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A person attempts to overcome a perceived weakness by emphasizing a more desirable trait or overachieving in a more comfortable area. (ex: a student who has difficulty with academics may excel in sports.)
A person refuses to acknowledge the presence of a condition that is disturbing. (ex: despite finding a lump in her breast, a woman does not seek medical treatment.)
a person transfers (displaces) an emotional reaction from one object or person to another object or person. (ex: an employee who is angry with a coworker kicks a chair.)
a person incorporates qualities or values of another person into his or her own ego structure. This mechanism is important in to the formation of conscience during childhood. (ex: an older sibling tells his preschool sister not to talk to strangers, expressing his parents' values to his younger sister.)
a person's thoughts or impulses are attributed to someone else. (ex: a person who denies any sexual feelings for a coworker accuses him of sexual harassment.)
a person tries to give a logical or socially acceptable explanation for questionable behavior ("behavior justification") (ex: a pt who forgot to keep a HC appointment says, "If pts didn't have to wait 3 months to get an appointment, they wouldn't forget them.")
a person develops conscious attitudes and behavior patterns that are opposite to what he or she would really like to do (ex: a married woman is attracted to her husband's best friend but is constantly rude to him.)
a person returns to an earlier method of behaving. (ex: children often regress to soiling diapers or demanding a bottle when they are ill.)
a person voluntarily excludes an anxiety-producing event from conscious awareness. (ex: a father may not remember shaking his crying baby.)
a person substitutes a socially acceptable goal for one whose normal channel of expression is blocked. (ex: an individual who is aggressive toward others may become a star football player.)
an act or communication used to negate a previous act or communication. (ex: a husband who was physically abusive to his wife may bring her an expensive present the next day.)
involve consciously thinking about the stress situation and then acting to solve problems, resolve conflicts, or satisfy needs. These reactions include attack behavior, withdrawal behavior, and compromise behavior.
occurs when a person attempts to overcome obstacles to satisfy a need; it may be constructive, with assertive problem solving, or destructive, with feelings and actions of aggressive anger and hostility.
physical withdrawal from the threat, or emotional reactions such as admitting defeat, becoming apathetic, or feeling guilty and isolated.
usually constructive, often involving the substitution of goals or negotiation to partially fulfill one's needs.
Are unconscious reactions to stressors, and useful in mild to moderate anxiety. But when extreme, they distort reality and create problems with relationships. At this point, the mechanisms become maladaptive instead of adaptive.
- Anxiety is often managed w/o conscious thought by these these mechanisms, which are behaviors used to decrease stress and anxiety. Many coping behaviors are learned, based on one's family, past experiences, and sociocultural influences and expectations. Coping behaviors may be positive or negative as they affect health. Typical coping behaviors include the following:
- - Crying, laughing, sleeping, cursing
- - Physical activity, exercise
- - Smoking, drinking
- - Lack of eye contact, withdrawal
- - Limiting relationships to those with similar values and interests
Stress and the health-illness continnuum
Health and homeostatic balance is at one extreme of the continuum, exhaustion and death are at the other extreme. Stress in a healthy person may promote health and prevent illness. (For example, the fear of developing lung cancer may motivate a person to stop smoking.) The effects of stress on a sick/injured person are usually negative. Stress can cause illness, and illness causes stress. The presence of an illness/disability demands new coping skills when homeostasis is challenged.
People who were neglected or abused as children are more vulnerable to stress as adults. The family is an integral part in the assessment, planning, nursing interventions, and evaluation of actions to promote adaptation to stress.
caring for a family member at home for long periods can cause prolonged stress. this stress response includes chronic fatigue, sleep problems, and an increased incidence of stress-related illnesses, such as high blood pressure and heart disease.
a disturbance caused by a precipitating event, such as a perceived loss, a threat of loss, or a challenge, that is perceived as a treat to self. crises may be maturational, situational, or adventitious. In a crisis, a person's usual methods of coping are ineffective, resulting in increasingly greater lvls of anxiety. This failure produces high lvls of anxiety and disorganized behavior, and an inability to fx adequately. The crisis is more likely to be successfully resolved if the person realistically views the event, if effective coping mechanisms are present, and if situational support systems are available.
occur during developmental events that require role change, such as when a teenager moves out
occurs when a life event disrupts a person's psychological equilibrium, such as loss of a job or a death of loved family member
are accidental and unexpected events, resulting in multiple losses and major environmental changes, such as fires, earthquakes, and floods, that involve not only individuals, but also entire communities.
occurs as a person progresses through the normal stages of growth and development from birth to old age. Within each stage, certain tasks must be achieved to resolve the crisis and reduce the stress.
Different from developmental stress; it does not occur in predictable patterns as one progresses through life. Rather, it can occur at any time although the person's ability to adapt may be strongly influenced by his/her developmental level.
have both a specific effect a general effect. The specific effect is an alteration of normal body structure and function. The general effect is the stress response. Primary physiologic stressors include chemical agents (drugs, poisons), physical agents (heat, cold trauma), infectious agents (viruses, bacteria), nutritional imbalances, hypoxia, and genetic and immune disorders.
- There are almost infinite variety of these, which become so much a part of our daily lives we often overlook them. They include both real and percievved threats. The person's responses are continuous and include individualized coping mechanisms for responding to anxiety, guilt, fear, frustration, and loss. The mechanisms serve to maintain psychological homeostasis.
- Examples of psychosocial stressors:
- - accidents: cause stress for victim, the person who caused the accident, and the families of both
- - stressful or traumatic experiences of family members and friends
- - horrors of history, such as nazi concentration camps, the dropping of the atomic bombs on Hiroshima, and 9/11 terrorist attacks
- - Fear of aggression or mutilation, such as muggings, rape, murder, and terrorism
- - Events of history that are brought into our homes through television such as wars, earthquakes, and violence in schools
- - Rapid changes in our world and way we live, including changes in economic and political structures and rapid advances in technology
Physical indicators of stress
may include cardiac dysrhythmias, chest pain, H/A, hyperventilation, diarrhea, tense muscles, and skin lesions, such as eczema.
Diagnosing: assessment data may reveal stress to be the problem or the etiology of a problem.
stress as the problem... the following are examples of nursing diagnoses that may be made when stress is the cause of the problem
- - Anxiety r/t conflicts about values and goals in life, threat to self-concept, threat of death, threat of or change in health status, threat to or change in environment or role, situational/maturational crisis, or unmet needs.
- - Stress Overload r/t single parenthood, inadequate economic resources, and chronic illness.
- - Moral Distress r/t cultural conflicts, end-of-life decisions, conflicting info about ethical decision making, or treatment decisions.
- - Defensive Coping r/t loss of job and economic security
- - Ineffective Denial r/t continued smoking behavior
- - Decisional Conflict r/t placement of parent in nursing home
- - Disabled Family Coping r/t lack of knowledge about home care of child on ventilator
Stress as the etiology... stress and anxiety may affect many other areas of human fxing. In the following nursing diagnoses, stress and anxiety are involved in the etiologies of other problems
- - Imbalanced Nutrition: Less than Body Requirements r/t indequate caloric intake while striving to excel in gymnastics
- - Caregiver Role Strain r/t long term stress of care for parent with Alzheimer's disease
- - Social Isolation r/t feelings of worthlessness and apprehension following failure in school
- - Spiritual Distress r/t inability to accept diagnosis of terminal illness
- - Hopelessness r/t presence of disabling physical injuries
- - Disturbed Sleep Patterns r/t anxiety about terminally ill spouse
The nurse plans and implements care to decrease anxiety and facilitate adaptation in the pt with stress. Expected outcomes of the plan must be mutally determined with the pt or family members. Examples of the expected outcomes of the plan of care may include...
- - Decrease the lvl of anxiety by verbalizing feelings and using support systems
- - Develop effective coping skills through problem-solving skills and anxiety-reducing techniques
- - Describe a reduction in anxiety and an increase in comfort
What are some interventions the nurse can implement for the pt to reduce stress?
- - exercise: helps maintain physical and emotional health. 30 to 45 mins of moderate activity above usual activity on most days of the week. ppl overweight, chronically ill and older than 35 should have a physically exam before beginning such a program. should be something they enjoy.
- - rest and sleep: help maintain homeostasis; restore energy lvls.
- - nutrition: maintain homeostasis; maintain a normal body weight. Reduce intake of salt, refined sugar, animal fat, and cholesterol. Eat more fruits, vegetables, and whole grains. Eat less red meat and more fish and poultry.
- - Support systems: provide emotional support and identify feelings associated with stress.
- - Stress management techniques: exercise, prayer, art therapy, music therapy, massage, and therapeutic touch.
- - Relaxation techniques: useful in many situations, such as childbirth, pain, anxiety, sleeplessness, illness, and anger, and other uses are being discovered. Promotes a body reaction opposite to that of the fight-or-flight response: respiratory, pulse, and metabolic rates; blood pressure; and energy use are all decreased. Can be taught to individuals/groups and is especially helpful because it allows a person to control his/her feelings and behaviors.
- - Meditation: has four components. (1) quiet surroundings, (2) a passive attitude, (3) a comfortable position, and (4) a word/mental image on which to focus. A person practicing practicing meditation sits comfortably with closed eyes, relaxes the major muscle groups, and repeats the selected word silently with ea. exhalation. Alternatively, person may focus on a pleasant scene and mentally place him/herself in it while breathing slowly in and out. This exercise should be performed for 20 to 30 min twice a day.
- - Anticipatory guidance: focuses on psychologically preparing a person for an unfamiliar/painful event. RNs use this technique to teach pts about procedures and the surgical experience. When pts know what to expect, their anxiety is reduced and their coping mechanisms are more effective.
- - Guided imagery: a person creates a mental image, concentrates on the image, and becomes less responsive to stimuli (including pain). The nurse sits by the pt and reads a description of a scene or an experience that the pt has described as happy, pleasant, or peaceful. The pt is then "guided" through the image.
- - Biofeedback: a method of gaining mental control of the autonomic NS and thus regulating body responses, such as BP, HR, and H/A. A measurement device (e.g., skin temperature sensors) is used, and the pt tries to control the readings through relaxation and conscious thought. Over a period of time, the feedback of the change is readings teaches the person to control physiologic fxs that normally are considered involuntary responses.
Crisis intervention (a crisis is a situation that cannot be resolved by usual coping mechanisms... as a result, the person cannot fx normally and requires interventions to regain equilibrium)
- is a 5 step problem-solving technique designed to promote a more adaptive outcome, including improved abilities to cope with future crises. The steps are as follows:
- 1. Identify a problem. This may be more difficult than it appears, as the cause of the crisis is often difficult for the person to identify accurately. Until it is clear, a solution is impossible.
- 2. List alternatives. All possible solutions to the problem need to be listed. An appropriate solution to a problem is much more likely if many options are considered.
- 3. Choose from among alternatives. Each option needs to be carefully considered, using a "what would happen if" approach. The alternative chosen will be highly individualized, based on the person's priorities and values.
- 4. Implement the plan. The alternative chosen is put into action. The nurse may need to provide support and encouragement so that action is taken.
- 5. Evaluate the outcome. In this final step, the effectiveness of the plan needs to be carefully considered. If it did not work as well as expected, and alternative should not be chosen. If it did work, it has the positive benefit of improving self-confidence and future problem-solving efforts.
The plan is considered successful if the pt and family achieve the following
- - Verbalize causes and effects of stress and anxiety
- - Identify and use sources of support
- - Use problem solving to find solutions to stressors
- - Practice healthy lifestyle habits and anxiety-reducing techniques
- - Verbalize a decrease in anxiety and an increase in comfort
What setting is considered most stressful for nurses?
Intensive care unit. Pts in intensive care units have complex needs and are at greater risk for death; their care is often stressful.
A nurse is assessing an obese teenager who is unhappy and stressed out because she has not lost weight despite working out at the gym. The doctor asks the nurse to try the modeling intervention for stress management for the pt. Which of the following actions should the nurse perform when adhering to the modeling intervention?
A. ask the pt to change her exercise regimen
B. ask the pt to cut down on her food intake
C. ask the pt to undergo liposuction surgery
D. introduce the pt to someone with a positive attitude
D. introduce the pt to someone with a positive attitude. (as this promotes the ability to learn an adaptive response. the other answers could lead to further medical complications.)
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A pt who is a drug addict visits a HC facility for treatment. During counseling, he discloses that he took drugs because it helps him deal with stressful situations. The RN explains that he is not using the correct coping strategy to overcome his stress-related problems. What kind of strategy has the pt used in this case?
A. Non-therapeutic coping strategy
B. Therapeutic coping strategy
C. Stress-reduction strategy
D. Antidepressant strategy
A. Non-therapeutic coping strategy (such as mind- and mood-altering substances to cope with stress. Negative coping strategies may provide immediate temporary relief from a stressor, but they eventually cause problems. Therapeutic coping strategies usually help the person to acquire insight, gain confidence to confront reality, and develop emotional maturity. Also, the pt has not used an antidepressant strategy.)
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As an occupational health nurse at an oil refinery on the Gulf coast of Texas you are doing pt education with a man in his mid-forties. The pt is being seen after having been exposed to a chemical spill at the refinery. What type of stressor has this pt been exposed to?
B. Physical (Physical stressors include cold, heat, and chemical agents; physiologic stressors include pain and fatigue. These facts make the other options incorrect.)
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Severe anxiety is manifested by difficulty communicating verbally, increased motor activity, tachycardia, and hyperventilating.
Mild anxiety is present in everyday living. It increases alertness and perceptual fields and motivates learning and growth. Although it may interfere with sleep, it also facilitates problem solving. And it is manifested by restlessness and increased questioning.
Moderate anxiety is manifested by a quavering voice, tremors, increased muscle tension, and slight increases in heart and respiration rates.
Panic causes the person to lose control and experience dread and terror. It is manifested by difficulty with verbal communication, agitation, poor motor control, tachycardia, hyperventilation, palpitations, choking sensation, and chest pain or pressure. Person is unable to learn, concentrates only on the present situation, and often experiences feelings of impending doom. This lvl of anxiety can lead to exhaustion and death.
A 35-year-old client is stressed because he is having problems with his superiors at work. The client says that he had an argument with his superiors about his salary. He has become very anxious and has started consuming large amounts of caffeine very frequently. He also suffers from insomnia and gets angry quickly. Which of the following techniques should the nurse suggest to help the client?
A)Therapeutic coping strategy
B)Negative coping strategy
C)Sensory manipulation strategy
D)Non-therapeutic coping strategy
A) Therapeutic coping strategy (Therapeutic coping strategies usually help the person to acquire insight, gain confidence to confront reality, and develop emotional maturity. Maladaption results when people use non-therapeutic coping strategies such as mind- and mood-altering substances, hostility and aggression, excessive sleep, avoidance of conflict, and abandonment of social activities. Sensory manipulation involves altering moods, feelings, and physiologic responses by stimulating pleasure centers in the brain using sensory stimuli. Negative coping strategies may provide immediate temporary relief from a stressor, but they eventually cause problems.)
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To assess the coping abilities of a first-time mother who expresses concern to the nurse about feeling overwhelmed by the needs of her newborn, the nurse should ask the client about her
a)Interpretation of events
b)Past experiences with childcare
a. interpretation of events (Knowing the nature of potential stressors, however, provides the means of anticipating problems and their related psychological reactions. The extent of activation of physiologic responses and subsequent recovery to daily hassles is important to a person's health because accumulated allostatic responses may adversely affect the body.)
The nurse is caring for a client with a stress-related problem. The client informs the nurse that he has two good job offers. One job offer will help the client settle in New York, something he has always dreamt of, whereas the other offer will keep him close to his family with a good raise. The client is stressed because he is unable to make a decision. The nurse suggests that the client use therapeutic coping strategies. What does the suggestion of the nurse imply?
a)It means that the client is asked to leave both the offers that are causing stress.
b)It means the client is asked to seek professional assistance.
c)It means that the client needs to go in for therapy to clear his mind.
d)It means the client is asked to resort to mood-altering substances.
b. it means the client is asked to seek professional assistance. (When a client seeks professional assistance in a crisis, it means that the client is using therapeutic coping strategies. Other coping strategies include using problem-solving techniques, demonstrating assertive behavior, practicing progressive relaxation, and turning to a comforting other or higher power. Nontherapeutic coping strategies refers to when a client is using mind- and mood-altering substances, hostility and aggression, excessive sleep, avoidance of conflict, and abandonment of social activities.)
A 35-year-old women comes to the local health center with a large mass is her right breast, she has felt the lump for about a year but was afraid come to the clinic because she was sure it was cancer. What is the most appropriate nursing diagnosis for this patient?
b)Altered family process
d)Ineffective individual coping
d. Ineffective individual coping (Ineffective individual coping is the inability to assess our own stressors and then make choices to access appropriate resources. In this case the patient was unable to access health care even when she was aware the disorder could be life threatening. Self-esteem disturbance, Altered family process, and Ineffective denial are all nursing diagnoses that are often associated with breast cancer, but her ineffective individual coping has created a significant safety risk and is therefore the most appropriate nursing diagnosis.)
The nurse is interviewing a client with complaints of chronic fatigue. The nurse understands that the client has a sedentary lifestyle and suggests that the client start low-intensity exercise. Which of the following exercises would be appropriate for the nurse to suggest the client engage in initially?
D)Gardening (The nurse should suggest that the client start with gardening, which is a low-intensity exercise and is particularly good preparation for sedentary persons before they progress to more vigorous aerobic exercise. Running, cycling, and brisk walking are vigorous aerobic exercises.)
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