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NUR 276 FINAL EXAM STUDY GUIDE WITH COMPLETE SOLUTION
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NUR 276 FINAL EXAM STUDY GUIDE WITHCOMPLETE SOLUTION
Be able to explain the relationship between the concepts of stress and
coping, cellular regulation, and oxygenation/perfusion - ANSWER
*Respiratory*: Increased ventilatory rate and depth of respirations, dilation of
bronchioles to facilitate increased oxygenation
*Cardiac*: Increased heart rate and cardiac output to promote transport of
oxygen and nutrients throughout the body
*Integumentary*: Increased sweat production (diaphoresis) to offset
increased body temperature secondary to increased metabolism; skin pallor
secondary to vasoconstrictive effects of norepinephrine
*GI*: inhibition of the parasympathetic nervous system leads to decreased
motility of gastric and intestinal contents (peristalsis) through the
gastrointestinal tract, which may cause constipation and exccess flatus
(intestinal gas); dry mouth due to decreased salivation secondary to
inhibition of the parasympathetic nervous system.
*Urinary*: Increased sodium and water retention due mineralocorticoid
release, which leads to decreased urine output and increased blood volume
*Opthalmic*: Pupillary dilation to allow entrance of more light and enhanced
visual perception
Neurological: Enhances awareness and alertness in response to severe threats
*Musculoskeletal*: Increased muscular tension in preparation for defense
(flight) or rapid mobility (flight)
,*Endocrine*: Increased release of glucocorticoids and increased
gluconeogenesis, which leads to an increased serum glucose (blood sugar)
What lab values are affected by stress and know why (Page 1903) - ANSWER
Stress Response causes
research suggests that peer rejection stimulates an increase in systolic blood
pressure and in the production of saliva a-amylase (sAA), which is an enzyme
that is reflective of sympathetic nervous system activation. Additionally,
stressors related to performance-based challenges were associated with
increased cortisol production and increased diastolic blood pressure
1. Release of *catecholamines* and *epinephrine* and *norepinephrine*. This
causes an increase in blood pressure and heart rate.
2. Release of *glucocorticoids* and increased gluconeogenesis
3. Increased serum glucose-increased risk for hyperglycemia and poor
glucose control in clients with diabetes
prolonged exposure to stress may lead to significant enlargement of the
adrenal glands and pronounced shrinkage (atrophy) of the lymphatic
structures, including the lymph nodes, thymus, and spleen. Additionally,
within the gastrointestinal tract, ulcers may develop.
the sympathetic nervous system triggers the body's "fight-or-flight"
response, which is necessary for survival. Activation of the sympathetic
nervous system causes release of hormones such as epinephrine, which
increases the heart rate and blood pressure to assist in the delivery of oxygen
to tissues and organs. Epinephrine also causes bronchial dilation, which
allows for increased oxygen uptake. This increase in oxygen uptake and
delivery is intended to meet the increased metabolic demands associated
,with facing a stressor (fight) or escaping the stressor (flight).
Local Adaptation Syndrome (LAS):
1. Alarm reaction: Body prepares for cascade of physiological reactions
2. Resistance: Body attempts to move toward restoration of homeostasis
3. Exhaustion: Energy and resources become depleted, body may rebound or
disease/death may occur
epinephrine- increased heart rate
Know how the nurse should interact/intervene with a client experiencing
anxiety or stress (Page 1906) - ANSWER Initial nursing actions that inspire
client confidence and that may help calm anxious clients:
1. Make eye contact, focusing on the person
2. Take a nonthreatening stance
3. Validate the client's feelings: "I know you are very uncomfortable; we will
do everything we can to help you feel better."
4. Determine and address the client's immediate concerns: "What can I do
right away to help you?"
5. Remember to address the client by name. Some clients find terms of
endearment such as "honey" or "sweetie" impersonal or demeaning. Using
the client's first name may be seen as patronizing if the client is expected to
use the nurse's last name. On the other hang, some clients respond positively
to the informality of first name use. Ask clients how they would prefer to be
addressed and never use the first name of anyone over 18 without
permission.
, 6. Recognize and acknowledge manifestations of stress
7. Identify health coping mechanisms, including ensuring adequate time
aware from the workplace and incorporation of recreational activities into
personal life
8. Seek out support and assistance when needed
9. Interview the client regarding level of anxiety and encourage open
expression of concerns and emotions.
a. the nurse acquires information about the individual; about the individual
prioritizes and appraises stressors. The nurse critically evaluates thoughts
that may be increasing the person's anxiety.
b. Levels of anxiety range from mild to panic. Because the individual is
unable to take in new information during these stages, interventions focus
on reducing the anxiety level prior to providing new information.
c. IMMEDIATE INTERVENTIONS: reducing exposure to stimuli and providing
comfort measures to assist in reducing symptom severity. Once anxiety level
has decreased additional interventions to reduce anxiety such as med
Know nursing diagnoses related to stress and coping - ANSWER Client with
phobia: Anxiety, Fear, Ineffective Health maintenance, Deficient Knowledge,
Ineffective Coping
Client with OCD: Anxiety, fear, ineffective coping, stress overload, disturbed
sleeping pattern, insomnia, fatigue, deficient knowledge, risk for caregiver
role strain
Client in a state of crisis: Risk for self-harm, risk for injury, ineffective
self-health management, anxiety, ineffective coping, social isolation,
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