potter Chapter 37: Stress and Coping

The nurse is interviewing a patient in the community clinic

and gathers the following information about her: she is intermittently homeless, a single parent with two children who have developmental delays. She has had asthma since she was a teenager. She does not laugh or smile, does not volunteer any information, and at times appears close to tears. She has no support system and does not work. She is experiencing an allostatic load. As a result, which of the following would be present during complete patient assessment? (Select all that apply.)

1. Post-traumatic stress disorder

2. Rising hormone levels

3. Chronic illness

4. Insomnia

5. Depression

3. Chronic illness

4. Insomnia

5. Depression

An increased allopathic load can result in longterm physiological and psychological problems such as chronic illness, depression, sleep deprivation, chronic fatigue syndrome, and autoimmune disorders. Post-traumatic stress disorder results from a single traumatic event. Hormone levels rise in the alarm stage.

A patient who is having difficulty managing his diabetes mellitus responds to the news that his hemoglobin A1c, a measure of

blood sugar control over the past 90 days, has increased by saying,

"The hemoglobin A1c is wrong. My blood sugar levels have been

excellent for the last 6 months." Which defense mechanism is the

patient using?

1. Denial

2. Conversion

3. Dissociation

4. Displacement

1. Denial

Denial is avoiding emotional stress by refusing to consciously acknowledge anything that causes intolerable anxiety. This patient's statements reflect denial about poorly controlled blood sugars.

When assessing a young woman who was a victim of a home invasion 3 months earlier, the nurse learns that the woman has vivid images of the event whenever she hears loud yelling or a sudden noise. The nurse recognizes this as ____________.

Post-traumatic stress disorder (PTSD).

PTSD originates with a person's experiencing or witnessing a traumatic event and responding with intense fear or helplessness. The home break-in is the traumatic event that is causing intense fear and/or flashbacks when the noises of the break-in are replicated.

While assessing an older woman who is recently widowed, the

nurse suspects that this woman is experiencing a developmental

crisis. Which questions provide information about the impact of

this crisis? (Select all that apply.)

1. With whom do you talk on a routine basis?

2. What do you do when you feel lonely?

3. Tell me what your husband was like.

4. I know this must be hard for you. Let me tell you what might

help.

5. Have you experienced any changes in lifestyle habits, such as

sleeping, eating, smoking, or drinking?

1. With whom do you talk on a routine basis?

2. What do you do when you feel lonely?

5. Have you experienced any changes in lifestyle habits, such as sleeping, eating, smoking, or drinking?

A developmental crisis occurs as a person moves through the stages of life, including widowhood. It is important to gather information about how this crisis affects the woman's interactions, how she is currently coping with loneliness, and any changes in her lifestyle habits. Although losing her husband is a source of stress, discussing him now does not focus on her current situation. Saying "I know this must be hard for you. Let me tell you what might help" is unacceptable because the purpose of assessment is to gather data and let the patient tell his or her story

The nurse plans care for a 16-year-old male, taking into consideration that stressors experienced most commonly by adolescents

include which of the following? (Select all that apply.)

1. Loss of autonomy caused by health problems

2. Physical appearance and body image

3. Accepting one's personal identity

4. Separation from family

5. Taking tests in school

2. Physical appearance and body image

3. Accepting one's personal identity

4. Separation from family

5. Taking tests in school

As adolescents search for identity with peer groups and separate from their families, they also experience stress. In addition, they face stressful questions about sex, jobs, school, career choices, and using mind-altering substances. During this stage of development, stress can occur because of a preoccupation with appearance and body image. A loss of autonomy caused by health problems usually applies to the older adult.

A 10-year-old girl was playing on a slide at a playground during a

summer camp. She fell and broke her arm. The camp notified the

parents and took the child to the emergency department according to the camp protocol for injuries. The parents arrive at the

emergency department and are stressed and frantic. The 10-yearold is happy in the treatment room, eating a Popsicle and picking

out the color of her cast. List in order of priority what the nurse

should say to the parents.

1. "Can I contact someone to help you?"

2. "Your daughter is happy in the treatment room, eating a Popsicle and picking out the color of her cast."

3. "I'll have the doctor come out and talk to you as soon as possible."

4. "I want to be sure you are ok. Let's talk about what your concerns are about your daughter before we go see her."

Answer: 2, 4, 3, 1.

2. "Your daughter is happy in the treatment room, eating a Popsicle and picking out the color of her cast."

4. "I want to be sure you are ok. Let's talk about what your concerns are about your daughter before we go see her."

3. "I'll have the doctor come out and talk to you as soon as possible."

1. "Can I contact someone to help you?"

First and most important the parents need to know the immediate status of their daughter. Letting them know the situation will help to relieve their immediate stress. Second, helping the parents discuss their concerns will reduce their stress and will allow them to see their daughter without increasing the 10-year-old's anxiety. Third, let the parents know that you recognize their need to talk to the doctor as soon as possible and that you will act as their advocate to get that accomplished. Last, but also important, you want to ask whether there is anyone you can call to help. There may be children who need to be picked up from camp/ day care, for example, and a neighbor or grandparent may be able to assist.

When assessing an older adult who is showing symptoms of anxiety, insomnia, anorexia, and mild confusion, what is the first assessment the nurse conducts?

1. The amount of family support

2. A 3-day diet recall

3. A thorough physical assessment

4. Threats to safety in her home

3. A thorough physical assessment

Stress often causes symptoms similar to physical illnesses. Physical causes for problems need to be investigated and treated before treatment for stress-related symptoms can be initiated.

A 34-year-old single father who is anxious, tearful, and tired from

caring for his three young children tells the nurse that he feels

depressed and doesn't see how he can go on much longer. Which

statement would be the nurse's best response?

1. "Are you thinking of suicide?"

2. "You've been doing a good job raising your children. You can

do it!"

3. "Is there someone who can help you during the evenings and

weekends?"

4. "Tell me what you mean when you say you can't go on any longer."

4. "Tell me what you mean when you say you can't go on any longer."

You need to get information about what the gentleman means when he says he can't go on any longer. He might be thinking of turning his children over to a grandparent or seeking other child-care arrangements. Asking about suicide initially might be premature. Asking "Are you thinking of suicide?" prematurely might shut the patient down entirely. If the patient talks about suicide, for safety reasons it is very important to further discuss his suicidal thoughts and refer to the appropriate health care professional. Asking the open-ended question provides an opportunity to understand what the person is thinking and open lines of communication.

The nurse is evaluating how well a patient newly diagnosed with

multiple sclerosis and psychomotor impairment is coping. Which

statements indicate that the patient is beginning to cope with the

diagnosis? (Select all that apply.)

1. "I'm going to learn to drive a car, so I can be more independent."

2. "My sister says she feels better when she goes shopping, so I'll

go shopping."

3. "I'm going to let the occupational therapist assess my home to

improve efficiency."

4. "I've always felt better when I go for a long walk. I'll do that

when I get home."

5. "I'm going to attend a support group to learn more about multiple sclerosis."

3. "I'm going to let the occupational therapist assess my home to improve efficiency."

5. "I'm going to attend a support group to learn more about multiple sclerosis."

Inviting the occupational therapist into the patient's home and attending support groups are early indicators that the patient is recognizing some of the challenges of the disease and participating in positive realistic activities to cope with the stressors related to changes in physical functioning. The other options relate to independence and other coping strategies but do not address coping with the specific challenges of the disease

A crisis intervention nurse is working with a mother whose child

with Down syndrome has been hospitalized with pneumonia and

who has lost her child's disability payment while the child is hospitalized. The mother worries that her daughter will fall behind in

her classes during hospitalization. Which strategies are effective in

helping this mother cope with these stressors? (Select all that apply.)

1. Referral to social service process reestablishing the child's disability payment

2. Sending the child home in 72 hours and having the child

return to school

3. Coordinating hospital-based and home-based schooling with

the child's teacher

4. Teaching the mother signs and symptoms of a respiratory tract

infection

5. Telling the mother that the stress will decrease in 6 weeks when

everything is back to normal

1. Referral to social service process reestablishing the child's disability payment

3. Coordinating hospital-based and home-based schooling with the child's teacher

4. Teaching the mother signs and symptoms of a respiratory tract infection

The stressors for this parent are her child's illness, missing school, and loss of disability payments. Obtaining resources to resolve these stressors will reduce the mother's stress load and allow her to focus on helping her child improve and on preventing another respiratory tract infection. Discharging the child in 72 hours with a return to school may not be best for the child's physical condition and may make the situation worse. Giving the mother a 6-week time frame is unrealistic because everyone's time frame is different. The mother may also need to adjust.