Chapter 43 - Stress and Adaptation

‭Homeostasis‬ ‭●‬ ‭Various physiologic mechanisms occur to maintain relative constancy internally‬ ‭●‬ ‭Regulators:‬ ‭○‬ ‭Autonomic nervous system‬ ‭○‬ ‭Sympathetic and parasympathetic‬ ‭Sympathetic‬ ‭●‬ ‭Fight or flight response‬ ‭●‬ ‭Stimulates heart rate‬ ‭●‬ ‭Blood glucose levels increase‬ ‭●‬ ‭Dilates skeletal muscle blood vessels‬ ‭●‬ ‭Mental alertness‬ ‭Parasympathetic‬ ‭●‬ ‭Slows things down‬ ‭●‬ ‭Regulates heart rate‬ ‭●‬ ‭Improves digestion‬ ‭●‬ ‭Stimulates digestive secretions‬ ‭●‬ ‭Reduces the effect of stress on the body‬ ‭Stressors‬ ‭●‬ ‭Any internal/external demand that threatens balance‬ ‭●‬ ‭Threat to self-integrity or well-being‬ ‭○‬ ‭Loss of something important‬ ‭○‬ ‭Challenge to be overcome‬ ‭Causes of Stress‬ ‭●‬ ‭Physical:‬ ‭○‬ ‭Aging‬ ‭○‬ ‭Illness‬ ‭○‬ ‭Injury‬ ‭○‬ ‭Pain‬ ‭●‬ ‭Psychological:‬ ‭○‬ ‭Loss of job‬ ‭○‬ ‭Loss of relationship‬ ‭○‬ ‭Role overload‬ ‭○‬ ‭Loss of self-esteem‬ ‭●‬ ‭Spiritual:‬ ‭○‬ ‭Loss of meaning‬ ‭○‬ ‭Loss of faith‬ ‭Physical Effects of Chronic Stress‬ ‭●‬ ‭Immune:‬ ‭○‬ ‭Infections‬ ‭○‬ ‭Allergies‬ ‭○‬ ‭Skin eruptions‬ ‭○‬ ‭Autoimmune‬ ‭○‬ ‭Cancer‬ ‭●‬ ‭Muscles:‬ ‭○‬ ‭Backaches‬ ‭○‬ ‭Arthritis‬ ‭○‬ ‭Accidents‬ ‭●‬ ‭Cardiovascular:‬ ‭○‬ ‭Myocardial infarction‬ ‭○‬ ‭Angina‬ ‭○‬ ‭Hypertension‬ ‭○‬ ‭Migraines‬ ‭○‬ ‭Arrhythmias‬ ‭○‬ ‭Strokes‬ ‭●‬ ‭Gastrointestinal:‬ ‭○‬ ‭Ulcers‬ ‭○‬ ‭Colitis‬ ‭○‬ ‭Constipation‬ ‭○‬ ‭Diarrhea‬ ‭Three Stages of Stress Response‬ ‭●‬ ‭Stage 1:‬‭Alarm stage‬ ‭●‬ ‭Stage 2:‬‭Resistance stage‬ ‭●‬ ‭Stage 3:‬‭Exhaustion stage‬ ‭Alarm Reaction‬ ‭●‬ ‭Person perceives stressor;‬‭defense mechanisms‬‭activated‬ ‭●‬ ‭Fight-or-flight response‬ ‭●‬ ‭Hormone levels rise, body prepares to react‬ ‭●‬ ‭Shock and counter-shock phases‬ ‭Stage of Resistance‬ ‭●‬ ‭Body attempts to‬‭adapt‬‭to stressor‬ ‭●‬ ‭Vital signs, hormone levels, and energy production return to normal‬ ‭●‬ ‭Body regains homeostasis or adaptive mechanisms fail‬ ‭Stage of Exhaustion‬ ‭●‬ ‭Results when adaptive‬‭mechanisms are exhausted‬ ‭●‬ ‭Body either rests and mobilizes its defenses to return to normal or dies‬ ‭Emotional Response to Stress‬ ‭●‬ ‭Anxiety:‬‭Unpleasant state in which stressor is not‬‭clearly identified‬ ‭●‬ ‭Levels of anxiety:‬ ‭○‬ ‭Mild‬ ‭○‬ ‭Moderate‬ ‭○‬ ‭Severe‬ ‭○‬ ‭Panic‬ ‭ uestion:‬‭Mild anxiety narrows a person’s perceptual‬‭fields so that the focus is on immediate‬ Q ‭concerns with inattention to other communications and details.‬ ‭a.‬ ‭True‬ ‭b.‬ ‭False‬ ‭Mild Anxiety‬ ‭●‬ ‭Physical: VS normal,‬‭minimal muscle tension‬‭, pupils‬‭normal‬ ‭●‬ ‭Cognitive/Perceptual: Broad perceptual field and awareness, thoughts controlled‬ ‭○‬ ‭Attentive‬‭; best stage for learning‬ ‭●‬ ‭Emotional/Behavioral: Feelings relative to comfort and safety‬ ‭○‬ ‭Relaxed behavior, habitual behaviors, automatic response‬ ‭●‬ ‭Day-to-day‬‭living‬ ‭Moderate Anxiety‬ ‭●‬ ‭Physical: VS‬‭slightly elevate‬‭d, muscle tension‬ ‭●‬ ‭Cognitive/Perceptual: Alert and‬‭narrowed perception‬ ‭●‬ ‭Emotional/Behavioral:‬‭Energized‬‭, concerned‬ ‭●‬ ‭Narrows a person’s perceptual field‬ ‭Severe Anxiety‬ ‭●‬ ‭Physical:‬‭Fight-or-flight‬‭response, ANS stimulated‬‭in an alarm stage of stress‬ ‭○‬ ‭Muscles rigid, senses affected‬ ‭●‬ ‭Cognitive/Perceptual: Perceptual field‬‭greatly narrowed‬‭,‬‭problem-solving difficult,‬ ‭selective attention or inattention,‬‭distortion of‬‭time‬ ‭●‬ ‭Emotional/Behavioral: Feels threatened, activity increases or decreases, depression and‬ ‭denial, need for space increased‬ ‭Panic‬ ‭●‬ ‭Physical: Sympathetic nervous system release occurs‬ ‭○‬ ‭Pale, BP decrease, hypotension, poor muscle coordination, pain‬ ‭●‬ ‭Cognitive/Perceptual: Perception totally‬‭scattered‬‭or closed, problem-solving and logical‬ ‭thinking very unlikely; sense of‬‭unreality‬‭about self,‬‭environment, or event‬ ‭●‬ ‭Emotional/Behavioral: Helpless with total loss of control, disorganized, erratic behavior,‬ ‭combative/withdrawn, dissociative‬ ‭Coping Mechanisms‬ ‭●‬ ‭Crying, laughing, sleeping, cursing‬ ‭●‬ ‭Physical activity, exercise‬ ‭●‬ ‭Praying‬ ‭●‬ ‭Smoking, drinking‬ ‭●‬ ‭Lack of eye contact, withdrawal‬ ‭●‬ ‭Limiting relationships to those with similar values and interests‬ ‭Achieving Homeostasis/Balance‬ ‭●‬ ‭Between perception of stressor (realistic) = sources for support/coping mechanisms‬ ‭(adequate)‬ ‭Imbalance During Stress‬ ‭●‬ ‭Perception of the event is exaggerated or sources for support/coping mechanisms are‬ ‭inadequate‬ ‭Defense Mechanisms‬ ‭●‬ ‭Unconscious reaction to protect a person’s‬‭self-esteem‬ ‭○‬ ‭Distorting reality‬ ‭○‬ ‭Create problems with relationships‬ ‭○‬ ‭Maladaptive‬ ‭●‬ ‭Effective short-term but blocks growth long-term‬ ‭ uestion:‬‭Which defense mechanism is portrayed in‬‭the following scenario? After throwing his‬ Q ‭lunchy tray on the floor, a patient complains to the nurse manager about the quality of the food‬ ‭he is being fed during his hospital stay.‬ ‭a.‬ ‭Denial‬ ‭b.‬ ‭Displacement‬ ‭c.‬ ‭Rationalization‬ ‭d.‬ ‭Reaction formation‬ ‭Types of Defense Mechanisms‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭‬ ● ‭●‬ ‭‬ ● ‭●‬ ‭ enial:‬‭Refusal to accept painful facts/feelings‬ D ‭Rationalization:‬‭Offering a plausible explanation‬‭or excuse‬ ‭Regression:‬‭Returning to an earlier method of behaving‬ ‭Repression: Unconscious‬‭forgetting of all/part of‬‭an experience‬ ‭Suppression:‬‭Only‬‭conscious‬‭defense mechanism; conscious‬‭blocking of an experience‬ ‭from awareness‬ ‭Compensation:‬‭Attempting to overcome a perceived weakness‬‭by emphasizing a more‬ ‭desirable trait or overachieving‬ ‭Displacement:‬‭A person transfers an emotional reaction‬‭from one object/person to‬ ‭another‬ ‭Dissociation:‬‭A person subconsciously protects oneself‬‭from a painful event by allowing‬ ‭the mind to forget it‬ ‭Introjection:‬‭a person incorporates‬‭qualities/values‬‭of someone else‬‭into their own ego‬ ‭structure; important in formation of conscience in childhood‬ ‭Projection:‬‭A person‬‭attributes‬‭thoughts or impulses‬‭to someone else‬ ‭Reaction formation:‬‭A person develops conscious attitudes‬‭and behavior patterns that‬ ‭are‬‭opposite‬‭to what they would really like to do‬ ‭Sublimation:‬‭Redirecting unacceptable impulses/emotions‬‭into socially‬‭acceptable‬‭ones‬ ‭Undoing:‬‭A person uses an act of communication to‬‭negate‬‭a pervious act‬ ‭Clinical Application‬ ‭●‬ ‭Assessment:‬ ‭○‬ ‭Understand stress and coping from the client’s perspective‬ ‭○‬ ‭Gather information about the stressors, meaning, social support, strengths, and‬ ‭coping in the past‬ ‭●‬ ‭Nursing diagnosis:‬ ‭○‬ ‭Ineffective individual coping‬ ‭○‬ ‭Powerlessness‬ ‭○‬ ‭Disturbance in self-concept‬ ‭○‬ ‭Sleep pattern disturbance‬ ‭○‬ ‭Potential for violence‬ ‭○‬ ‭Knowledge deficit‬ ‭●‬ ‭Planning:‬ ‭○‬ ‭Coping tasks in healthcare settings are aimed at:‬ ‭■‬ ‭Decreasing the toxic effects of the environment‬ ‭■‬ ‭Helping the patient tolerate new realities‬ ‭■‬ ‭Sustaining a positive self-image‬ ‭■‬ ‭Maintaining emotional equilibrium‬ ‭■‬ ‭Maintaining interpersonal relationships‬ ‭●‬ ‭Interventions:‬ ‭‬ A ○ ‭ ssist client to identify and name stressors and response‬ ‭○‬ ‭Teach or refer‬ ‭○‬ ‭Assist client in increasing coping‬ ‭■‬ ‭Ventilating feelings‬ ‭■‬ ‭Repeating information‬ ‭■‬ ‭Setting priorities‬ ‭■‬ ‭Teaching healthy ADLs‬ ‭■‬ ‭Use of stress management techniques‬ ‭Teaching Healthy ADLs‬ ‭●‬ ‭Exercise‬ ‭●‬ ‭Rest and sleep‬ ‭●‬ ‭Nutrition‬ ‭●‬ ‭Use of support systems‬ ‭ uestion:‬‭In the stress management technique known‬‭as anticipatory guidance, a person creates‬ Q ‭a mental image, concentrates on the image, and becomes less responsive to stimuli.‬ ‭a.‬ ‭True‬ ‭b.‬ ‭False‬ ‭Stress Management Techniques‬ ‭●‬ ‭Progressive relaxation:‬‭Tensing, then relaxing‬ ‭●‬ ‭Autogenic training:‬‭Focused mental exercises‬ ‭●‬ ‭Meditation:‬‭Training the midn to focus and redirect‬‭thoughts‬ ‭●‬ ‭Breathing exercises:‬‭Diaphragmatic breathing‬ ‭●‬ ‭Anticipatory guidance:‬‭Preparing a person for an unfamiliar/painful‬‭event‬ ‭●‬ ‭Guided imagery:‬‭Creating a mental image, concentrating‬‭on it, and becoming less‬ ‭responsive to other stimuli (including pain)‬ ‭●‬ ‭Biofeedback:‬‭Learning to control involuntary bodily‬‭functions (ex. HR, RR, muscle‬ ‭tension)‬ ‭●‬ ‭Self-hypnosis:‬‭Uses suggestions‬ ‭●‬ ‭Crisis intervention:‬‭Short-term management focused‬‭on reducing damage to an‬ ‭individual/group affecting by a crisis, often in a mental/medical emergency‬ ‭Stress and the Nurse‬ ‭●‬ ‭Burnout:‬‭Physical, mental, emotional exhaustion caused‬‭by excessive/prolonged stress‬ ‭●‬ ‭Compassion fatigue:‬‭Indifference to charitable appeals‬‭on behalf of those suffering‬ ‭Risk Factors and Warning Signs‬ ‭●‬ ‭Inability to say no‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ I‭ nability to set limits‬ ‭Inability to protect personal time‬ ‭Inability to delegate‬ ‭Increased impatience‬ ‭Forgetfulness‬ ‭Not attending to needs for socialization, fun, and intimacy‬ ‭Burnout Prevention‬ ‭●‬ ‭Develop awareness‬ ‭●‬ ‭Restore balance‬ ‭●‬ ‭Choice‬ ‭●‬ ‭Detachment‬ ‭●‬ ‭Focus‬ ‭●‬ ‭Goals‬ ‭●‬ ‭Hope‬ ‭●‬ ‭Altruistic egoism‬ ‭○‬ ‭Benefitting others and self‬