Content check — Fundamentals of Nursing, Chapter 34: Stress, Adaptation, and Homeostasis

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Chapter 34: Stress, Adaptation, and Homeostasis

6 problems · 0 figures

Case Study 34.1.1 §34.1 source ↗

Refer to Chapter 33 Sexuality for Unfolding Case Study Parts 1 and 2 to review the patient data. Mr. Morales, a 46-year-old male, is being seen in the clinic for an annual wellness examination. During the examination, Mr. Morales reports that he has been having trouble achieving and maintaining erections during sex. He states, “My wife is getting frustrated and so am I. I’m not even that old yet. Why is this happening to me?”

Past Medical History	Medical history: Type 2 diabetes, hypertension, depression Family history: Both parents alive and well, mother has hypertension and depression Social history: Married twenty years, two teenage children. Wife recently diagnosed with breast cancer. Current medications: • Fluoxetine (Prozac) 20 mg PO daily • Metoprolol (Lopressor) 50 mg PO twice daily
Assessment	1000: Neurological: Alert and oriented ×4 Respiratory: Clear lung sounds, normal breathing pattern Cardiovascular: Tachycardia, bounding pulses, trace edema noted in bilateral lower extremities Abdominal: Bowel sounds present in all four quadrants, no pain or tenderness noted Musculoskeletal: Full range of motion in all joints, bilateral muscle strength of extremities equal Integumentary: Skin warm, dry, and intact
Flow Chart	1030: Blood pressure: 155/92 mm Hg Heart rate: 103 beats/min Respiratory rate: 20 breaths/min Temperature: 98°F (36.6°C) Oxygen saturation: 99 percent on room air Pain: No pain reported at this time
Nursing Notes	1035: Patient expresses concern about erectile dysfunction (ED). He reports frustration about being unable to participate fully in sexual intercourse with his wife. He reports his wife is also frustrated with the situation, especially given her new diagnosis of breast cancer. He states, “I don’t want to start taking Viagra in my 40s. That’s just embarrassing. Surely there is something else I can do. My wife thinks I don’t want to have sex with her because she has cancer, which isn’t even remotely true. My body is failing me.” When asked about other potential contributing factors, patient reports experiencing a significant amount of stress at work lately, and worry about how he will afford his wife’s cancer treatments.

Recognize cues: Based on the assessment findings and nursing notes, what cues are the most important for the nurse to recognize?

Answer

First, the nurse recognizes the patient’s blood pressure and heart rate are both elevated. Additionally, the patient expresses concern about being unable to participate in sexual activity with his wife due to ED symptoms. The nurse should also recognize the patient has been under a lot of stress at work and is experiencing stress related to his wife’s cancer diagnosis, which could be contributing to some of his symptoms.

Case Study 34.1.2 §34.1 source ↗

Past Medical History	Medical history: Type 2 diabetes, hypertension, depression Family history: Both parents alive and well, mother has hypertension and depression Social history: Married twenty years, two teenage children. Wife recently diagnosed with breast cancer. Current medications: • Fluoxetine (Prozac) 20 mg PO daily • Metoprolol (Lopressor) 50 mg PO twice daily
Assessment	1000: Neurological: Alert and oriented ×4 Respiratory: Clear lung sounds, normal breathing pattern Cardiovascular: Tachycardia, bounding pulses, trace edema noted in bilateral lower extremities Abdominal: Bowel sounds present in all four quadrants, no pain or tenderness noted Musculoskeletal: Full range of motion in all joints, bilateral muscle strength of extremities equal Integumentary: Skin warm, dry, and intact
Flow Chart	1030: Blood pressure: 155/92 mm Hg Heart rate: 103 beats/min Respiratory rate: 20 breaths/min Temperature: 98°F (36.6°C) Oxygen saturation: 99 percent on room air Pain: No pain reported at this time
Nursing Notes	1035: Patient expresses concern about erectile dysfunction (ED). He reports frustration about being unable to participate fully in sexual intercourse with his wife. He reports his wife is also frustrated with the situation, especially given her new diagnosis of breast cancer. He states, “I don’t want to start taking Viagra in my 40s. That’s just embarrassing. Surely there is something else I can do. My wife thinks I don’t want to have sex with her because she has cancer, which isn’t even remotely true. My body is failing me.” When asked about other potential contributing factors, patient reports experiencing a significant amount of stress at work lately, and worry about how he will afford his wife’s cancer treatments.

Analyze cues: What physiological effects might the patient be experiencing due to his recent reported stress?

Answer

When the patient experiences stress, his body releases hormones that activate the “fight-or-flight” response. In some cases, this can be beneficial as a compensatory response, but in this case, it is likely that the patient is experiencing chronic stress, which is no longer compensatory. Chronic stress tends to be responsible for negative physiological responses such as hypertension, gastrointestinal upset, anxiety, and heart failure. This patient is experiencing hypertension and depression, both of which are exacerbated by the chronic stress.

Case Study 34.2.3 §34.2 source ↗

Refer to Unfolding Case Study #5: Part 3 for a review of the patient data.

Provider’s Orders

1115:
Full laboratory workup including BMP, CBC, lipid panel, and hemoglobin A_1C.

Lab Results

• BUN 21 mg/dL

• Creatinine 1.1 mg/dL

• Glucose 139 mg/dL

• WBC 15,000/mm³

• Total cholesterol 245 mg/dL

• HDL cholesterol 50 mg/dL

• LDL cholesterol 110 mg/dL

Prioritize hypotheses: What connections can you make between the patient’s self-reported stress and his lab results?

Answer

Chronic stress can have profound effects on the body, such as those that are reflected in the patient’s laboratory results. First, the patient’s kidney function is normal, but on the higher end of normal. Chronic stress can negatively affect the kidney’s ability to function optimally, so these values could be related to stress. The patient is also experiencing elevated lab values related to his diabetes (e.g., HbA_1C, glucose), which may be exacerbated by stress. His elevated white blood cell count may indicate that his body is fighting an infection. Individuals who experience chronic stress have an increased risk of infections because the stress weakens their immune system. Last, the patient has elevated lipid levels, which are often associated with stress.

Case Study 34.2.4 §34.2 source ↗

Refer to Unfolding Case Study #5: Part 3 for a review of the patient data.

Provider’s Orders

1115:
Full laboratory workup including BMP, CBC, lipid panel, and hemoglobin A_1C.

Lab Results

• BUN 21 mg/dL

• Creatinine 1.1 mg/dL

• Glucose 139 mg/dL

• WBC 15,000/mm³

• Total cholesterol 245 mg/dL

• HDL cholesterol 50 mg/dL

• LDL cholesterol 110 mg/dL

Generate solutions: Based on the patient’s lab results, what interventions do you anticipate being ordered by the provider?

Answer

First, the nurse should anticipate the provider will order counseling or other interventions to target the patient’s stress levels. Chronic stress can result in many negative physiological symptoms, so treating the underlying stress may help address some of the other health issues the patient is experiencing. The nurse should also anticipate that the provider will order medications or lifestyle changes to address the elevated glucose, hemoglobin A_1C, and cholesterol levels.

Case Study 34.4.5 §34.4 source ↗

Refer to Unfolding Case Study #5: Part 4 for a review of the patient data.

Provider’s Orders

1230:
Referral to dietitian for lifestyle changes related to diet to address elevated HbA_1C and cholesterol levels.
Provide patient with support group information for spouses of patients with cancer.
Referral to psychiatry for history of depression and increased stress.

Take action: When implementing the provider’s orders, how do these actions reflect concepts included in Roy’s adaptation model?

Answer

One of the main components of Roy’s adaptation model is nursing activities, which are equivalent to nursing actions/interventions. This model encompasses a foundation for all aspects of nursing and patient interactions, including the interventions prescribed by the provider. Additionally, this model states that an individual’s potential for adaptation is limited to their ability to cope and the body’s resources. In this case, another important nursing action would be for the nurse to assess the patient’s ability to cope, which would give a better indication as to whether they will be able to adapt from their current stress level.

Case Study 34.4.6 §34.4 source ↗

Refer to Unfolding Case Study #5: Part 4 for a review of the patient data.

Provider’s Orders

Evaluate outcomes: After implementing the provider’s orders, what findings should the nurse assess for that would indicate positive patient outcomes have been achieved?

Answer

After meeting with the dietitian and making dietary changes, the nurse would recheck laboratory values and hope to see improvements (decreases) in cholesterol and hemoglobin A_1C over time. The nurse would also assess for improvement in depression symptoms and the patient’s ability to cope with stress related to his wife’s diagnosis, both of which would indicate a positive patient outcome.

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Problems and answers are adapted from Fundamentals of Nursing by Christy Bowen, Lindsay Draper and Heather Moore, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/fundamentals-nursing/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.