Flashcards in TERM 3- MY NOTES MENTAL HEALTH NURSING CARE CH.6 " STRESS AND COPING" Deck (46):
Homeostasis is the state of dynamic balance of the human body's internal environment, which is always adjusting in response to internal and external changes.
A stressor is anything that puts the individual out of homeostasis. The brain has evolved to seek homeostasis, so it initiates the stress response, which is the reaction of the body in an attempt to restore homeostasis
The Stress Response
Theorist Hans Selye (1976) described stress as the physiological response to changes experienced by a biological organism. He found that the stress response is a general body reaction. Whether a person is being chased by a hungry alligator or has to walk up on a stage to accept an important award, the physiological reaction will be the same. This physiological reaction to a stressor is called the fight or flight response
Epinephrine stimulates the sympathetic nervous system to prepare the body to fight the source of danger or to run away. This stress response is only adaptive when the stressor is a physical threat.
In such an emergency, it would help people survive if they could see better in low light (dilated pupils), could run faster (blood diverted away from GI traer to skeletal muscle), and had more energy to run longer (increased glucose availability)
Chronic exposure to sympathetic nervous system stimulation is not healthy. Although increased blood glucose is great in an emergency, prolonged hyperglycemia causes early fatigue and increased risk of type 2 diabetes.
A chronically elevated blood pressure can increase risks of stroke, heart attack, and kidney disease. Inhibition of the immune system increases the risk of infection in the short term and inhibits tumor immunity in the long term
It is the person's perception of an event that makes it stressful. One person receiving an immunization who has had several before with no problems may not be concerned about it (and experience no stress response). Another person, whose father died from anaphylactic shock after an immunization, may be terrified (and will experience a severe stress response)
A variety of faccors influence how a person perceives and reacts to a stressor. The predisposing faccors include age, maturity, culture, life experiences, and personality traits.
EFFECT OF CULTURE ON STRESS RESPONSE
For example, a fracture of a right-handed client's right hand requiring a cast may be especially stressful if the client is from the Middle East where the left hand is considered unclean. This client would not be able to touch people politely, gesture, or even pass food or other items to another person with her left hand, so she would be under more stress and would feel more disabled than a European American client with the same injury who only sees it as an inconvenience to function with her nondominant hand.
CULTURAL PULSE POINTS
Cultural Effects on Signs and Symptoms of Stress
Western European and North American cultures generally expect that emotional stress will be expressed emotionally and physical stress will be expressed physically. In contrast, the majority of African, Asian, and Central American cultures expect people to express emotional distress in physical terms.
For example, a client from Mexico, Nigeria, or Vietnam may have abdominal pain or a headache when they are worried or under psychological stress. To be culturally sensitive, nurses must recognize that a client's physical discomfort may have emotional causes and must include this possibility in nursing assessments
Adaptation to Stress
Adaptation is behavior that maintains the integrity of the individual. It is a healthy response to stress or life events.
Maladaptation is unhealthy behavior that disrupts the integrity of the individual
POSITIVE (ADAPTIVE} STRESS RESPONSES
• Problem solving. Identify the problem, plan a response, and actively work on it.
• Using social support. Request and accept help from caring others.
• Reframing. Redefine the situation to see positive as well as negative sides and how to use the situation to your advantage.
NEGATIVE (MALADAPTIVE} STRESS RESPONSES
• Avoidance. Choosing not to deal with the situation. Negative feelings may become chronic.
• Self-blame. Blaming self takes the focus off working toward resolution of the problem. Feelings are about the self and not the problem.
• Wishful thinking. Thinking that "everything will be fine" to the exclusion of doing anything to make this happen. This is a form of denial.
Factors Affecting the Ability to Adapt to a Stressor
The capacity to adapt is decreased in the very young and the old
A family history of psychological or physical conditions, intelligence, or physical strength or weakness may affect ability to cope with stressors.
Severe or chronic illness can decrease a client's reserves of energy and healing capacity when confronted with a new stressor. Good nutrition and adequate sleep can improve the ability to adapt.
The individual's prior experience in a similar situation may help (by learning strategies for success) or hinder (by causing the anticipation of a bad result) the ability to adapt this time.
The availability of financial, personal (such as maturity), social, and coping skills improve the individual's ability to adapt.
Levels of Assertiveness
The passive person meets the needs of others, without asking for own needs to be met.
"OK, you can have my ice cream cone.l didn't want it anyway."
The assertive person asks for own needs to be met, with respectful concern for the needs of others
Sure, I'll drive you to work today. Will you drive me on Tuesday when my sister needs to use my car?"
The aggressive person demands for own needs to be met, without regard for the needs of others.
"I want to play now. I don't care if you think it's your turn."
cognitive reframing-restructuring irrational or self-defeating beliefs
coping mechanisms-mental process by which knowledge is acquired and processed, including reasoning, judgement, memory, awareness and perception
• Stress has become an epidemic in our society.
• The stress response functions to alert the individual to a threat and to return the body to homeostasis. When it lasts after the stressor is resolved or is activated too frequently, some diseases are more likely to occur.
• People can respond to stress adaptively or maladaptively.
• The stress response begins with the fight or flight response.
• The stress response is nonspecific, meaning that the body responds the same no matter what the stressor is.
• The degree of stress caused by an event depends on how the individual perceives it. Two people experiencing the same event can feel different amounts of stress related to it.
• Culture affects how people perceive and react to stressful events.
• There are many approaches to stress management.
• Nurses experience many job-related stressors and must engage in self-care.
NCLEX-PN® Exam Preparation
A nurse is caring for a client who was admitted to the hospital with pneumonia. The client is constantly clenching his fists, refusing to eat, and having difficulty sleeping. He may be experiencing stress from more than his current illness. If all of the following events had recently occurred for this client, which would be the most likely source of his
1. Promotion at work
2. Recognition for 25 years of service at his firm
4. Ticket for minor traffic violation
According to Hans Selye's theory of a general body reaction to any stressor, which of the following symptoms might be experienced by a client concerned about his X-ray results?
2. Increased heart rate
3. Increased urine output
4. Constricted pupils
Which of the following physical conditions can be caused by continuous stimulation of the sympathetic nervous system?
3. Cardiovascular disease
4. Chronic obstructive pulmonary disease
As a nurse, you would be more concerned about the stress response of a client being admitted into the hospital if you knew that:
1. His wife died in the same hospital recently.
2. This was his first hospitalization.
3. This was his first serious illness.
4. He is concerned about missing his son's first soccer game.
Which of the following clients is likely to be more susceptible to the negative aspects of stress?
1. A teenager living at home with a single parent
2. A poor, elderly widow suffering from chronic back pain due to osteoporosis
3. A young married woman with her first pregnancy
4. A successful businessman with a broken hip
Which of the following clients is handling stress in an adaptive way?
1. The client assesses a situation to see why he is responding in such a stressed way.
2. The client avoids dealing with the stressor, assuming it will disappear soon.
A newly admitted client has an accidental gunshot wound to her thigh. She states that she is concerned that she might lose her job if she has to be in the hospital for a long
time. Choose the best response by the nurse.
1. "It's too soon to worry about that right now."
2. "You have a great physician. I'm sure you won't be in here a long time."
3. "I can see this is really a concern to you. Let's talk about this."
4. "Do you have a history of attendance problems at work?"
The nursing diagnosis of Ineffective Coping is appropriate for a client who:
1. Discusses her stress openly and frequently with family and friends.
2. Chooses not to discuss the source of her stress.
3. Writes about her feelings daily in a private journal.
4. Requests to see the hospital chaplain for prayer
Select the best stress management technique that you might suggest to a client confined to bed:
1. Drink herb tea.
2. Practice progressive muscle relaxation.
3. Practice being aggressive with those who have been a source of stress in the past.
4. Get a cat or dog
The client has expressed extreme stress about his current health situation of chronic renal disease. He is recently widowed and his wife had done all the driving due to his
He has now been told that he must begin renal dialysis. The nurse and the client agree that a nursing diagnosis of"ineffective Coping related to a situational crisis" is
appropriate. Select the appropriate early nursing interventions from the following choices.
1. Ask the client to list all perceived sources of his stress.
2. Reassure the client that everything will work out.
3. Review community resources for alternate transportation sources to dialysis.
4. Educate him on the methods of dialysis available.
5. Ask him if he is sure that dialysis is necessary at this point.
6. Advocate with his physician for a stress-relieving medication for him.
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