ATI Ch 9, Stress Management Flashcards
1
Q
What is stress?
A
Stress is the brain’s natural response to any demand.
2
Q
What are stressors?
A
Stressors are physical or psychological factors that produce stress.
3
Q
Do stressors have to be perceived as ‘bad’ to produce a biological response?
A
No, any stressor, whether perceived as ‘good’ or ‘bad,’ produces a biological response.
4
Q
What can too much stress or too many stressors cause?
A
Distress.
5
Q
What are examples of damaging stressors?
A
Anxiety and anger.
6
Q
What is the body’s response to a perceived or actual threat?
A
Activating the fight or flight response.
7
Q
What can occur if stress is prolonged?
A
Maladaptive responses.
8
Q
What is stress management?
A
A client’s ability to experience appropriate emotions and cope with stress.
9
Q
What characterizes a client who manages stress in a healthy manner?
A
Flexibility and use of a variety of coping techniques or mechanisms.
10
Q
What factors affect responses to stress and anxiety?
A
Age, gender, culture, life experiences, and lifestyle.
11
Q
What is the cumulative effect of stressors?
A
The effects of stressors build up over time.
12
Q
What can high amounts of stress from multiple stressors lead to?
A
Illness.
13
Q
How can a client’s ability to use successful stress management techniques impact their health?
A
It can improve stress-related medical conditions and improve functioning.
14
Q
What does viewing a stressor as positive indicate?
A
Adaptation or learning, also known as preconditioning.
15
Q
Fill in the blank: A short-term or acute stress response allows a person to be at a high level of mental and physical _______.
A
performance.
16
Q
A
17
Q
What are protective factors that increase a client’s resilience?
A
- Physical health
- Strong sense of self
- Religious or spiritual beliefs
- Optimism
- Hobbies and other outside interests
- Satisfying interpersonal relationships
- Strong social support systems
- Humor
These factors help clients resist the effects of stress.
18
Q
What are the five responses an individual can have to stress?
A
- Fight
- Faint
- Flight
- Freeze
- Fawn
These responses describe different ways individuals may react to stressors.
19
Q
Describe the ‘fight’ response to stress.
A
Facing the stressor or situation ready to confront or fight
This response is characterized by an active approach to dealing with stress.
20
Q
What does the ‘faint’ response to stress involve?
A
Limiting exposure to stress by physically fainting or experiencing syncope
This response is a physiological reaction to extreme stress.
21
Q
Define the ‘flight’ response to stress.
A
Running away from or fleeing the stressor or situation
This is an avoidance mechanism in response to perceived danger.
22
Q
What does the ‘freeze’ response entail?
A
Unable to respond or react against the stressor or situation
This response can lead to inaction in stressful situations.
23
Q
Explain the ‘fawn’ response to stress.
A
Attempting to please or give in to the stressor or situation
This response often involves submission to avoid conflict.
24
Q
What are expected findings in acute stress (fight or flight)?
A
- Apprehension
- Unhappiness or sorrow
- Decreased appetite
- Increased respiratory rate
- Increased heart rate
- Increased cardiac output
- Increased blood pressure
- Increased metabolism and glucose use
- Depressed immune system
These findings indicate the body’s immediate response to stress.
25
List some effects of prolonged stress (maladaptive response).
* Chronic anxiety or panic attacks
* Depression
* Chronic pain
* Sleep disturbances
* Weight gain or loss
* Increased risk for myocardial infarction
* Increased risk for stroke
* Poor diabetes control
* Hypertension
* Fatigue
* Irritability
* Decreased ability to concentrate
* Increased risk for infection
* Chronic exposure to cortisol
## Footnote
Prolonged stress can lead to various physical and psychological issues.
26
What role does cortisol play in stress response?
Chronic exposure to stress hormones, specifically cortisol, weakens the immune system
## Footnote
This leads to increased susceptibility to illness and infection.
27
What are standardized screening tools for measuring stress?
* Life-changing events questionnaires (Holmes and Rahe stress scale)
* Perceived Stress Scale
* Lazarus's Cognitive Appraisal
## Footnote
These tools help assess a client's experience of stress and risk for developing illness.
28
How can stress scales be useful in nursing care?
They provide insight into the client's experience of stress and risk for developing an illness
## Footnote
This information is valuable for creating a plan of care focused on stress reduction and coping.
29
What is the primary focus of most nursing care?
Teaching stress-reduction strategies to clients
30
What is cognitive reframing?
Helping clients look at irrational cognitions in a realistic light and restructure those thoughts positively
31
Give an example of cognitive reframing.
Changing 'I am a terrible father' to 'I've made mistakes, but I've learned and improved my parenting skills.'
32
What should nurses encourage clients to do in terms of self-talk?
Talk to themselves with kindness rather than doubt or blame
33
What are some benefits of positive self-talk?
Linked to physical and mental health benefits
34
What is meditation in the context of relaxation techniques?
A technique used to train the mind and promote calm
35
What is guided imagery?
A relaxation technique where the client is guided through a series of images
36
What is the purpose of breathing exercises?
To decrease rapid breathing and promote relaxation
37
What does progressive muscle relaxation involve?
Tensing specific muscle groups and then relaxing them in a progressive format
38
Where can progressive muscle relaxation be performed?
Almost anywhere
39
How does physical exercise affect anxiety?
Causes release of endorphins that lower anxiety and promote relaxation
40
What should nurses use to determine relaxation techniques for clients with psychotic disorders?
Nursing judgment
41
What is the benefit of journal writing?
Allows for therapeutic release of stress and can ease anxiety and worry
42
How can journaling help clients identify stressors?
By helping them make specific plans to decrease stressors
43
What does priority restructuring aim to achieve?
To reduce the number of stressors affecting the client by learning to prioritize differently.
## Footnote
For example, delegating tasks to others rather than handling them all alone.
44
What is biofeedback?
A method where a trained professional uses a device to help clients gain voluntary control over autonomic functions like heart rate and blood pressure.
## Footnote
Exercise gadgets and smart watches can track sleep and heart rates.
45
What is the primary focus of mindfulness in stress reduction?
Encouraging the client to be mindful of their surroundings using all of their senses.
## Footnote
This includes recognizing sensations like sunlight and the sound of a breeze.
46
How does mindfulness help in thought restructuring?
It teaches the client to transform negative thoughts into positive ones.
## Footnote
For instance, changing 'It's so frustrating that the elevator isn't working' to 'Using the stairs is a great opportunity to burn off some extra calories.'
47
What is the goal of assertiveness training?
To help the client communicate in a more assertive manner to decrease psychological stressors.
## Footnote
This includes techniques for expressing feelings and making behavioral changes.
48
What technique is used in assertiveness training?
Describing a stressful situation, discussing feelings about it, and stating the need for change.
## Footnote
Example: 'When you keep telling me what to do, I feel angry and frustrated. I need to try making some of my own decisions.'
49
What role does the nurse play in individual stress-reduction techniques?
To assist each client in identifying individual strategies to improve coping with stress.
## Footnote
This may include hobbies, music therapy, pet therapy, sleep, massage, and aerobic exercise.
50
Fill in the blank: Examples of individual stress-reduction techniques include _______.
hobbies, music therapy, pet therapy, sleep, massage, aerobic exercise.
51
What are brain stimulation therapies?
Nonpharmacological treatment for clients with certain mental health disorders
## Footnote
Includes electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS)
52
What is electroconvulsive therapy (ECT)?
Uses electrical currents to induce brief seizure activity while the client is anesthetized
## Footnote
The exact mechanism of ECT is still unknown
53
What is one theory regarding the mechanism of ECT?
Seizure activity produced by ECT can enhance the effects of neurotransmitters
## Footnote
Key neurotransmitters include serotonin, dopamine, and norepinephrine
54
What is a potential diagnosis for ECT in clients with major depressive disorder?
Clients whose manifestations are not responsive to pharmacological treatment
## Footnote
Other indications include suicidal or homicidal clients needing rapid therapeutic response
55
List three indications for ECT in major depressive disorder.
* Clients whose manifestations are not responsive to pharmacological treatment
* Clients for whom the risks of other treatments outweigh the risks of ECT
* Clients who are suicidal or homicidal
56
What is a potential diagnosis for ECT in clients with schizophrenia spectrum disorders?
Clients who have schizophrenia with catatonic manifestations
## Footnote
Also applicable to clients with schizoaffective disorder
57
What type of episodes in bipolar disorder may indicate the use of ECT?
Acute manic episodes
## Footnote
Specifically for clients with rapid cycling
58
Fill in the blank: ECT may be indicated for clients who are unresponsive to treatment with _______.
lithium and antipsychotic medications
59
True or False: ECT is used for clients with schizophrenia who do not have catatonic manifestations.
False
## Footnote
ECT is indicated for clients with catatonic manifestations
60
What is the risk consideration for using ECT?
Risks of other treatments outweigh the risks of ECT
## Footnote
Important for clients needing rapid response or with severe symptoms
61
What are the absolute contraindications for ECT?
There are no absolute contraindications for ECT.
## Footnote
Nurses should assess for medical conditions that increase the risk of adverse effects.
62
Which cardiovascular disorders should be assessed before ECT?
* Recent myocardial infarction
* Hypertension
* Heart failure
* Cardiac arrhythmias
## Footnote
ECT increases stress on the heart due to seizure activity.
63
What cerebrovascular disorders should be assessed before ECT?
* History of stroke
* Brain tumor
* Subdural hematoma
## Footnote
ECT increases intracranial pressure and blood flow through the brain.
64
What mental health conditions have not been found useful for ECT?
* Substance use disorders
* Personality disorders
* Dysphoric disorder
## Footnote
ECT is not effective for these conditions.
65
What is the typical course of ECT treatment for depression?
Two to three times a week for a total of 6 to 12 treatments.
## Footnote
This schedule is common for managing depression.
66
How is informed consent obtained for ECT?
Consent can be obtained from the client, next of kin, or a court order if involuntary.
## Footnote
It's important to ensure legal and ethical compliance.
67
What pre-ECT workup may be included?
* Chest x-ray
* Blood work
* ECG
## Footnote
This helps assess the client's health status before treatment.
68
What medication is administered 30 minutes prior to ECT?
An IM injection of atropine sulfate or glycopyrrolate.
## Footnote
This decreases secretions and counteracts vagal stimulation effects.
69
What type of anesthetic is given during the ECT procedure?
A short-acting anesthetic such as etomidate or propofol via IV bolus.
## Footnote
This is necessary for the anesthesia during the procedure.
70
What muscle relaxant is administered during ECT?
Succinylcholine.
## Footnote
It paralyzes muscles during seizure activity to reduce injury risk.
71
What should be monitored regarding blood pressure during ECT?
Severe hypertension should be controlled.
## Footnote
A short period of hypertension occurs immediately after the procedure.
72
What should be monitored before and after the ECT procedure?
Vital signs and mental status.
## Footnote
Monitoring is crucial for safety and effectiveness.
73
What should the nurse assess regarding client and family knowledge of ECT?
The nurse should assess understanding and provide teaching as necessary.
## Footnote
Many have misconceptions due to media portrayals.
74
True or False: Tonic-clonic seizure activity associated with ECT is still an effect of the treatment.
False.
## Footnote
Due to anesthesia and muscle relaxants, tonic-clonic seizures are no longer a concern.
75
What is rTMS commonly prescribed for?
Daily for a period of 4 to 6 weeks
76
How is rTMS performed?
As an outpatient procedure
77
What is the duration of the rTMS procedure?
30 to 40 minutes
78
What device is used in the rTMS procedure?
A noninvasive electromagnet
79
How does the electromagnet interact with the client during rTMS?
Allows magnetic pulsations to pass through the scalp
80
What sensations might clients feel during rTMS?
Tapping or knocking sensation, scalp skin contraction, tightening of jaw muscles
81
What treatment is combined with FEMS for effective depression treatment?
Psychotherapy
82
What are common adverse effects of rTMS?
Mild discomfort, tingling sensation, headaches
83
What should clients with a history of seizure disorders use?
Low-frequency rTMS
84
What should be monitored after rTMS?
Lightheadedness
85
What is a rare but potential complication of rTMS?
Seizures
86
Is rTMS associated with systemic adverse effects?
No
87
Who should not receive rTMS?
Clients with cochlear implants, brain stimulators, or medication pumps
88
What does VNS provide to the brain?
Electrical stimulation through the vagus nerve
89
Where is the VNS device implanted?
Under the skin on the client's chest
90
What is the purpose of VNS?
To increase neurotransmitter levels and enhance antidepressant medication actions
91
What type of depression is VNS indicated for?
Depression resistant to pharmacological treatment and/or ECT
92
Is VNS approved by the FDA?
Yes
93
What are current research studies evaluating for VNS?
Effectiveness for anxiety disorders, obesity, and pain
94
What does VNS stand for?
Vagus Nerve Stimulation
## Footnote
VNS is a treatment method used for various conditions, including epilepsy and depression.
95
Is VNS typically performed as an inpatient or outpatient procedure?
Outpatient surgical procedure
96
How often does the VNS device deliver programmed pulsations?
Every 5 minutes
97
What is the duration of each programmed pulsation delivered by the VNS device?
30 seconds
98
How long does it usually take to achieve therapeutic antidepressant effects from VNS?
Several weeks
99
How can the client turn off the VNS device?
By placing a special external magnet over the site of the implant
100
Who assists in obtaining informed consent for VNS?
The provider
101
What is a common complication associated with VNS?
Voice changes
102
What causes voice changes in VNS patients?
Proximity of the implanted lead on the vagus nerve to the larynx and pharynx
103
What are some other potential adverse effects of VNS?
* Hoarseness
* Throat or neck pain
* Coughing
104
Do the adverse effects of VNS commonly improve over time?
Yes
105
What is dyspnea, and when might it occur in VNS patients?
Difficulty breathing, especially with physical exertion
106
What might a client consider doing during exercise or prolonged speaking to manage dyspnea?
Turn off the VNS device
107
What is deep brain stimulation (DBS)?
A treatment that surgically implants electrodes into the brain to stimulate underactive regions.
108
What conditions is DBS FDA-approved to treat?
Parkinson's disease and treatment-resistant obsessive-compulsive disorder.
109
How does DBS affect neurotransmitter levels?
It is believed to result in an increased level of neurotransmitters and enhances the actions of antidepressant medications.
110
What is a key characteristic of DBS compared to vagus nerve stimulation (VNS)?
DBS is more invasive and is implanted surgically.
111
Who is DBS reserved for?
Clients who have tried many other treatments that have failed.
112
What is the typical schedule for the programmed pulsations delivered by the DBS device?
Around-the-clock programmed pulsations, usually every 5 minutes for a duration of 30 seconds.
113
How long does it typically take to achieve therapeutic antidepressant effects from DBS?
Several weeks.
114
What can a client do to turn off the DBS device?
Place a special external magnet over the site of the implant.
115
What should nurses provide in terms of care for clients undergoing DBS?
Standard postoperative care.
116
What is a potential risk associated with the pulse generators installed during DBS?
Risk for infection.
117
Can clients experience hypomania as a result of DBS?
Yes, it is possible even without a history of bipolar disorder.
118
What are some potential adverse effects of DBS?
* Headaches
* Seizures
* Stroke
* Confusion
119
What role does the nurse play in the informed consent process for DBS?
Assist the provider in obtaining informed consent.
120
Is DBS commonly performed as an inpatient or outpatient procedure?
Outpatient surgical procedure.
