Chapter 4 - Stress and Defense Mechanisms

Question 1

“Always” Healthy defense mechanisms

Answer 1

Altruism - dealing with anxiety by reaching out to others (became a firefighter because lost family in fire)
Sublimation - dealing with unacceptable feelings by unconsciously substituting acceptable forms of expression (working out to deal with anger towards supervisor)

Question 2

Intermediate defense mechanisms

Answer 2

Suppression - voluntarily denying unpleasant thoughts/feelings (lost job and won’t worry about bills until next week)
Repression - putting unacceptable ideas/thoughts/emotions out of conscious awareness (“forgetting” dentist appts because afraid of drill)
Reaction formation - Overcompensating/demonstrating opposite behavior of what is felt (dislikes sister’s daughter and offers to babysit so sister can go out)
Displacement - shifting feelings r/t to something to another less threatening (person lost job and angry so destroys his child’s favorite toy)
Rationalization - creating reasonable and acceptable explanations for unacceptable behavior (man drives drunk because he had to feed his dog at home)
Undoing - performing an act to make up for prior behavior (teenager do chores without being asked after arguing with parents)

Question 3

Immature defenses

Answer 3

Projection - blaming others for unacceptable thoughts and feelings (teenager blames his drug problem on his parents’ refusal to buy him a new car)
Dissociation - temporarily blocking memories and perceptions from consciousness (teenager witness shooting but cannot recall any details)
Splitting - demonstrating inability to reconcile neg/pos attributes of self or others (client tells nurse she is the best one day, and the next day won’t talk to her)
Denial - pretending truth is not reality to manage anxiety of acknowledging what is real (parent lost a child in combat but tells people he is coming home for holidays)
Regression - demonstrating behavior from earlier developmental level (parents are separating and child starts sucking thumb)

Question 4

Anxiety

Answer 4

Acute (state) - precipitated by imminent loss or change that threatens one’s sense of security (losing a loved one)
Chronic (trait) - develops over time, may have fatigue or headaches

Question 5

Levels of Anxiety

Mild

Answer 5

normal everyday
increases ability to perceive reality
finger/foot tapping, fidgeting, restlessness, irritability, impatience

Question 6

Levels of Anxiety

Moderate

Answer 6

slightly reduced perception and processing of info
selective attention
hampered thinking clearly, learning and problem solving still occur
tiredness, difficulty concentrating, pacing, change in voice, increased HR and RR, somatic complaints (headaches, backache, urinary urgency, insomnia)
benefits from direction of others

Question 7

Levels of Anxiety

Severe

Answer 7

perceptual field greatly reduced w/ distorted perceptions
NO learning/problem solving
ineffective functioning
confusion, feeling of doom, hyperventilation, tachycardia, withdrawal, loud/rapid speech, aimless activity
NOT able to take direction from others

Question 8

Levels of Anxiety

Panic-level

Answer 8

markedly disturbed behavior
not able to process environment
extreme fright
hyperactivity/flight
immobility
dysfunction in speech, dilated pupils, severe shakiness/withdrawal, inability to sleep, delusions, hallucinations

Question 9

Nursing Interventions

Mild to Moderate Anxiety

Answer 9

active listening (open-ended q’s, broad openings, exploring, seeking clarification)
calm presence, recognize distress
evaluate past coping mechanisms
explore alternatives to problem situations
encourage participation in activities, exercise

Question 10

Nursing Interventions

Severe to Panic Anxiety

Answer 10

safe environment
stay with client
quiet environment with minimal stimulation
meds and restraint
gross motor - walking
set limits by using firm, short, simple statements, repetition
direct client to acknowledge reality and focus on present