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54 Cards in this Set
- Front
- Back
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Anxiety
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An apprehension, uneasiness, or dread about something and you don’t know exactly why you feel that way, an unrecognized cause
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External stressors
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Originate outside a person (extreme environmental temperature, peer pressure, changes in role).
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General Adaptation Syndrome (GAS)
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A defense response of the whole body to stress
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Internal stressors
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Originate inside a person (fever, pregnancy, and menopause).
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Local Adaptation Syndrome (LAS)
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A physiological response to stress that is a response of a body tissue, organ, or part to the stress of trauma, illness, or other physiological change.
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Role performance
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The way in which an individual perceives his or her competency in carrying out significant roles.
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Self-concept
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- an individual’s knowledge about the self.
- influenced by health, family experiences, social and occupational roles, and intellectual and leisure activities. - a subjective sense of the self and a complex mixture of unconscious and conscious thoughts, feelings, attitudes, and perceptions. |
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Stress
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- Any situation in which a nonspecific demand requires an individual to respond or take action.
- Some stress is positive and even necessary. |
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Stressors
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The stimuli preceding or precipitating the change
examples of identity stressors: – Adolescence: adjustment to physical, emotional, and mental changes of increasing maturity. – Puberty; menarche (initial menstrual period). – Menopause. – Retirement. – Aging/decreasing physical abilities. |
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Psychological needs
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- our relationship with our self is our most intimate relationship, one of the most important aspects of our life experience, yet it is one of the most difficult to define.
- What we think and feel about ourselves affects the way in which we care for ourselves physically and emotionally and the way in which we are able to care for others. |
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examples of Psychological needs
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- Self-esteem (how we feel about ourselves)
- Love (an emotional bond/connection with another person) - Belonging (a sense of belonging) - Hope (without a sense of hope, there is no will to live) - Security - Stimulation |
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components of self concept.
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1) Identity- who you are, what makes you, you (gained from self-observations and from what individuals are told about themselves)
2) Body image- pride in how you look, a mental picture of your physical appearance (internal and external) (culture and society influence the norms of body image) 3) Self-esteem- how you feel about yourself, an individual evaluation of your own worth (influenced by self-evaluation and the response of others) 4) Role performance- roles we assume or follow – Roles: expected behavior patterns associated with one individual’s function in various social groups (Sundeen et al 1998). Roles assumed involve expectations or standards of behavior that have developed in their society or culture. Role development is based on patterns established through socialization. |
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Role conflict
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when a person is required to simultaneously assume two or more roles that are inconsistent, contradictory, or mutually exclusive
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Role ambiguity
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unclear role expectations
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Role strain-
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blends role conflict and role ambiguity
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Role overload
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having more roles or responsibility within a role than is manageable
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ANXIETY:
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• Anxiety is felt in response to stressors.
• Anxiety may be felt in various degrees and manifested in a variety of ways during stress. • Anxiety and fear are different. • Subjective feeling of apprehension that is experienced when the self-identity or essential values are threatened but which has no specific object. |
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FEAR:
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• Is a feeling of apprehension or disaster in response to a specific object
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Ways in which anxiety manifests itself in the body:
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1) Physiological (sweat, increased heart rate)
2) Motor Activity (fighting) 3) Perception and attention changes 4) Verbalization 5) Nonverbal behavior (stroking hair, biting lip) * Stress placed upon the body manifests itself as anxiety. * |
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levels of anxiety
Mild (+1) |
• Psychological: Tension of needs motivates behavior. Adaptive to variety of internal and external stimuli
• Motor Activity: Mild restlessness • Perceptions and attention changes (Cognitive): Increased awareness, attentive, alert, perceptive to variety of stimuli, effective problem solving. • Verbal behavior: Increased questioning to seek information, logical thought, Speech rate and volume are appropriate • Nonverbal behavior: appears alert, confident, and relatively secure • Emotional- No intense feelings; self-concept not threatened, Use of ego adaptive mechanisms minimal, flexible, Behavior appropriate to situation |
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levels of anxiety
Moderate (+2) |
• Psychological: Increased Resp. and Pulse rates, Diaphoresis, sleep and or Eating disorders, irritability
• Motor Activity: Pacing, head shaking, increased muscular tension • Cognitive (Perceptions and attn): Narrowed focus, can focus on what’s happening if directed, tangible problems solved fairly effectively • Verbal behavior: voice tremors, pitch change, increased rate and quantity of speech, expresses feelings of tension, frequent changing of topic, joking, loss of train of thought • Nonverbal behavior: Frequent changes of body position, assumes aggressive body posture • Emotional- Impatient, irritable, forgetful, demanding, crying, angry, uses adaptive mechanisms to protect from feelings and meaning of behavior |
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levels of anxiety
Severe (+3) |
• Psychological: Tachycardia, palpitations, diaphoresis, hyperventilation, Dilated pupils, pallor, dry mouth
• Motor Activity: Immobilization, purposeless activity, hand wringing, increased muscle tension, rigid posture • Cognitive (Perceptions and attn): Distorted perception and sensory input, difficulty concentrating, disoriented to time and place, inability to focus on reality, focus is on scattered details, selective inattention prevails • Verbal behavior: “I can’t stand this”, “I can’t think”, fragmented sentences, inappropriate verbalization, verbalizes pain • Nonverbal behavior: Facial grimaces, stares, lack of eye contact |
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levels of anxiety
Panic (+4) |
• Psychological: Continued assault on CNS may lead to failure
• Motor Activity: may scream and run about wildly, may cling tenaciously to someone or something • Cognitive (Perceptions and attn): Grossly distorted, can’t tell real from unreal, concentration, learning and problem solving are impossible, sensory ability and attention reduced so that only objects of anxiety noticed • Verbalization- May scream, cry, pray. • Nonverbal- May run, hit others, hurt self, thrash limbs. • Emotional- Self-concept overwhelmed; ego defense mechanisms ineffective; behavior often inappropriate and uncontrollable; behavior focused on finding relief. |
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defense mechanisms and their role in reducing anxiety
Psychological Adaptive Behaviors |
- Coping Mechanisms
- Fread came up with |
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defense mechanisms and their role in reducing anxiety
Task Oriented Behaviors |
• Attack behavior is acting to remove or overcome a stressor or to satisfy a need.
• Withdrawal behavior is removing the self physically or emotionally from the stressor. • Compromise behavior is changing the usual method of operating, substituting goals, or omitting the satisfaction of needs to meet other needs or to avoid stress. |
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defense mechanisms and their role in reducing anxiety
- Ego-Defense Mechanisms |
• Unconscious behaviors that offer psychological protection from a stressful event.
• Used by everyone and help protect against feelings of worthlessness and anxiety. • Maladaptive use may lead to self-deception that can interfere with individual growth and personal satisfaction. |
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Consious Defense mechanisms:
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Suppression- Consciously putting something out of your mind, conscious denial of a disturbing situation or feeling.
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Unconscious defense mechanisms:
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- Repression- The exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness.
- Intellectualization- Separating emotion from an idea or thought because emotionally it is too painful. - Rationalization- Explain away, justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations. - Reaction formation- behaving opposite of how we feel to cover anxiety, overcompensation. - Projection- Person unconsciously rejects emotionally unacceptable features and attributes them to other people, objects, or situation. (they don’t like me) - Denial- Failure to recognize unpleasant, unacceptable, or undesirable realities by ignoring their existence. |
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Unconscious defense mechanisms:
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- Sublimation- substituting an acceptable activity for a less acceptable method (using negative behaviors in a positive way)
- Undoing- making up for something you feel you did wrong - Regression- The ego returns to an earlier, more comforting time, although less mature way of behaving. - Compensation- Overachievement in one area to offset deficiencies, real or imagined, or to overcome failure or frustration in another area. - Conversion- Unconscious conflicts are disguised and expressed symbolically by physical symptoms involving portions of the body, especially the five senses and motor areas. Symptoms are frequently not related to innervations by sensory or motor nerves. - Displacement- Release or redirection of feelings and impulses upon a safe object or person as a substitute for that which aroused the feeling. - Identification- Unconscious modeling of another person’s behavior and assuming that person’s qualities, characteristics, and actions. |
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Examples of Subjective data:
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1) Who are the significant others who are important to the patient….Who’s going to help them when they get home?
2) The person’s self description… What do they think of themselves? 3) Home environment….Where and how do they live 4) What are their coping mechanism’s….the positive things they do to relieve anxiety 5) Occupation/Education… 6) Financial resources 7) Philosophy, Religion, Values, Ethnicity 8) Health care insurance |
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Examples of Objective data:
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1)General appearance…. Sex, Age, Size, Skin color, What is their dress and grooming.
2) Attitude (the position one takes towards others or an issue) 3) Affect emotional state: happy, calm, relaxed, euphoric, depressed, edgy facial expression: flat, angry, defensive, sad, anxious 4) Speech/language 5) Nonverbal behavior 6) Interaction with others 7) General information- What do they know of the world outside themselves? 8) Orientation 9) Memory 10) Thought- Can they stay with the conversation? 11) Insight 12) Judgment |
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types of stressors:
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- stressors affecting self concept
- stressors affecting self concept - identity stressors - identity confusion - body immage - self esteem - role stressors - role amiguity- unclear expectations - role strain- inadequate - role overload - sick role |
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Nursing Diagnoses
stress: |
– Anxiety
– Caregiver role strain – Ineffective coping – Fatigue – Fear – Risk for injury – Sleep pattern disturbance |
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Nursing Diagnoses
Alteration in Self-Concept |
– Anxiety
– Body image disturbance – Denial – Hopelessness – Risk for loneliness – Altered role performance – Self-Esteem disturbance; low – Risk for self-directed violence |
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Self-concept is linked to job performance and satisfaction in what developmental stage?
A. Early childhood B. Adolescence C. Young adulthood D. Older adulthood |
c. Young adults are involved in career building, and success or failure in the job has significant effects on self-esteem.
a. Self-concept in early childhood is related to praise and recognition for the child's accomplishments in school. b. Self-esteem in adolescence is related to acceptance by peers and by appearance. d. Older adults' self-esteem is affected by feelings of usefulness and value but is not necessarily job related. |
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The awareness of being a unique person distinct and separate from others is typically related to which component of self-concept?
A. Identity B. Body image C. Role performance D. Sense of competency |
a. Identity is the feeling of wholeness, of being a separate and unique individual.
b. Body image refers to feelings about the appearance, structure, or function of the body. a. Role performance is the ability of a person to fulfill certain roles in his or her life. b. Competency is how well a person feels he or she performs a role or task. |
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The nurse determines that the self-concept of an older adult client is at risk when the client reports that:
A. His family counts on him to plan the family reunion. B. He manages his retirement money and investments. C. He was asked to train some new employees where he works. D. His family plans an outing to look at some assisted-living facilities. |
d. Loss of independence and feelings of usefulness are major threats to the self-concept of the older adult.
a. Expectations of family and society give the older adult a sense of belonging and usefulness. b. The older adult who is able to manage his or her own affairs has higher self-esteem and feeling of worth. c. Serving as a guide to younger generations promotes generativity and increases self-esteem. |
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The nurse recognizes that a client is experiencing role performance stress when the client:
A. Expresses difficulty managing a career and a family B. Has had a failed marriage C. Has been diagnosed with a chronic condition D. Reports symptoms of postpartum depression |
a. This is a conflict involving the roles of the young adult.
b. This involves self-esteem rather than role. c. Chronic illness is a threat to body image. d. A change in health is a stressor affecting self-concept. |
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A client is admitted following an amputation of his leg. A priority consideration of the nurse in dealing with the client’s altered self-concept is that the nurse:
A. Speaks to the client through the family members B. Makes decisions for the client until the client is discharged C. Becomes aware of his or her own identity, values, and beliefs D. Keeps the affected limb covered to avoid embarrassment |
c. A nurse can only be effective if he or she is comfortable with his or her own identity.
a. The nurse should speak directly to the client and include the family. b. The client should always be included in the decisions made in his care. c. The nurse should convey acceptance by looking at and talking openly about the amputation. |
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During an assessment interview the nurse observes the following client behaviors. Which one could be indicative of a poor self-concept?
A. Using humor during the interview B. Expressing a strong opinion about the cost of health care C. Looking down at the floor during the interview D. Apologizing for being late to the appointed time for the interview |
c. Avoidance of eye contact is suggestive of altered self-concept.
a. Humor is a healthy emotion and indicates self-confidence. b. Being confident instead of passive or hesitant to express opinions indicates good self-concept d. Being overly apologetic might indicate poor self-concept, whereas a polite apology for lateness would be appropriate. |
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A client says, “I’m no good to anyone anymore.” The nurse’s best response should be:
A. “Why would you say something like that?” B. “Tell me what you mean.” C. “I know how you must feel.” D. “Oh, you know how important you are.” |
b. The nurse should explore further. This encourages the client to discuss the feelings behind the statement.
a. This is a block to communication and belittles what the client has said. c. The nurse may be trying to empathize, but it is not appropriate to change the focus away from the client d. This is a block to communication. It expresses disbelief or not accepting what the client has said. |
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A middle-adult woman who lives with and takes care of her aged mother is given the nursing diagnosis “caregiver role strain.” An appropriate goal for this diagnosis should be:
A. The client will deal with her stress in appropriate ways. B. The nurse will teach the client four actions to deal with stress. C. The client’s mother will decrease the demands made on her daughter. D. The client will identify two community resources that offer respite care. |
d. The goal is specific, client-centered, and measurable.
a. The goal is not specific. What would be "appropriate" ways to handle stress? b. The goal should be written in terms of the client, not the nurse. c. Goals should be client-centered. This one focuses on the mother. |
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Desirable outcomes when evaluating a client with low self-esteem following a stroke should include:
A. The client asks the nurse to write down the schedule for his or her physical therapy. B. The family members take shifts to care for the client’s needs. C. The client bathes himself or herself but does not include the paralyzed leg. D. The client changes the subject when the nurse talks about the stroke. |
a. This shows a positive move by the client that he or she is dealing with the problem and accepting.
a. Desirable outcome would be for the client to participate in his or her own care. b. The client should begin to acknowledge the affected leg . c .This indicates that the client is not able to deal with his or her condition. This is indicative of low self-esteem. |
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10. A client with a goal to improve self-esteem continues to avoid eye contact and is hesitant to talk about his or her feelings. The most likely reason that the goal is unmet is that:
A. The goal is unrealistic for adult clients. B. More time is needed to meet the goal. C. Self-esteem cannot be changed. D. The nurse is from a different culture than the client. |
b. Changes in self-esteem occur slowly over time with continued intervention.
a. There is no indication that the goal is unrealistic. Adult or child is irrelevant. c. elf-esteem can change, but does so over time. d. he nurse from a different culture should be aware of his or her own beliefs, values, etc., but is fully capable of helping clients of any culture to set and meet goals. |
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Increased blood volume, heart rate, blood glucose levels, and increased mental alertness occur during which part of the general adaptation syndrome (GAS)?
A. Alarm reaction B. Resistance stage C. Exhaustion stage D. Situational crisis |
a. The general adaptation syndrome is divided into a three-stage reaction to stress. The first stage is the alarm reaction. It is characterized by an increase in hormone levels leading to the initiation of fight-or-flight.
b. During the resistance stage of the GAS, the body stabilizes itself and responds in an opposite manner to the alarm reaction. It is during this time that the body repairs any damage that may have occurred; however, if stress continues and there is no adaptation, the client will enter the third stage. c. The body reaches the exhaustion stage when the body can no longer resist the effects of the stressor and when the energy necessary to maintain adaptation is depleted. The body can no longer defend itself against the impact of stressful events, and if this situation continues, death may result. d. A situational crisis is not part of the GAS. |
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A client presents to an outpatient psychiatric unit complaining of frequent flashbacks and nightmares. The nurse listens attentively to her client as he describes vividly his military duties during the Vietnam War. This information leads the nurse to believe the client is experiencing_____________.
A. Bipolar disorder B. Chronic depression C. Posttraumatic stress disorder D. Developmental crisis |
c. Posttraumatic stress disorder is a psychiatric disorder that is a result of a trauma the effects of which may last well after the traumatizing event ends. It may have a delayed onset longer than 4 weeks and persist longer than 1 month.
a. A bipolar disorder is characterized by episodes of mania and depression. It is not typically initiated by a traumatizing event. b. Chronic depression is an emotional condition characterized by feelings of hopelessness and inadequacy that is long-term. d. A developmental crisis is associated with changing developmental levels and is not associated with a traumatizing event. |
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A client’s effort to manage psychological stress is known as _____________.
A. Secondary appraisal B. Coping C. Primary appraisal D. Distress |
b. Coping is a client's ability to take action to change a stressful situation and successfully deal with the pressure of stress.
a. Secondary appraisal is the tool a client uses to identify the appropriate coping strategy for stress that is already present. c. Primary appraisal is the ability of the client to evaluate an event for its personal meaning and how the stress will affect the body in the long-term. d. Distress is not associated with coping; it is a type of damaging stress. |
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The theory of nursing that views the person, family, or community as constantly changing in response to the environment and stressors is known as_______________.
A. Neuman’s systems model B. Pender’s health promotion model C. Situational crisis theory D. Hans Selye’s general adaptation syndrome |
a. Neuman's systems model is based on the concepts of stress and reaction to stress.
b. Pender's health promotion model focuses on increasing the level of well-being of an individual or group by encouraging stress reduction strategies. c. Situational crisis theory does not exist as a theory; however, a situational crisis is described as a person facing a turning point in life. d. Han's Selye's general adaptation syndrome is a three-stage reaction that the body experiences after being initiated by stress. |
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Initially, it is imperative that the nurse establish a _________ with the client in order to adequately interview the client.
A. Defense mechanism B. Trusting relationship C. Coping strategy D. Judgmental attitude |
b. Development of a trusting relationship with a client is imperative. This allows the client to feel comfortable and more open to verbalize concerns about his or her stress.
a. Defense mechanisms are used to regulate emotional distress and give a person protection from anxiety and stress. They are not associated with the assessment process. c. This answer does not fit within the sentence. Coping strategies are dependent upon the individual's needs, and the nurse can assist the client in developing strategies to better cope with their stress. d. If a nurse uses a judgmental attitude when obtaining a health history from a client, the client may feel threatened and will not disclose vital information important for proper diagnosis and treatment of his or her problem. |
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The anterior pituitary gland is stimulated to secrete _____________, which in turn stimulates the adrenal gland to release cortisol.
A. Adrenocorticotropic hormone (ACTH) B. Thyroid-stimulating hormone (TSH) C. Parathyroid hormone (PTH) D. Follicle-stimulating hormone (FSH) |
a. The hypothalamus releases corticotropin-releasing hormone, which stimulates the pituitary gland to secrete ACTH, which in turn stimulates the adrenal gland to secrete cortisol. If a problem arises during this sequence of events, the adrenal gland may shut down, causing no cortisol to be released. This can be detrimental to a client's health, especially during a stressful situation because cortisol assists the body in combating stress.
b. Thyroid-stimulating hormone is not associated with being a stress hormone. It is responsible for stimulating the thyroid gland. c. Parathyroid hormone is not associated with stress. d. Follicle-stimulating hormone is not associated with stress; however, it is secreted by the pituitary gland to stimulate the testes in the male and ovaries in the female. |
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Which of the following systems recognizes bacteria as a threat or stress to the body and attacks them?
A. The gastrointestinal system B. The reproductive system C. The circulatory system D. The immune system |
d. The immune system is also involved in the stress response. Physiological responses to stress include immunological responses, and research has shown that when the body is in a prolonged state of stress, illness ensues.
a. The gastrointestinal system is not a part of the stress response. b. The reproductive system is not typically affected by the stress response. c. The circulatory system is affected by the stress response during the alarm reaction stage of the GAS. |
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Physiological signs of stress that occur during the early stage of the general adaptation syndrome include all of the following except?
A. Increased blood pressure B. Increased respiratory rate C. Impaired mentation D. Increased pulse rate |
c. Impaired mentation is not considered an early physiological response to stress; however, mental alertness does occur during the early stage.
a. Blood pressure increases during the alarm stage of the GAS. The medulla oblongata sends messages throughout the body to increase and decrease vital functions such as the blood pressure as necessary. b. Respiratory rate increases during the alarm stage of the GAS. The medulla oblongata sends messages throughout the body to increase and decrease vital functions such as the respiratory rate as necessary. d. The pulse rate increases during the alarm stage of the GAS. Again, the medulla oblongata is responsible for this reaction. |
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The nurse assists a client in connecting a stressful event with the client’s reaction to the event; this approach is known as _______________.
A. Evaluative care B. Problem solving C. Situational intervention D. Crisis intervention |
d. Crisis intervention aims to return the client to a precrisis level of functioning and to promote growth.
a. Evaluative care is not a method of intervention; however, evaluation is a method of determining if the goals and expected outcomes of care set forth by the nurse and client are working. b. Problem solving does not fit as an answer; however, the nurse may assist the client with ways of coping with problems. c. Situational intervention is not an appropriate term; crisis intervention is a specific type of brief psychotherapy with prescribed steps. |
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Stress that is considered damaging is known as _____________.
A. Eustress B. Crisis C. Distress D. Fight-or-flight response |
c. Distress is considered damaging stress that a client may have problems coping with.
a. Eustress is defined as stress that leads to motivating energy, such as happiness, hopefulness, and purposeful movement. b. Crisis is a turning point in life that may be developmental or situational. d. The fight-or-flight response is arousal of the sympathetic nervous system. |
