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75 Cards in this Set

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Adaptation
The process of modifying to meet new, changing or different conditions.
Biofeedback
Stress management technique that brings under conscious control bodily processes normally thought to be beyond voluntary command.
Coping Styles
A particular means of managing stress;
innate or acquired way of responding to a changing environment or situation
Defense Mechanism
Any reaction that serves to protect against something physically or psychologically harmful
Distress
Physical or mental pain or suffering
Eustress
Eustress can be defined as a pleasant or curative stress. Good Stress.
Ex. coming in first in an athletic competition is an example of eustress
Holmes and Rahe Social Readjustment Scale
Scale that identifies changes that can occur in one's life. Each change is correlated with a number that when added with other change numbers provide a total that indicates one's risk for developing a stress related illness. The higher the number the higher percentage chance of getting ill.
Differentiate between eustress and distress
Distress: negative, draining energy (anxiety, depression, confusion, helplessness, hopelessness, fatigue)

Eustress: Positive, motivating, energy (happiness, hopefulness, peacefulness, purposeful movement)
State the two major body systems which act as regulators in the stress response
Sympathetic: Initiates 'fight/flight' response to a perceived threat.


Parasympathetic: returns body to homeostasis after threat has passed.
Both of these are part of the Autonomic Nervous System, which is responsible for many bodily functions that occur automatically
Define stressor: physical vs psychological
Physical stressors: environmental conditions i.e., trauma and excessive cold or heat; physical conditions such as infection, hemorrhage, hunger, pain

Psychological stressors: include divorce, loss of a job, unmanageable debt, death of a loved one, retirement, AND changes we might consider to be positive, such as marriage or unexpected success.
Coping Style enhancements
- health sustaining habits ( Ex. medical compliance, proper diet, relaxation, pacing ones energy.)
- Life satisfactions ( Ex. work, family, humor, spiritual solice, arts
and , nature)
- Social Support
-Effective and healthy response to stress
Identify the characteristics of the four levels of anxiety
Mild
Moderate
Severe
Panic
Fear vs Anxiety
-Fear is a reaction to a specific event ( unknown)

-Anxiety has an unknown or unrecognized source and is the most debilitation
Discuss and list behavioral and cognitive nursing interventions to minimize anxiety in a client, include Herbert Benson’s relaxation technique
guided imagery
cognitive
reframing
journal keeping
assertive training
music
pets
exercise
Discuss ways in which the nurse can manage stress in his/her own life
separate sheet
What did Hans Selye formulate?
A theory of Stress called: the General Adaptation Syndrome (GAS)
( cannons theory of stress)
2 stages
initial adaptive response- alarm stage-acute stress
eventual maladaptive response
More common in males

Psychological response
Distress(negative) an Eustress ( positive Energy)
According to Selye, how many stages does stress occur in?
Three stages:
1. Alarm or Acute stress phase (fight/flight)
2. Stage of Resistance (body's adaptation to stress)
3. Stage of exhaustion (previous adaptation cannot be maintained... stress may spread to whole body)
What are some reactions a person can experience from first stage (Alarm/Acute) stress?
Loss of appetite, infertility, sadness, uneasiness, suppression of immune system
What are some reactions a person can experience from second stage (Chronic) stress?
Anxiety, depression, Lowered resistance to infection, hypertension, fatigue and irritability and many serious health risks.
Identify verbal manifestations of stress.
Crying (releases tension)
Verbal abuse (e.g. yelling when you lose keys)
Laughing (can lead to constuctive problem solving)
Screaming (response to fear or intense frustration and anger)
Identify motor manifestations of stress.
Kicking, hitting. Can be helpful in reducing tension but can be destructive as well.
Holding and touching are often responses to joyful or sad events.
What are the four coping styles relative to stress?
Rahe says the four are:
1. Health sustaining habits
2. Life satisfactions
3. Social Supports
4. Response to stress
Rahe's Health sustaining habits include:
Medical compliance, proper diet, nutrition and pacing one's energy
Rahe's Life Satisfactions include:
Work, family, humor, spiritual solace and arts and nature.
Rahe's Social Supports include:
Intimate supportive relationships
Holmes and Rahe's Response to Stress includes:
Effective and healthy responses to stress.
Holmes & Rahe - social adjustment rating scale
-monitir level of stressful life events over a given period of time

ect...
-
Mediating factors in the response to stress
Individual factors - deep breathing
Social Factors - support groups
Culture
Spirituality and prayer fullness
optimism
Known benefits of Stress Reduction
-Alerts the course of certain medical conditions such as high BP, arrhythmia's , arthritis, cancer, and peptic ulcers
-Decreasing needs for medications such as insulin, analgesics
-Eliminates or diminishes the urge for unhealthy and destructive behaviors
-Increase cognitive functions
-BREAKS UP TATIC PATTERNS OF THINKING AND ALLOWS FRESH AND CREATIVE WAYS OF PERCEIVING LIFE EVENTS
-INCREASE SENSE OF WELL BEING, ALLOWS PEOPLE TO THINK OUTSIDE THE BOX
Cognitive Behavioral Methods of Stress Reduction
The most effective way to reduce stress
- Behavioral approaches
Relaxation Techniques ( Benson's) repeating ONE word
Meditation
Guided Imagery
Breathing Exercises
-Muscle and relaxation and exercise
progressive muscle relaxation
Biofeedback - Does not get hypnotized easily
Defense Mechanism: ALTRUISM
Category:
a. mild
b. extreme
Meeting the needs of others.
Mature
a. letting other person go first in checkout
b. shielding another soldier from a bomb
Thinking of others and putting yourself aside
Defense Mechanism: SUBLIMATION
Category:
a. mild
b. extreme
Unconscious process of substituting constructive/acceptable activity for strong, unacceptable impulses
Mature
a. butcher instead of hannibal lecter
b. agressive person fights heroically in war
Defense Mechanism: HUMOR
Category:
a. mild
b. extreme
self explanatory
Mature
a. deal with anxiety by joking about it.
b. laugh like carrie
Defense Mechanism: SUPPRESSION
Category:
a. mild
b. extreme
Conscious denial of disturbing situation or feeling.
Mature
a. need to pee during a test
b. engage your kidnapper
Defense Mechanism: REPRESSION
Category:
a. mild
b. extreme
Exclusion of unpleasant/unwanted experiences, emotions, ideas from conscious awareness.
Neurotic
a. Forgetting your ex-husband's name
b. Forgetting your current wife's name
Defense Mechanism: DISPLACEMENT
Category:
a. mild
b. extreme
Transfer of emotions associated with a particular person, object, situation to another one that is non-threatening
Neurotic
a. man yells at wife, wife yells at kid
b. man yells at kid, kid tortues cat
11. Defense Mechanism: REACTION FORMATION
Category:
a. mild
b. extreme
Unacceptable feelings are kept out of awareness by developing opposite awareness or emotion
Neurotic
a. Ned Flanders
b. hostile to children becomes a kidneygarden teacher
Defense Mechanism: SOMATIZATION
Category:
a. mild
b. extreme
Transfering anxiety on unconscious level to physical symptom that has no organic basis.
Neurotic
a. Boy who cries wolf
b. hypochondriac
Defense Mechanism: RATIONALIZATION
Category:
a. mild
b. extreme
Justifying illogical or unreasonable ideas, actions, feelings by developing acceptable explanations that satisfy teller and listener.
Neurotic
a. Everybody cheats so why shouldn't I
b. Witness a crime: "it's not my business".
Defense Mechanism: UNDOING
Category:
a. mild
b. extreme
Makes up for an act or communication
Neurotic
a. Gift to undo an argument
b. Compulsive handwashing to erase a crime (Lady MacBeth)
All about guilt. Do something wrong try to make up for it.
Defense Mechanism: REGRESSION
Category:
a. mild
b. extreme
Resorting to an earlier more comfortable level of function that is characteristically less demanding/responsible
Neurotic
a. Temper tantrum from an adult
b. Capable client allows nurse to bath and feed
11. Defense Mechanism: PASSIVE AGGRESSION
Category:
a. mild
b. extreme
Dealing with stress or conflict indirectly by unassertively expressing agression toward others. (procrastination, failure, inefficiency)
Immature
a. Forgetting Valentine's day because your mad at partner
b. Going golfing on wedding day
11. Defense Mechanism: ACTING OUT
Category:
a. mild
b. extreme
Destructive coping style; deals with conflict by impulsive actions rather than rational decision making.
Immature
a. Lashing out in anger when feeling powerless
b. Shooting others from a tower
11. Defense Mechanism: DISASSOCIATION
Category:
a. mild
b. extreme
Disruption in ussually integrated function of consciousness, memory, identity, perception of environment
Immature
a. Witness a violent act and forgetting it.
b. PTSD or Multiple personality
11. Defense Mechanism: DEVALUATION
Category:
a. mild
b. extreme
When emotional conflicts/stressors are dealt with by attributing negative qualities to self or other
Immature
a. Sour grapes
b. Holocaust
11. Defense Mechanism: IDEALIZATION
Category:
a. mild
b. extreme
Conflicts/stressors are dealt with by attributing exagerated positive qualities to others. (important to devpmt of self)
Immature
a. Idealizing parents
b. Idealizing Hitler
11. Defense Mechanism: SPLITTING
Category:
a. mild
b. extreme
Inability to integrate positive and negative qualities of one's self into a cohesive image.
Immature
a. going to extremes in one's view of another
b. Dr. Jekyl / Mr. Hyde
Defense Mechanism: PROJECTION
Category:
a. mild
b. extreme
A person unconsciously rejects unacceptable features and projects them to others or other situations.
Immature
a. scapegoating a child
b. Hitler was Jew
Defense Mechanism: DENIAL
Category:
a. mild
b. extreme
Escaping unpleasant realities by ignoring their existence
Psychotic
a. Alcoholic prior to admitting the illness
11. Defense Mechanism: DISTORTION
Category:
a. mild
b. extreme
Psychotic
2 categories of Stress
Physical - illness
Environmental - power lines

Psychological stressors -can be both positive and negative
Cognitive Approaches
journal keeping writing ( Ex. someone that has STSD)
restructuring and setting priorities
COGNITIVE REFRAMING - REFRAIN THE WAY YOU THINK
Humor
Assertive training ( not aggressive)
Most effective Stress Busters
Sleep
Exercise
Reduction of cessation of caffeine intake
Music Pets Massage
Prayer
Stress Leads to Anxiety
Produced by change in Environment
Individual perceives change as
-challenging
-Threatening
-Damaging
Stress leads to a variety of psychological responses
***Anxiety the most common response*****
Categories of Anxiety
-Normal anxiety- healthy life force necessary for survival
-Acute or state anxiety - crisis threatens sense of security
-Chronic or trait anxiety/ Long term anxiety (chronic fatigue, insomnia, poor job performance, and discomfort in relationship
Ex. Mild / Moderate
calm environment, successful coping mechanisms: meditation Ex. virtuous- selfless concern for welfare of others
Mild Anxiety
Good Anxiety

Stress leads to anxiety
Mild/ Moderate
Interventions
-anticipate anxiety
-show interest and support
-Ask questions
-Educate
-Help Establish cause and effect if possible
-What has worked in the past?
Explore alternative solutions
-Suggests outlets for physical and or emotional expression
Sever to Panic
Interventions

No coping
-Stay calm
-Remain with Patient
-Minimize stimuli
-Keep it Simple... may need to repeat
-Keep voices low and slow
- Reinforce reality
Listen for themes
- Attend to physical and safety needs first
-Set limits to maintain safety for all
-Offer PRN's ( anxiety, least restrictive alternatives)
-5 words or less
-Chemical or Physical restraints
5 Properties of Defense Mechanisms
1. Manage conflict and affect
2. RELATIVELY UNCONSCIOUSS, DO IT WITHOUT THINKING, AUTOMATIC REACTION
3. Discrete from one another
4. often hallmarks of psychiatric syndromes, but reversible
5. Adaptive as well as pathological
Most Healthy Defenses
Altruism
Sublimation
Humor
Suppression - realize your thinking it know you are doing it, conscious denial, deal with later
Relief Behaviors
shopping, can be addictive
Immediate Defenses
-Repression - put away, never think of it again
-Displacement
-Reaction Formation
-Somatization
-Undoing
-Rationalization
Immature Defenses
Passive aggression
Acting out of Behaviors
Dissociation
Idealization
Devaluation
Splitting
Projection
Denial
Adaptive
Is the healthy way
Maladaptive
UNhealthy
2 Always have health Use
altruism
sublimination
Kubler- Ross's Stages of Death and Dying
Denial
Anger
Bargaining
Depression'
Acceptance
Controversy with Stage theory of grieving
Palliative Care
Hospice Care
Ensuring client dignity, supporting a peaceful, prain free death, proving patient control and choice, viewing the patient holistically
Available to all regardless to $ situation, age, diagnosis
Nursing Goals
Listening and Observing
THESE ARE FALSE!!!!!!!!!!!
1, hospice care means giving up hope
2. pt must sign a DNR
3. only for cancer pts
4. for pts that close to death or actively dying
Nursing Goals in End of Life Care
-practice observing the clients nonverbal communications
-Ask client open ended questions
-offer a reassuring touch
-Assess for spiritual issues
Provide Palliative
Goal is to relieve a suffering person's pain, nausea
The goals of care are defined by the client or by the clients advance directives and medical proxy
Fears of Dying
Loss of control
Pain
Having it prolonged artificially
Submitting to the suffering of death hospice nurse returns a sense of control to a dying person as well as hope that uncomfortably symptoms can be alleviated.
Core Competence for nursing at the end of life
Knowledge of hot to talk to clients and families about dying
CAREGIVERS value practical information: inform about the illness, how to give medication, effect of medications, how to provide comfort care,