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Stress Tolerance
| Question | Answer |
|---|---|
| Stress | A physiological response produced by the normal wear and tear of bodily processes & external and internal demands. |
| Examples of Stressors | Extreme hot or cold, an argument, a virus, an examination, cigarette smoke, a death, job promotions, arrival of a new family member, & admission to a hospital. |
| Stress can contribute to _________. | Disease |
| Illness | An imbalance that occurs when the body fails to adapt to complex physical and emotional stressors in the internal & external environment. |
| _________ is the ability or tendency to maintain internal __________ by interacting & adjusting to __________ changes. | Homeostasis, Equilibrium, External |
| One way the human body maintains homeostasis is through ________ _________ (__________ & ___________ nervous system). | Physiological responses (sympathetic & parasympathetic) |
| Physiological Stress Response--3 stages of stress | 1. Alarm-rxn stage 2. Resistance stage 3. Exhaustion stage |
| Alarm-Rxn Stage | Fight or Flight--adrenaline surges, heart rate increases, there is a release of cortisone, nor-epinephrine, and epinephrine. |
| Resistance Stage | The body attempts to adapt to the stressor. The Parasympathetic NS modulates the response by opposing actions of the Sympathetic NS. |
| During the Resistance stage, the person either recovers or becomes _________. | Exhausted. |
| During the Exhaustion Stage | The body cannot function effectively against the stressor. |
| If stress continues during the Exhaustion stage, ________ occurs. | Death |
| Research shows that psychological stress can lead to...... | Increased susceptibility to disease by suppressing the immune response. |
| Psychoneuroimmunology | The study of the interface between the brain & immunology. |
| Stress and Illness impacts various organ systems of the body including.. | Cardiovascular disease, arrhythmia's, sudden death, rate & rhythm of breathing, volume of breathed air, changes in CO2 levels, GI, endocrine system, male/female reproductive system, & dental. |
| Stress can also contribute adversely to: | Hypertension, major burn injuries, critical illness, ulcerative colitis, rheumatoid arthritis, & multiple sclerosis. |
| Conversely, Illness can Cause ________. | Stress |
| Concepts of Coping--Coping: | Any effort directed toward management of dangerous, threatening, or challenging situations. |
| Concepts of Coping--Adaption: | A process through which individuals accommodate to changes in the internal or external environment to preserve functioning & pursue goals. |
| Adaptive Coping Methods Include: | Listening to music, Talking, Leisure activities, Emotional release, Spiritual activity, Pets, & Creative activities. |
| Maladaptive Coping Methods: | Drugs & Alcohol, Violence, Withdrawal from society, & Excessive risk taking. |
| 3 Types of Coping Methods: | 1. Adaptive 2. Maladaptive 3. Defense Mechanisms |
| Defense Mechanisms as Coping Methods: | Mental processes used, w/out planning or even full awareness, to protect & to defend one's self from stress, & to maintain homeostasis (Table 46-1, p. 1155). |
| Anxiety | A vague uneasy feeling ranging from mild apprehension to full blown panic. Example of a coping challenge. |
| 2 types of Coping Challenges | 1. Anxiety 2. Crisis |
| Developmental Crisis: | Occurs when a person is unable to complete the tasks needed for a particular developmental level. |
| Two Major Types of Crises: | Developmental & Situational |
| Situational Crisis: | A physically or psychologically hazardous situation that is not easily anticipated and for which a person is inadequately prepared. |
| Crisis Characteristics: | Crisis Characteristics: |
| Disturbs _________ | Homeostasis |
| Involves ______. | Loss |
| Does not respond to usual ______. | Coping |
| Perceived as overwhelming or _____ _______. | Life threatening. |
| Self-______. | Limiting |
| Demands an _______ response. | Immediate |
| Produces change: _______ or _______. | Positive or Negative |
| Brings unresolved ________ to the forefront. | Problems |
| Associated with increased ________ and decreased ________. | Affect, Communication abilities. |
| Requires intervention to regain/reach ________. | Equilibrium. |
| Two Factors affecting stress tolerance include: | 1. Perception of the stressful event 2. Resilience |
| Perception of a stressful event is highly ______. | Individualized |
| The stimuli needed to produce stress ______ with the individual. | vary |
| Resilience: | The ability to recover from or successfully cope with both internal and external stresses. |
| Factors thought to enhance Resilience are: | Intelligence, sense of humor, supportive family, cultural & spiritual beliefs, presence of caring & emotionally available friends & family, determinism, optimism, hope, effective communication skills, flexibility, autonomy, self-esteem,sense of purpose |
| Assessment of a client under Stress includes: | Health Hx, Physical examination, Defining characteristics, & Related factors. |
| Ineffective Coping: | Used for a life event that tends to produce crisis, diagnostic cues include observable anxiety, & behavior & language & disorganized & difficult to understand. |
| Ineffective Denial: | Client delays seeking health care to the point of harm, refuses treatment after hearing benefits of care, & shows signs of physiological imbalance. |
| Planning--The client will be able to ________ potential stressors. | identify |
| Planning--The client will demonstrate both ______ and ________, decreased stress. | verbally and behaviorally |
| Planning--The client will develop ______ ________ of coping with stress. | Effective methods |
| Interventions to increase coping skills can help the client cope effectively by using: | Social supports, protecting vulnerable self, practicing adaptive thinking, increasing receptivity, and learning new information (knowledge). |
| Enhancing social supports. | Encourage and enlist the involvement of family & significant others to help the client tolerate the stressful event. Teach effective support. |
| Protecting a Vulnerable Self. | Help clients identify strengths, or introduce information about the stressor in small, manageable amounts. Help them to recognize the negative effects of defensive behavior. |
| Practicing Adaptive Behavior. | Cognitive therapy refers to methods of treatment that help a person change attitudes, perceptions, and patterns of thinking from irrational to realistic thoughts about the self & situations. |
| Gaining Control Through Knowledge. | Provide information to help the client and family feel a sense of control. Knowledge is power, and although it may not change the situation, it can increase the sense of control. |
| Interventions to Prevent a Crisis: | Make sure all of client's basic needs are met. Anticipate situations that could precipitate a crisis. Prepare them for expected and unexpected changes. Guided Imagery. |
| Interventions During Crisis: | Use calm, slow tone voice, attentive posture,& eye contact. Use short phrases & reduce sensory input. Focus on what client is experiencing at the moment. Point out any movement toward dealing w/ the crisis. |
| Interventions to Help Effectively Manage Stressors (4): | 1) Focusing 2) Reconstructing 3) Compensating 4) Stress Management Skills |
| Focusing: | Ask clients to focus on recognizing their body's signals that stress is interfering w/ comfort. |
| Reconstructing: | Clients can enhance resilience by reconstructing stressful situations in a way that puts the experience in perspective. This exercise increases their ability to put the situation in perspective-a technique for reducing stress. |
| Compensating: | Through self-improvement will lower a clients stress level. The feeling of loss of control can be balanced by taking on a new challenge, such as learning to sew, teaching someone a skill, or helping someone else. |
| Stress Management Skills: | Teach clients to enhance comfort, well-being, and client satisfaction. Relaxation techniques such as sleep, progressive muscle relaxation, meditation, imagery, and music. |
| Evaluation--If stress was reduced, and client is able to show increased coping abilities.. | Continue and adjust plan as necessary. |
| If stressors were not identified, stress was not reduced, and new coping behaviors were not effective... | Overall goals were not met, reassess and adjust the care plan to meed client's needs. |
| Family Structures Include: | Nuclear, Inter-generational, Extended, Single-parent, and Non-traditional families. |
| Role Stress | Occurs when a person has difficulty meeting the demands of a role. |
| Role Conflict | Incompatible expectations for behavior w/in a role, between 2 or more roles, or when a role is in-congruent w/ a person's beliefs & values. |
| Caregiver | Provides care to a dependent or partially dependent family member. |
| Caregiver Stress | Rxn to stressors brought on by care-giving experience. |
| Caregiver Burden | The strain or load felt during the care-giving experience. |
| Caregiver Burnout | Depletion of physical & mental energy caused by providing care for a chronically ill person over a long period of time. |
| Caregiver Role Strain occurs when the caregiver has ________ ________ the caregiving role. | Trouble performing |
| Caregiver role strain associated with the burden & responsibilities involved in the care of dependent family members can result from: | Developmental level of caregiver, situations stressors, or need for extensive care. |
| Caregiver role strain due to unresolved ______ between the caregiver & care recipient. | Conflicts |
| Caregiver role strain when there is resentment, anger, or ______ about the role. | Guilt |
| 5 Factors Affecting Family Coping: | Family, Economic, Social, Psychological, Cultural & Religious Factors. |
| The ability to cope is affected by characteristics of the family: | Developmental stage, Situational stressors, Coping patterns. |
| Coping Patterns | The specific protective behaviors used by an individual or a family to respond to stressful situations. |
| Dysfunctional Families | Families that either cannot meed the needs of the family or function in a way that is harmful to its members. |
| Economic Factors Associated w/ Caregiving: | Financial costs create enormous burdens & many times the caregivers must either stop working or decrease hours worked in order to provide care for dependent family members. |
| Caregivers social support system may include: | relatives, friends, and others who will help in caring for the dependent family member. |
| Social Support can include: | Financial, Emotional, or Daily caregiving assistance. |
| Caregiver stressors can include: | a lack of time for one-self (personal time). |
| Research has shown that many caregivers: | Have not leisure time and receive inconsistent or no help from family or friends. |
| Another intrafamily stressor results from: | Feelings about lack of appreciation for one's efforts. |
| Caregivers can minimize their psychological stress through: | Their coping patterns & the quality and quantity of support provided by their social network. |
| The caregiving role is also affected by: | Locus of Control |
| Internal Locus of Control: | More likely to take responsibility for their decision to serve as caregiver. Taking responsibility for one's actions helps to alleviate the stress associated w/ caregiving. |
| Cultural & Religious Factors: | Cultural expectations & Religious specificity. |
| General Assessment of Families: | Demographic data and Family dynamics, strengths, roles, & stressors. Use of formal & informal support systems. |
| Dx--Caregiver Role Strain | difficulty in performing role. |
| Dx--Risk for Caregiver Role Strain: | A caregiver is vulnerable for felt difficulty in performing the family caregiver role. |
| Dx--Readiness for Enhanced Family Coping: | Effective managing of adaptive tasks by family member involved with the clients health challenge, who now is exhibiting desire & readiness for enhanced health & growth in regard to self & in relation to the client. |
| Dx--Compromised Family Coping: | A usually supportive primary person is providing insufficient, ineffective, or compromised support, comfort, assistance, or encouragement that may be needed by the client to manage or master adaptive tasks related to his/her health challenge. |
| Dx--Disabled Family Coping: | Behavior of significant person that disables his/her capacities and the clients capacities to effectively address tasks essential to either person's adaptation to the health challenge. |
| Dx--Impaired Parenting: | Inability of the primary caretaker to create, maintain, or regain an environment that promotes the optimum growth & development of the child. |
| Always plan ______ the family, not for the family. | With |
| Expected Outcomes | p. 1180-1181 |
| Intervention | Establish nurse-family relationship. Promote family problem solving. Change family behaviors. Prevent caregiver role strain. Prevent risk for caregiver role strain. |
| To prevent caregiver role strain: | Be empathetic, Realistically appraise situation, Utilize appropriate resources, & Provide assistance. |
| To prevent risk for caregiver role strain: | Engage family & friends. Encourage social support & advocacy. |
| Periodically reassess for changes in.. | Health care situation & development of new stressors. |
| Assess for factors impacting ______ of the _______ __________. | Outcomes, Nursing Process. |
| Encourage ______ to periodically reassess the situation. | Family |
| Assess progress made toward reducing _______ _______ __________ & other nursing dx. | Caregiver Role Strain. |
Created by:
ltalley
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