressor
246
1 A nurse is assessing a client who is working at home due to COVID-19 restrictions client reports abdominal cramping/bloating w/ diarrhea/states, "I am completely stressed out from working at home" nurse should identify that client is experiencing manifestations of which of following stress-related conditions?
Irritable bowel syndrome
247
2 A nurse is planning care for a client who is recently divorced w/ two young children client Reports difficulty sleeping, feeling hopeless,/being estranged from family nurse should plan to monitor client for which of following potential manifestations of chronic stress
Suicide
248
3 A nurse is interviewing a client who recently experienced an act of workplace violence when an Armed person held workers at gunpoint before police intervened client now reports being anxious/fears gunman might return nurse should identify that client is experiencing which of following types of crisis?
Adventitious
249
4 A nurse in a health clinic is interviewing a client who is upset/reports that their stress "is too much to handle" client is unemployed, a single guardian to young children,/has periodic asthma attacks Which of following stress-related conditions is client experiencing?
Allostatic load
250
5 A nurse in a community clinic is interviewing a client who is distressed/reports being unable to sleep following a neighborhood fire several days ago client has hypertension, tachycardia,/is diaphoretic nurse should identify that client is experiencing which of following types of stress?
Acute stress
251
6 A nurse is caring for a client who reports experiencing stress over an upcoming surgical procedure Which of following statements describes characteristics of stress?
body responds to physical, emotional,/environmental changes affecting one's state of equilibrium
252
7 A nurse is caring for a client who is in crisis following breakup of a long-term relationship client tells nurse, "I might as well just die My life is over" Which of following actions should nurse take first?
Conduct a suicidal risk evaluation
253
8 A nurse is assessing a client who was sexually assaulted 6 months ago/has been diagnosed w/ post-traumatic stress disorder (PTSD) Which of following manifestations should nurse expect? (Select all that apply)
Intrusive memories of event Flashbacks of event Exaggerated startle response when reminded of event
254
9 A nurse is providing discharge teaching about health promotion to a client who has a new diagnosis of type 2 diabetes mellitus Which of following instructions should nurse include? (Select all that apply)
Practice mindful breathing Start each day w/ a to-do list Develop habits to mitigate stress
255
10 A nurse is caring for a college student admitted for acute alcohol intoxication client reports feeling overwhelmed/expresses an inability to cope w/ stressors at school Which of following statements should nurse make?
"Let's talk about coping methods that have worked for you in past"
256
11 A nurse is caring for a client who has delivered a healthy newborn client tells nurse that while they are somewhat stressed about being a new parent, they are thrilled by birth of their child nurse should identify that client is experiencing which of following types of stress?
Eustress
257
12 A nurse is caring for a client who has delivered a healthy newborn client is tense, refuses to hold baby,/tells nurse, "I have no idea how to handle having a baby I wish this pregnancy had never happened" Which of following statements should nurse make?
"Becoming a parent is a new experience for you Let's talk about your concerns"
258
13 A nurse is caring for a client who has pancreatic cancer that is unresponsive to treatment client is experiencing significant weight loss/fatigue, but when nurse asks how they are feeling, they respond w/, "Great! I'm going to beat this cancer" Which of following defense mechanisms is client using?
Denial
259
14 A nurse is caring for a client who has migraine headaches/reports that they are "getting worse" Which of following questions should nurse ask client to determine if headaches are a stress-related disorder? (Select all that apply)
"What is intensity of your migraine headaches?" "How often do migraine headaches occur?" "What type of support is available to you when you have a migraine headache?" "What coping strategies do you use when you experience a migraine headache?"
260
15 A nurse is caring for a client whose partner was recently hospitalized w/ COVID-19 client is experiencing manifestations related to alarm stage of general adaptation syndrome (GAS) For which of following manifestations should nurse monitor? (Select all that apply)
Hypertension Dilated pupils ↑d state of arousal
261
16 A nurse is interviewing a client who is in distress/tells nurse, "My ex-partner is suing for full custody of my children I am so worried/don't know what to do" Which of following questions should nurse ask to evaluate client's coping skills?
"What strategies have you used in past to deal w/ stress?"
262
17 A nurse is caring for a client who has been charged w/ partner violence against their spouse client is angry, pacing,/yells out, "I wouldn't lose my temper if my spouse would just leave me alone It's their fault" nurse should identify client is displaying which of following defense mechanisms?
Projection
263
18 A nurse is talking about implementing self-care strategies to cope w/ stress of caregiving w/ partner of a client who has dementia Which of following strategies reported by partner should nurse identify as an EX: of effective coping?
Practicing deep breathing while sitting outside
264
19 A nurse is conducting an educational session for clients who report experiencing stress-related disorders A client asks nurse which part of body activates stress response Which of following responses should nurse provide?
Hypothalamus
265
20 A nurse is caring for an older adult client who reports being stressed about their health status due to problems w/ short-term memory, slower reaction times when driving,/urinary frequency nurse should recognize that client is experiencing which of following types of stressors?
Developmental stressors

NURS 112 - TEST 4 - Unite E.2 (7 decks)

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