Stress and Adaptation

Question 1

Stress

Answer 1

• defined as an acual or alleged hazard to the balance of homeostatis
• change in a person’s internal or external environment that is preceived as a threat, challenge, or a danger
• stress is unavoidable
• stressors: physical, psychological, or social stimuli that can produce stress or tension in the body or mind to endanger homeostatis
• stress should be brief
• usual association is neg
• stress produces anxiety

Question 2

Adaptation

Answer 2

• The change that takes place as a result of a stressor
• can occur individually, in families & groups
• necessary for normal growth and development, the ability to tolerate changing situations, and to respond to emotional stressors
• homeostatis: various physiologic mechanisms within the body that respond to internal changes to maintain consistancy in the internal homeostasis

Question 3

components of a system of balances during stress

Answer 3

• a balance is achieved when the perception of the stressful event is realistic and support// coping mechanisms are adequate
• An imbalance can occur if the perception of the event is exaggerated or if sources for support or coping mechanisms are inadequate

Question 4

physciological homeostasis

Answer 4

• local adaptation syndrome involes one body part
• reflex pain response
• inflammatory response
• General adaptation syndrome
  -inital alarm reaction
  -stage of resistance
  -stage of exhaustion

**After the inital alarm & resistance, if the person continues to resist then they will eventually become exhasuted

Answer 5

Alarm reaction
* Person perceives stressor, defense mechanisms activated

• Fight-or-flight response
• Hormone levels rise, body prepares to react
• Shock and counter-shock phases

Stage of resistance
* Body attempts to adapt to stressor

• Vital signs, hormone levels, and energy production return to normal
• Body regains homeostasis or adaptive mechanisms fail

stage of exhaustion
* Results when adaptive mechanisms are exhausted

• Body either rests and mobilizes defenses to return to normal or dies

Question 6

physiological homeostasis

Answer 6

• To maintain mental well-being, humans also must maintain psychological homeostasis.
• Refer to Maslow’s Hierarchy of Needs:
• Love and belonging needs
• Safety and security needs
• Self-esteem needs
• If the person has the necessary resources, adaptation takes place and balance is maintained.
  Adaptive responses include
• The mind-body interaction
• Anxiety
• Coping or defense mechanisms

Question 7

Mind and body interactions

Answer 7

• Relationship between psychological stressors and the physiological stress response
• A person perceives the threat on an emotional level, and the body prepares itself either to resist the danger or to run away from it.

Question 8

indicators of stress

Answer 8

Physiological Indicators
* Psychoemotional Indicators
* Anxiety
* Fear
* Anger
* Depression
Cognitive Indicators
* Problem solving
* Structuring
* Self-control
* Suppression
* Fantasy

Physical signs and symptoms
* Dilated pupils
* Heart rate, BP, Resp increase
* Skin pale
* Mouth dry
* Urine decreased
* Peristalsis decreases
* Mentally alert
* Muscles tense
* Blood Glucose elevates

Question 9

Immune Response and Reaction to Psychological Stress

Answer 9

Immune System
* Impaired immune function
* Increased risk of infection

Endocrine System
* Fight or Flight response (epinephrine, norepinephrine)

Reaction to Stress
* Unexpected stressor is more threatening

Personal Characteristics
* Level of control
* Support system

Question 10

Effects of stress on health

Answer 10

• Depression
• Dyspepsia
• Eating Disorders
• Erectile Dysfunction
• Fatigue
• Fibromyalgia
• Headaches
• Hypertension
• Insomnia
• Irritable Bowel Syndrome
• Low back pain

Question 11

Post-traumatic stressed disorder

Answer 11

• Occurs after witnessing or experiencing severe trauma
• Common among military personnel, veterans, and police
• Reliving of traumatic events or situations
• Anxiety, depression, and nightmares can complicate the picture
• Flashbacks are common
• Flashbacks are vivid recollections of the event in which the individual relives.
• Flashbacks - life threatening to the person.
• Symptoms: intense fear, horror, helplessness, emotionally numb, extremely alert, guarded, agitated, easily startled, eating and sleeping disturbances
• Isolation is common

Question 12

Crisis

Answer 12

• Is a disturbance caused by a precipitating event, such as a perceived loss, a threat of loss, or a challenge, that is perceived as a threat to self.
• Person’s usual methods of coping are ineffective and this failure produces high levels of anxiety, disorganized behavior, and an inability to function adequately.
• One’s ability to cope with anxiety is overwhelmed.
• New coping behaviors must be developed to successfully resolve the source problem.

Question 13

compassion fatigue

Answer 13

• State of burnout and secondary traumatic stress
• Occurs when perceived demands outweigh perceived resources
• State of physical and mental fatigue and exhaustion that often affects health

Question 14

Second Victim Syndrome

Answer 14

• Affects healthcare providers when a medical error happens that harms a patient and causes the nurse complex psychological harm
• Causes loss of confidence, remorse, depression, humiliation and guilt

Question 15

coping

Answer 15

Behaviors used to decrease stress and anxiety; ability to adapt to a stressor.

Conscious, learned behaviors based on a person’s family, past experiences, religion, sociocultural influences and expectations.

Affected by one’s personal choice

Can include behaviors like: Laughing, crying, sleeping, cursing, physical activity, exercise, smoking, drinking, lack of eye contact, withdrawal, limiting relationships to those with similar values and interest, et.

Physical – directly handle problem
Intellectual – changing perception
Spiritual – prayer, faith, rituals
Emotional – crying, communicating

Question 16

Factors affecting stress and coping

Answer 16

Sources of stress
Developmental stress: occurs when person progresses through stages of growth and development

Situational factors: does not occur in predictable patterns
E.g. illness or traumatic injury, marriage or divorce, loss, new job, role change

Maturational Factors: The ability to adapt is lower in the very young, very old, preadolescents have body image and self-esteem issues

Sociocultural Factors: poverty, physical disability,imprisonment, substance abuse, homelessness, social isolation, culture

Question 17

Coping V. Adaptation

Answer 17

COPING
* Short-term and immediate
* Oriented towards survival
* Not continuous
* Motivated by crisis; reactive
* Often degrades the resource base
* Prompted by a lack of alternatives

ADAPTATION
* Practices and results are sustained
* Oriented towards longer-term livelihood security
* A continuous process
* Involves planning
* Uses resources efficiently and sustainably
* Focused on finding alternatives
* Combines old and new strategies and knowledge

Question 18

Effective vs Ineffective coping

Answer 18

Effective coping
Adaptation is behaviour that maintains integrity of the individual
Person utilizes active problem solving - Thiscoping mechanism involves identifying a problem that is causing stress and then developing and putting into action some potential solutions for effectively managing it.
Lead to healthy choices

Ineffective coping
Maladaptation is UNHEALTHY behavior that disrupts the integrity of the individual.
Person utilizes withdrawal, compromise or avoidance,
Excessive use of the defense mechanisms can lead to negative impact on mental and emotional well-being

Question 19

Coping responses

Answer 19

Adaptive–> Problem solving, using social support, reframing

Maladaptive–> Avoidance, self blame & wishful blaming

Question 20

Defense mechanism

Answer 20

Protect a person’s self –esteem and are useful in mild to moderate anxiety.

Are mental pressure valves
Are considered to be “unconscious”

Give the illusion of being helpful, when in reality they mask the stress and may actually increase it

When used in small “doses” may be helpful for short-term stress relief

When used to excess, become ineffective and may lead to breakdown of personality and relationships.

Question 21

Anxiety

Answer 21

An unpleasant feeling of uneasiness, uncertainty, apprehension, dread, unexplained discomfort, tension, and/or helplessness.

A normal emotional response to a real or imagined threat or stressor

Diagnosis is made when individuals become overwhelmed and nonfunctional.

Question 22

purpose of anxiety

Answer 22

A warning of impending danger

Mild anxiety can increase learning by enhancing concentration and focus

Uncontrolled anxiety often leads to ineffective and maladaptive behavior

A normal part of survival and growth

What are the disadvantages of having too much or too little anxiety?

Too little anxiety can result in a lack of focus or recklessness;

too much anxiety can lead to inability to accomplish important tasks.

Question 23

Self-awareness and anxiety

Answer 23

-Anxiety is contagious
-it is important for caregivers to reconize and cope effectivley with their own anxieties

Question 24

Nursing process:Assessment

Answer 24

Complete nursing history
Physical examination

Mental health assessment
Severity of stressor–“How is this affecting you?”

How severely client’s emotional state affected– “How do you feel about this?”

Coping Mechanisms:
Usual coping behaviour – “What do you usually do when something like this happens?”

Coping strategies – “Can you think of anything to do about this?”

Social support – “Whom can you call on to help you with this?”

Question 25

Nursing process: Nursing diagnosis stress and coping

Answer 25

• Ineffective Coping
• Compromised Family Coping
• Stress Overload

Question 26

Nursing Process: Nursing Diagnoses r/t Anxiety

Answer 26

• Anxiety
• Risk for self or other directed violence
• Rape-Trauma syndrome
• Risk for post-trauma syndrome/Post trauma syndrome
• Insomnia
• Self care deficit
• Powerlessness

Question 27

Nursing Process: Client Goal/Outcome

Answer 27

The client will:
Remain free of destructive behavior toward self or others
Identify three concrete stress reduction techniques that are of interest

Identify cause of anxiety
Decrease level of anxiety by verbalizing feelings and using support systems

Develop effective methods of coping through problem-solving skills and anxiety-reducing techniques

Sleep a minimum of 6 or more hours every night

Question 28

Nursing Process: Coping Interventions

Answer 28

Cognitive approach – teaching the client or helping client think about the problem. (reframing)

Anticipatory guidance - Focuses on psychologically preparing a person for an unfamiliar or painful event

Biofeedback – a process that provides visual or auditory information about autonomic body functions.

Question 29

Nursing Process: Coping Interventions

Answer 29

Behavioral approach – encourage clients to engage in stress reducing behavior

Relaxation techniques –
rhythmic breathing, reduced muscle tension, and altered state of consciousness.

Meditation – quiet surroundings, a passive attitude, a comfortable position, and a word or mental image on which to focus.

Guided imagery – a person creates a mental image, concentrates on the image, and becomes less responsive to other stimuli.

Journaling – practice of writing out one’s thoughts and feelings as an exercise to identify and evaluate one’s own sources of stress and coping strategies

Listening to music – helps anxious individuals distract and redirect their attentions

Question 30

Nursing Process: Coping Interventions

Answer 30

Teaching Healthy Activities of Daily Living:

Exercise – improves a person’s general sense of well-being, relieves tension, and enables coping with day-to-day stressors.

Rest and sleep – help the body maintain homeostasis and restore energy levels; can insulate against stress; recommend 7-9 hours of sleep per day.

Nutrition – helps increase resistance to stress

Use of support systems – help a person identify and verbalize feelings associated with stress; safe environment to explore problem-solving methods and try out new coping skills; help maintain a positive self-concept and establish an avenue for new relationships and social roles.

Question 31

Nursing Process: Anxiety Interventions

Answer 31

• Maintain a calm environment
• Establish therapeutic relationship
• Maintain open communication
• Identify effective coping strategies
• Observe for signs of suicidal thoughts
• Client sign contract to refrain from violence
• Reinforce personal strengths
• Encourage client to establish and maintain relationships
• Monitor medications for therapeutic response and for adverse reactions
• Document any changes in behavior
• Encourage client attend therapies and activities

Question 32

Nursing Process: Coping Evaluation

Answer 32

Did the client:
* The patient verbalizes the causes and effects of stress and anxiety.

• The patient identifies and uses sources of support.
• The patient uses problem solving to find a solution to stressors.
• The patient practices healthy lifestyle habits and anxiety-reducing techniques.
• The patient verbalizes a decrease in anxiety and increase in comfort.

Question 33

Nursing Process: Anxiety Evaluation

Answer 33

Did the client:
* Remain free of destructive behavior toward? self or others?

• Use effective coping strategies?
• Identify cause of anxiety?
• Decrease level of anxiety?
• Sleep a minimum of 6 or more hours every night?