CH 33 - COPING Flashcards
Stress describes
changes in an individual’s state of balance in response to stressors,
Any stressor, whether it is perceived as “good” or “bad,” produces
similar biological response in the body.
Stress can be situational
(adjusting to a chronic disease or a stressful job change)
Role conflict:
This develops when a person must assume opposing roles with incompatible expectations.
Sick role:
Expectations of others and society regarding how one should behave when sick (caring for self while sick and continuing to provide childcare to grandchildren).
Role ambiguity:
Uncertainty about what is expected when assuming a role; creates confusion.
Role strain:
The frustration and anxiety that occurs when a person feels inadequate for assuming a role (caring for a parent with dementia).
Role overload:
More responsibility and roles than are manageable; very common (assuming the role of student, employee, and parent).
List at least four factors that influence an individual’s ability to cope.
● Number of stressors
● Duration of the stressors
● Intensity of the stressors
● Individual’s past experiences
● Current support system
● Available resources
A nurse is caring for a client whose partner passed away 4 months ago. The client has a recent diagnosis of diabetes mellitus. The client is tearful and states, “How could you possibly understand what I am going through?” Which of the following esponses should the nurse make?
A. “It takes time to get over the loss of a loved one.” (USE ALT + ENTER - MOVE TEXT TO NEW LINE IN SAME CELL)
B. “You are right. I cannot really understand. Perhaps you’d like to tell me more about what you’re feeling.”
C. “Why don’t you try something to take your mind off your troubles, like watching a funny movie.”
D. “I might not share your exact situation, but I do know what people go through when they deal with a loss.”
A. Telling the client it will take more time to heal belittles the client’s feelings and gives false reassurance.
B. CORRECT: By stating there is a lack of understanding, the nurse is using the therapeutic communication technique of validation, whereby a person shows sensitivity to the meaning behind a behavior. The nurse is also creating a supportive and nonjudgmental environment, and inviting the client to express frustrations.
C. Telling the client to try a distraction dismisses the client’s feelings and gives common advice instead of expert advice.
D. Saying the nurse knows what clients feel is presumptive and inappropriate.
Coping describes how an individual deals with
problems (illness and stress)
Factors Involved in coping and adaptation include
family dynamics
adherence to treatment regimens
role an individual can play in important relationships
Stress describes
changes in an individual’s state of balance in response to stressors
stressors
internal / external forces - disrupt state of balance
any stressor can be perceived as:
good or bad
whether a stressor is perceived as “good” or “bad,”it produces
a similar biological response in the body
Stress can be (2)
situational (adjusting to a chronic disease or a stressful job change)
developmental (varying with life stage)
Adult stressors can include
losing parents, having a baby, and getting married
Stress can be caused by sociocultural factors, including (pls)
substance use, lack of education, and prolonged poverty
Stress impairs and weakens
immune system
stress is a causal factor in
numerous health conditions
presence of stressors delays a client’s
return to health in the same way that the presence of a foreign body or infection delays the healing of a wound
Coping describes
how an individual deals with problems and issues
Coping is
behavioral and cognitive efforts of an individual to manage stress
Factors influencing an individual’s ability to cope include
number, duration, and intensity of stressors; the individual’s past experiences; the current support system; and available resources
Coping strategies are unique to an individual and can
vary greatly with each stressor
Ego defense mechanisms
assist a person during a stressful situation or crisis by regulating emotional distress
Adaptation
Coping behavior that describes how an individual handles demands imposed by the environment
General adaptation syndrome (GAS)
Also known as “stress syndrome.”
Hans Selye developed a theory of adaptation that describes the stress reaction in three stages.
General adaptation syndrome (GAS)
General adaptation syndrome (GAS) - 3 stages
alarm; resistance; exhaustion
Alarm stage:
Body functions heightened to respond to stressors, also called fight-or-flight response.
what happens to the body in the alarm stage
Hormones (epinephrine, norepinephrine, cortisone) are released, which cause elevated blood pressure and heart rate, heightened mental alertness, increased secretion of epinephrine and norepinephrine, and increased blood flow to muscles
Resistance stage:
Body functions normalize while responding to the stressor
what happens to the body in the resistance stage
The body attempts to cope with the stressor and return to homeostasis.
Stabilization of blood pressure, heart rate, and hormones will occur
Exhaustion stage:
Body functions are no longer able to maintain a response to the stressor and the client cannot adapt.
what is the end result of the exhaustion stage
The end of this stage results in recovery or death
Adherence
commitment and ability of the client and family to follow a given treatment regimen
Commitment to the regimen increases
adherence
Complicated regimen interferes with
adherence
Involvement of the client and significant support people in the planning stage increases
adherence
Adverse effects of medications diminish
adherence
Negative coping mechanisms (denial) can cause
nonadherence
positive coping mechanisms can increase
adherence
Available resources increase
adherence
TO ASSESS / COLLECT DATA ON CLIENT STRESSORS ASK QUESTIONS RELATED TO
Current stress, perception of stressors, ability to cope
Support systems
Adherence to healthy behaviors and/or treatment regimen
Sleep patterns
Altered elimination patterns, changes in appetite, weight loss / gain
TO ASSESS / COLLECT DATA ON CLIENT STRESSORS OBSERVE WHAT
client’s appearance and eye contact, verbal, motor, and cognitive status during the assessment’ Observe for irritability, anxiety, and tension
health promotion strategies
regular exercise, optimal nutrition, adequate sleep and rest
relaxation techniques
breathing exercises, massage, imagery, yoga, meditation
Control the environment to
reduce the number of external stressors
Examples of environmental controls to reduce stressors
noise
breaks in the continuity of care
training to manage stress
journal writing, assertiveness training, stress management in the workplace, mindfulness-based stress reduction
optimal time to teach a client about stress-management skills
after coping with crisis successfully
Use effective communication techniques to foster
expression of feelings
Nursing interventions ot help client cope
empathetic in communication -encourage client to verbalize feelings
Identify client’s / family’s strengths / abilities
Encourage client’s autonomy w/ decision‑making
Discuss client’s / family’s abilities to deal w/ current situation
Encourage client - describe coping skills used effectively in past
Identify available community resources - refer client for counseling if needed
Nursing interventions to help adherence
Put instructions in writing
Allow client to give input into treatment regimen
Simplify treatment regimens as much as possible
Follow up w/ client - address any questions / problems
Family is defined by
the client
family consists of
individual structures and roles
typically two or more people whose relationships create a bond - influence their mutual development, support, goals, resources
five realms of processes involved in family function during a family assessment (hi cid)
interactive, developmental, coping, integrity, health
Family dynamics are constantly evolving due to
processes of family life and developmental stages of the family members
FASTEST‑GROWING POPULATION
Those older than 65 years, leading to caregiver issues
Current Trends of families and populations
fastest growing population is >65
declining ecomonic status of families
family violence
acute/chronic illness - disrupt family unit
homelessness
DECLINING ECONOMIC STATUS OF FAMILIES why?
increased unemployment
Family violence is what kind of cycle
endless cycle
acute / chronic illness can do what to family unit
disrupt family unit
HOMELESSNESS
Lack of stable environment, financial issues, inadequate access to health care
fastest‑growing homeless population
families w/ children
The homeless population is increasing due to
lack of affordable housing
structure dicates the families ability to
cope
what two types of family structures
regid and open
rigid structure
dictatorial and strict
open structure
few or no boundaries, consistent behavior, or consequences
the two types of familiy strucutres can provide what types of outcomes
either can provide both positive or negative outcomea
function describes the course a family uses to
reach its goals, including members’ communication skills, problem‑solving abilities, and available resources
Assess all clients within the context
of family
Assess a family by looking at its
structure and function
Assessment of a family can focus on
family as a context, a client, or a system
A role is
function a person adopts within their life. Seldom is it limited to one role, but rather is multidimensional and is often relative to the role of others
(6) examples of roles
grandparent, parent, dependent child, employee/employer, committee member, community activist
Illness causes role stress by
creating a situation in which roles can change simply due to the effect and progression of the illness
Nurses must be aware of a client’s roles in life, as well as
how the situation of illness might change these roles, either temporarily or permanently
Types of role problems (5)
role conflict
sick role
role ambiguity
role strain
role overload
Role conflict
develops when person must assume opposing roles w/ incompatible expectations.
Role conflicts can be what two types
interpersonal and inter-role
Role conflicts interpersonal EX:
(when parents expect adolescents to participate in sports and perform household tasks)
Role conflicts can be inter-role EX:
inter‑role (when a mother wants to stay at home with her infant, but family finances require her to work).
Sick role:
Expectations of others and society regarding how one should behave when sick (caring for self while sick and continuing to provide childcare to grandchildren)
Role ambiguity:
Uncertainty about what is expected when assuming a role; creates confusion
Role strain:
The frustration and anxiety that occurs when a person feels inadequate for assuming a role (caring for a parent with dementia). Caregiver burden results from the accumulated stress of caring for someone else over time.
Role overload:
More responsibility and roles than are manageable; very common (assuming the role of student, employee, and parent).
SITUATIONAL ROLE CHANGES caused by
situations other than physical growth and development (marriage, job changes, divorce)
SITUATIONAL ROLE CHANGES can disrupt
one or more of the client’s roles in life (with illness or hospitalization)
TEMPORARY ROLE CHANGES:
client will resume the role when illness resolves.
PERMANENT ROLE CHANGES
Illness has altered the level of the client’s health to a point that previous roles are no longer available.
five realms of family life
(interactive processes, developmental processes, coping processes, integrity processes, health processes
potential stressors - 2 Ex’s.
social isolation, physical demands
List at least four factors that influence an individual’s ability to cope
Number of stressors
Duration of Stressort
Intensity of stressor
Individuals past expierience
Current support system
Available resources
List three interventions the nurse can take to assist the client in coping with a stressful event or situation
Be empathetic in communication, and encourage the client to verbalize feelings.
Identify the client’s and family’s strengths and abilities.
Discuss the client’s and family’s abilities to deal with the current situation.
Encourage the client to describe coping skills used effectively in the past.
Identify available community resources, and refer the client for counseling if needed
A nurse is caring for a client whose partner passed away 4 months ago. The client has a recent diagnosis of diabetes mellitus. The client is tearful and states, “How could you possibly understand what I am going through?” Which of the following esponses should the nurse make?
A. “It takes time to get over the loss of a loved one.”
B. “You are right. I cannot really understand. Perhaps you’d like to tell me more about what you’re feeling.”
C. “Why don’t you try something to take your mind off your troubles, like watching a funny movie.”
D. “I might not share your exact situation, but I do know what people go through when they deal with a loss.”
A. Telling the client it will take more time to heal belittles the client’s feelings and gives false reassurance.
B. CORRECT: By stating there is a lack of understanding, the nurse is using the therapeutic communication technique
of validation, whereby a person shows sensitivity to the meaning behind a behavior. The nurse is also creating a supportive and nonjudgmental environment, and inviting the client to express frustrations.
C. Telling the client to try a distraction dismisses the client’s feelings and gives common advice instead of expert advice.
D. Saying the nurse knows what clients feel is presumptive and inappropriate.
A nurse is caring for a client awaiting transport to the surgical suite for a coronary artery bypass graft. Just as the transport team arrives, the nurse takes the client’s vital signs and notes an elevation in blood pressure and heart rate. The nurse should recognize this response as which part of the general adaptation syndrome (GAS)?
A. Exhaustion stage
B. Resistance stage
C. Alarm stage
D. Recovery stage
A. Although the exhaustion stage is a component of GAS, body functions are no longer able to respond to the stressor in this stage.
B. Although the resistance stage is a component of GAS, body functions normalize in an attempt to cope with the stressor in this stage.
C. CORRECT: In the alarm stage of GAS, body functions (blood pressure and heart rate) are heightened in order to respond to stressors.
D. Although not technically a component of GAS, recovery stage is an alternative to the exhaustion stage, but it would not account for an elevation in blood pressure and heart rate.
A nurse is caring for a client who has left‑sided hemiplegia resulting from a cerebrovascular accident. The client works as a carpenter and is now experiencing a situational role change based on physical limitations. The client is the primary wage earner in the family. Which of the following describes the client’s role problem?
A. Role conflict
B. Role overload
C. Role ambiguity
D. Role strain
A. CORRECT: The client is experiencing role conflict because their career is extremely physical, and they can no longer perform the job duties. However, the client is the primary wage earner in the family.
B. Although the client can feel overloaded and overwhelmed, role overload occurs when the client is trying to juggle too many roles.
C. The client is not experiencing role ambiguity because their job duties and physical limitations are quite clear.
D. The client is not experiencing role strain. That occurs when one feels inadequate for assuming a role.
A nurse is caring for a client who has a new diagnosis of type 2 diabetes mellitus. Which of the following nursing interventions for stress, coping, and adherence to the treatment plan should the nurse initiate at this time? (Select all that apply.)
A. Suggest coping skills for the client to use in this situation.
B. Allow the client to provide input in the treatment plan.
C. Assist the client with time management, and address the client’s priorities.
D. Provide extensive instructions on the client’s treatment regimen.
E. Encourage the client in the expression of feelings and concerns.
A. Although it can seem helpful to suggest specific coping skills for the client, it is best to allow the client to discuss coping skills that have worked in the past.
B. CORRECT: Allowing the client to contribute to the treatment plan allows for greater adherence to the plan.
C. CORRECT: Helping the client to prioritize is an intervention that can reduce levels of stress for the client because many times time management is extremely difficult in times of stress.
D. Although it is necessary to provide complete information on treatment plans, simplifying treatment regimens as much as possible allows for greater adherence to the treatment plan.
E. CORRECT: By using effective communication techniques, encouraging the client to verbalize feelings is an intervention for stress, coping, and adherence that allows the client to reduce stress, validate emotions, and start planning for valid concerns.
A nurse is caring for a family who is experiencing a crisis. Which of the following approaches should the nurse use when working with a family using an open structure for coping with crisis?
A. Prescribing tasks unilaterally
B. Delegating care to one member
C. Speaking to the primary client privately
D. Convening a family meeting
A. Prescribing tasks is too rigid for acceptance by a family with an open structure.
B. Delegating care is too rigid for acceptance by a family with an open structure.
C. Speaking to the primary client privately excludes the family.
D. CORRECT: An open structure is loose, and convening a family meeting would give all family members input and an opportunity to express their feelings.
Role conflicts can be.
interpersonal (when parents expect adolescents to participate in sports and perform household tasks) or inter‑role (when a mother wants to stay at home with her infant, but family finances require her to work)
stressors, the
internal and external forces that disrupt that state of balance
Caregiver burden results from the
accumulated stress of caring for someone else over time.
