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NS 320 EXAM 2 STUDY GUIDE
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NS 320 EXAM 2 STUDY GUIDE
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CHAMBERLAIN COLLEGE OF NURSINGNS 320 EXAM 2 STUDY GUIDE
Chapter 1: Stress and Stress Adaption
Stress may be viewed as an individual’s reaction to any change that requires an adjustment or
response, which can be physical, emotional, and or mental. Responses directed at stabilizing
internal biological processes and preserving self-esteem can be viewed as health adaptions to
stress.
Seyl’s “Fight or Flight” model is commonly cited (see Figure 1-1 on pg 3).
Three distinct stages:
1. Alarm reaction stage; during this stage, the physiological response of the “fight or flight”
syndrome are initiated
2. Stage of Resistance; the individual uses the physiological responses of the first stage as a
defense in the attempt to adapt to the stressor. If adaptation occurs, the third stage is
prevented or delayed. Physiological symptoms may disappear
3. Stage of Exhaustion ; this stage occurs when there is a prolonged exposure to the stressor
to which the body has become adjusted. The adaptive energy is depleted, and the
individual can no longer draw from the resources for adaptation described in the first two
stages. Disease of adaptation (headaches, mental disorders, coronary artery disease,
ulcers, colitis) may occur. Without intervention for reversal, exhaustion, and in some
cases even deah can ensue (reserves are gone and can lead to death).
Useful theory if thinking of cavemen fighting off bears or aliens….afterwards (if the
caveman survived) restored to a sense of homeostasis and learned from the situation as a
basis for coping.
This is why our mothers told us that if we could survive something really bad we often came
out of the situation as stronger people.
The survival part of adaption has a lot to do with temperament, resources, and our own innate
quality of resilience.
The resilience factor is why some children survive in extremely stressful situations and keep
on functioning; ex. growing up in a brothel.
In terms of stress as an environmental event look at table 1-1 on pg 5 (recent life changes that
may place the individual at risk for illness of some kind. Be aware that a modern concept of
stress emphasizes the relationship between the individual and the environment. Some
precipitating event is a stimulus arising in the environment and is perceived by the individual
in some manner ….primary appraisal (a threat, something harmful or simply challenging or
loss of some kind)…secondary appraisal (how will I cope?).
Adaptation: occurs when an individual’s physical or behavioral response to any change in his or
her internal or external environment results in preservation of individual integrity or timely
return to equilibrium.
Maladaption (mental health problems for example…suicidal thoughts over sudden loss of a
child) occurs when the individual’s physical/behavioral response throws them into some sort of
disequalibration, a disruption of individual integrity
Key Adaptive Coping Strategies
, Awareness Interpersonal Music
Relaxation communication Prayer or some sort
Meditation with Caring Other of fellowship where
Problem-Solving you are not alone
Pets
Peplau’s 4 levels of anxiety:
Mild
o seldom a problem/heightened awareness
o normal response to day to day living
Moderate
o less alert to events occurring in environment around them/more tense
o attention span and ability to concentrate decreases
o assistance with problem solving may be needed
o muscular tension and restlessness are evident
Severe
o focuses on one detail with limited attention span
o difficulty completing a simple task
o physical symptoms (headaches, palpitations, insomnia)
o overt behavior is aimed at relieving anxiety
Panic
o most intense state
o may experience hallucinations or delusions
o characterized by wild or extreme actions
o feelings of terror and loosing control
o can be life threatening.
o Key nursing intervention is to take control of the situation for the client and
keep them safe.
Important to identify triggers to avoid stress
CHAMBERLAIN COLLEGE OF NURSING
NS 320 STUDY GUIDE-DR. RICE
CHAPTER 13: CRISIS INTERVENTION
When stress or stressful situations drive an individual to disequilibrium to the point where it
becomes a crisis in their lives we do crisis intervention.
Individuals who are in crisis feel helpless to change. They do not believe they have the
resources to deal with the precipitating stressor.
Levels of anxiety rise to the point that the individual becomes nonfunctional, thought
become obsessional, and all behavior is aimed at relief of the anxiety being experienced.
The feeling is overwhelming and may affect the individual mentally, emotionally, and/or
physically.
See phases of the development of a crisis as a general guide as to how things manifest…be
aware that an individuals response to a stressful situation or crisis depends on
, 1. The individual’s perception of the event: if the event is perceived realistically the
individual is more likely to draw upon adequate resources to restore equilibrium. If the
perception of the even is distorted, attempts at problem solving are likely to be
ineffective, and restoration of equilibrium goes unresolved
2. The availability of situational supports: Aguilera stated, “ Situational supports are
those persons who are available in the environment and who can be depended on to help
solve the problem”. Without adequate situational supports during a stressful situation, an
individual is most likely to feel overwhelmed and alone
3. The availability of adequate coping mechanisms: when a stressful situation occurs,
individuals draw upon behavioral strategies that have been successful for them in the
past. If these coping strategies work, a crisis may be diverted. If no, disequilibrium may
continue
(THIS IS WHY WE NURSES ALWAYS ASSESS HOW A PERSON DOES
COPE….historical coping patterns… AS IT GIVES US SOMETHING TO WORK ON OR
BUILD ON WITH THE PATIENT WHO IS IN A MENTALLY UNHEALTH STATE).
See power point and pg 240-242:
types of crisis (ex. of interest to us because we see them in our clinical setting; these are the ones
hospitalized (often involuntary) or jailed-psychiatric emergencies- (suicidal or homicidal
individuals; overdose; uncontrollable anger; alcohol intoxication).
1. Dispositional Crises: an acute response to an external situational stressor
a. Ex: Nancy and Ted have been married for 3 years. Ted is having difficulty at
work. Last night Ted came home angry and punched Nancy until she was fearful
for her life
2. Crisis of Anticipated Life Transitions: normal life-cycle transitions that may be
anticipated but over which the individual may feel a lack of control
a. Ex: college student is placed on academic probation, but tuition has increased so
he now needs to work full time
3. Crises resulting from Traumatic Stress: crisis precipitated by unexpected external
stresses over which the individual has little or no control and as a result of which he or
she feels emotionally overwhelmed and defeated
a. Ex: Sally is a waitress who needed to work late on Tuesday. On her way to her car
she was abducted and raped. She is constantly fearful and relived the experience
in flashback and dreams.
4. Maturational/Developmental Crises: crises that occur in response to situations that
rigger emotions related to unresolved conflicts in one’s life. These crises are of internal
origin and reflect underlying developmental issues that involve dependency, value
conflicts, sexual identity, control, and capacity for emotional intimacy
a. Ex: Bob is 40 years old. He is angry at work and alienates himself. He has been
passed up on 3 promotions because he has become passive-aggressive. His father
was domineering and became abusive when bob did not comply with his every
command.
5. Crises Reflecting Psychopathology: emotional crises in which preexisting
psychopathology has been instrumental in precipitating the crisis or in which
psychopathology significantly impairs or complicates adaptive resolution.
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