Last updated on May 15th, 2022 at 11:24 am
Stress Nursing Care Plans Diagnosis and Interventions
Stress NCLEX Review and Nursing Care Plans
Stress is the body’s natural response to a threat or crisis. When a person is presented with a stressful stimulus, he or she responds by either fighting it or running away. When someone feels stressed, the tiny region of the brain called the hypothalamus distinguishes the adrenal gland to release hormones namely adrenaline and cortisol into the bloodstream.
When these hormones are released, the liver is activated to create more blood glucose that increases the energy of the person, rapid breathing, hypertension, and tachycardia. Frequent adrenaline rush due to stress can also lead to complications such as damaged blood vessels, increased risk for cardiac disorders, digestive issues, sleep, and psychological problems.
When one experiences stressors, the body produces both physical and mental responses. Stress can be also a good sign, keeping us being aware of our surroundings and avoiding dangerous situations. For example, if you have an upcoming exam, being stressed will signalize your body to put in the best effort and work hard.
However, stress may harm the body when a person faces continuous challenges without relief or relaxation between challenges. As a result, the person becomes overworked and this could have an outcome of a mental or physiological disorder.
Types of Stress
Most types of stress have an impact on mental and physical health. Here are the different types of stress that can negatively affect our lives.
- Acute Stress. Acute stress is caused by responding to a short-term crisis or sudden change. This type of stress can last anywhere from minutes to weeks. It depends on how long someone is exposed to an intense situation. This type of stress is characterized by tightening of the muscles, chest discomfort, tremors, increased heartbeat, rapid breathing, and excessive sweating. Some symptoms are feeling of fear or helplessness, panic attacks, and being unable to focus and concentrate. Examples of acute stress are hearing bad news, thinking of the future or overthinking, and having an argument with a loved one.
- Episodic Acute Stress. This is another kind of stress that occurs when someone experiences stress more often. Examples of episodic acute stress are those people who are taking on too much accountability, being the breadwinner of the family and being responsible to the family, and always working in a stress-related environment such as health care professionals.
- Chronic Stress. This type of stress that’s often caused by the pressure you put on yourself to meet all your expectations. Chronic stress symptoms are just the same as other types of stress such as muscle tension in the back, neck, and shoulders, rapid heartbeat, and difficulty sleeping. This may include life events such as arguing with someone close to you. Working multiple jobs while trying to get by in life can also cause chronic stress.
Theories of Stress
Stressors are demands from the internal and external environment that an individual perceives as being harmful or threatening.
- Lazarus and Folkman. Stress and coping start with the primary appraisal which is just determining the severity of the appraisal while the secondary appraisal is determining how much control he/she has over the stressor. The cognitive appraisal was proposed by Lazarus and Folkman. Problem-focused coping is a method of dealing with stressors that involve thinking about and altering the situation. Emotion-focused coping is a method of dealing with stressors that involves altering the way one thinks or feels about the situation. The final stage of coping with stress is reappraisal, which is a feedback loop where an individual evaluates whether or not the stressor has been effectively controlled. The model diagram of stress and coping is the stressor is the initial situation then the primary appraisal in which questions such as “Am I okay”? and “What is going on?” as well as “What can I do about this?” are asked. According to the theorists, stress coping strategies will be problem-based and emotion-focused. The stress coping strategies will then need to undergo reappraisal.
- Hans Selye. Another model for stress and coping is proposed by Hans Selye in which he outlines 3 biological phases in the body’s reaction to stress, such as (1) the alarm stage (fight or flight response), (2) the stage of resistance (body adapts to resistance), and (3) the stage of exhaustion (burn out and hazardous to health). An example of the alarm phase is when a person with severe social anxiety attempts to attend a party. During the resistance stage, the socially anxious party guest might be circled with many people trying to talk to him, but he experiences stress and exhibits symptoms of stress such as increased muscle tension, increased heart rate, and perspiration. In the exhaustion phase, the social anxiety may be prolonged and if experienced often and over a long time, this can result in illness and diseases.
Signs and Symptoms of Stress
● Pain or aches
● Chest pain or palpitation
● Trouble sleeping or lack of sleep
● Headaches
● Hypertension
● Muscle tension
● Digestive problems.
● Decreased libido
Causes of Stress
- Work. Being unhappy in one’s current job, feeling overworked, having too much workload but less salary, frequent overtimes, poor management, working in an unsafe environment, no clear goals, and discrimination at work are all common causes of stress.
- Personal or family life. Stress may come from sudden death in the family, loss of job, chronic illness or disability, emotional problems, taking care of an elderly/sick family member, and traumatic events.
Risk Factors of Stress
These are the risk factors that predispose people to stress:
- Work or job pressure
- Family problems
- Health-related concerns
- Financial obligations or money problems
- Level of social support
- Coping mechanism and type of personality
Diagnosis of Stress
Stress itself cannot be precisely measured because it is subjective. Only the person experiencing it can determine it. However, behavioral coding, physiological measurements, and self-report measures are done to determine stress levels in an individual.
Healthcare professionals may also use a variety of tests to rule out various medical conditions that are highly related to stress. For instance, many cardiovascular disorders are caused or aggravated by high-stress levels. Healthcare professionals may ask questions to understand a patient’s stress levels and how it affects his or her health.
Treatment for Stress
- Early recognition. Consulting a healthcare professional is the first step for treating stress and stress-related health problems. They are helpful in identifying the cause of stress and may suggest ways to manage and treat it. They can also check if the patient’s symptoms are caused by stress or another preexisting condition.
- Stress management. There are several ways to deal with stress on a daily basis. Stress management techniques can help an individual fight over stress and deal with it. These may include:
- Eating a healthy diet which includes fresh vegetables and fruits
- Avoiding foods with lots of sugar and preservatives
- Performing regular exercise to stay fit and active
- Having good quality sleep regularly
- Doing relaxation, meditation, and breathing techniques, especially during stressful moments
Nursing Considerations to Caring for Patients Under Stress
Nurses play a crucial role in helping patients to cope with their daily stress. It is important for nurses to provide quality mental health care for patients. There are different stress management techniques that nurses can use, and these include:
- Establishing rapport and creating a therapeutic relationship. Use open-ended questions during the conversations with the patient to explore their thoughts and feelings.
- Practicing active listening skills to the patient’s concerns and stressors.
- Encouraging deep breathing exercises and relaxation techniques. Teach the patient the proper way to do deep breathing exercises and have a schedule for at least 15 mins every day. Deep breathing will alleviate stress and help improve lung function.
- Scheduling a regular sleep pattern for patients. This can help improve sleep and get quality sleep at night.
- Encouraging meditation activities. This is another tool to help patients relax and reduce stress levels. Make sure to do it in a quiet and calm environment. Examples of meditation are yoga, listening to music, and watching refreshing videos or recordings. Meditation is very beneficial in clearing out our minds.
- Encouraging regular exercise. Exercise is a proven stress-relief technique because it boosts endorphins and helps release muscle tension. Always schedule a daily routine of time to the patient for exercise. Examples are attending exercise classes, dancing, aerobics, going to the gym, or simply walking.
- Advising the patient to adopt a healthy diet. Nurses can advise the patient to increase the intake of fish, poultry, fruits, vegetables, and whole grains. A referral to a dietitian may also be needed. Foods that are high in magnesium foods are also good stress relievers. These include avocados, bananas, and broccoli. Help the patient understand the need to decrease consumption of preservatives and sugar. Caffeine should also be limited because it increases and stimulates the nervous system which could increase stress levels.
Nursing Diagnosis for Stress
Stress Nursing Care Plan 1
Self-Care Deficit
Nursing Diagnosis: Self-care Deficit related to stress secondary to recovering from recent surgery as evidenced by low mood, offensive body odor, unkempt hair, and poor oral hygiene.
Desired Outcome: The client will be able to show willingness to perform his/her activities of daily living with or without assistance from his/her caregiver.
| Stress Nursing Interventions | Rationale |
| Identify the barriers that prevent the client from doing his or her self-care tasks. | It is important to know the reasons why the client was not able to perform self-care so the nurse or caregiver can give and address the problem. Examples may include lack of health teachings regarding his/her condition and fear that it might cause pain and stress |
| Assess the client’s strength and ability to perform self-care activities safely. | This is to know to what extent the client needs help in performing his or her activities of daily living safely and avoid unnecessary accidents while performing the task. |
| Give appropriate pain medications or management at least 30 minutes prior to self-care activities. | If the reason why the client was not able to perform his or her activities of daily living is because of pain from surgery, then it must be addressed as soon as possible. The nurse should administer PRN medications as ordered or may consult with the attending physician if pain still persists. |
| Establish a safe and warm environment that may encourage client participation. | Initially give the client a warm and safe environment that is enticing for the client to perform his or her activities of daily living |
| Motivate the client to perform his or her self-care activity independently | This will allow the client to independently perform the task as much as possible. Also to avoid being dependent on their caregiver as this might create new barriers in the future. |
| Promote energy-saving techniques | Clients who have recently undergone surgery might not tolerate standing or be mobile for a long time. The caregiver can assist him or her to the sitting position first if he or she can tolerate it while performing self-care tasks. Nurses can also identify the best time to do the activity of daily living while the client still has the strength to do the tasks. |
Stress Nursing Care Plan 2
Powerlessness
Nursing Diagnosis: Powerlessness related to constantly receiving negative feedback from peers secondary to social stress as evidenced by a reluctance to express his or her own thoughts.
Desired Outcome: The client will be able to effectively verbalize his or her own thoughts without fear of receiving negative feedback from peers.
| Stress Nursing Interventions | Rationale |
| Help the client to assess the reasons why he or she is receiving undesirable feedback from peers. | The client must know and be aware as to why he or she is receiving that kind of feedback from others and learn to accept it. If it is something that the client can control then she or she should identify ways to improve it, but if it is the other way around then let him or her learn to accept it. |
| Encourage the client to verbalize his or her feelings and thoughts. | The client must be able to express himself or herself. Listening to the client’s verbalization without interruption is advised. The nurse should be able to effectively use good therapeutic skills during this process. |
| Establish a safe environment for the client. | When the client is stressed, he or she has low concentration and is not likely to be aware of the dangers around his or her surroundings. Priority at this time is safety. |
| Allow the client to set realistic goals to address the problem. | It is essential that the client must learn how to set realistic goals and interventions for it to become successful. Unrealistic goals are bound for failure which will further cause powerlessness and stress to the patient. |
| Encourage the client to surround himself or herself with people that truly care for him or her | Clients who are stressed need a strong support system coming from their family, friends, and loved ones. This will also help the client to realize that there are still people that care for him or her. |
Stress Nursing Care Plan 3
Ineffective Coping
Nursing Diagnosis: Ineffective Coping related to fear of failure secondary to stress as evidenced by verbalization of being indecisive, having difficulty in problem-solving, and anxiety
Desired Outcome: The client will be able to effectively verbalize realistic problem-solving skills and attempt to perform healthy coping mechanisms.
| Stress Nursing Interventions | Rationale |
| Assess the reason for the client’s stress or situation that causes the client not to show effective coping skills. | It is important to identify the reason behind the client’s action and what triggers it to help decrease if not eliminate the stress. |
| Encourage the client to verbalize his or her thoughts. | One effective way to help people with stress is to let him or them verbalize their feelings. Give the client an ample time to express himself or herself to motivate the client to share his or her thoughts. |
| Establish a safe environment for the client. | People who are stressed have a limited perception of their environment and sometimes they are not aware of the dangers around it. So to promote safety, create a safe space for the client. |
| Motivate the client to be independent and give positive feedback for the desired response. | Giving positive feedback allows the client to know that he or she is on the right track and this will help boost up their self-esteem. |
| Discuss with the client healthy coping mechanisms he or she can perform. | Enumerating healthy coping mechanisms to the client will give him or her an idea of how to healthy act the stress under a manageable level. |
| Give the client time to rest or encourage relaxation techniques such as deep breathing exercises. | Whenever the client feels anxious, teach him to perform effective relaxation techniques such as deep breathing exercises to promote the client’s calmness and improve focus. |
| Advice client to surround with people he or she identifies as his or her strong support system. | Having a good and strong support system is helpful in facing problems and uncomfortable situations. They serve as your guidance and motivation. |
Stress Nursing Care Plan 4
Anxiety
Nursing Diagnosis: Anxiety related to stress secondary to situational and maturational crises as evidenced by poor attention span, restlessness, and verbalized feelings of helplessness
Desired Outcome: The client will be able to discuss and perform healthy ways to cope with anxiety. The client will also be free from environmental hazards due to a lack of attention span.
| Stress Nursing Interventions | Rationale |
| Keep a calm and relaxed approach when dealing with the client. | If the client shows signs of anxiety, the nurse should approach him or her in a calm manner. Being calm can promote relaxation and the sense of security of the client will also increase. |
| Establish a good rapport with the client. | Establishing rapport is one of the steps in having good therapeutic communication. The client will develop a trusting relationship with the healthcare provider and this will allow more verbalizations of feelings and thoughts of the client. |
| Reassure the client that he or she is in a safe environment. | Clients who are anxious need constant reassurance that he or she is safe. The nurse should tell the client what to do next to avoid increasing their stress level. |
| Create a quiet and relaxed room for the client. | Anxiety might increase in the client whenever there are factors that cause it such as a noisy environment, large crowds, and bright lighted room. |
| As much as possible do not leave your client unsupervised. Stay with the client when necessary. | Anxious clients might have panic attacks at any moment. The nurse should reassure the client that he or she is not alone. |
| Teach the client about different relaxation techniques such as deep breathing exercises. | Relaxation techniques such as deep breathing exercises will help the client to avoid having panic attacks by helping the body relax. It is advisable to teach these techniques the client when he or she is cooperative and can follow simple instructions. |
Stress Nursing Care Plan 5
Disturbed Thought Process
Nursing Diagnosis: Disturbed Thought Process related to stress secondary to psychological trauma as evidenced inappropriate social behavior, withdrawn appearance, short periods of hallucination.
Desired Outcomes:
- The client will be able to distinguish reality from delusions and hallucinations.
- The client would be able to perform effective coping mechanisms to deal with stress and can communicate what he or she has in mind to others.
| Stress Nursing Interventions | Rationale |
| Establish a good rapport with the client. | It is very important that the client should be able to get herself or himself comfortable with the nurse or the caregiver. Building a trusting relationship with the client helps the nurse do appropriate interventions. |
| Assess the patient’s stress and trauma that leads him or her to have a disturbed thought process. | The nurse should know what causes the client’s trauma to address his or her needs. This will also help the nurse gauge the appropriate and suitable interventions for the client’s case. |
| Create a calm and relaxed environment for the client. | Clients with disturbed thought processes have a slim perception of their environment. They cannot distinguish the environmental hazards around them. So to prevent accidents, safety is the priority. |
| Constantly reorient the client of the reality and distinguish what is real and not to him or her. | The patient should be aware of his or her surroundings and must know the difference between reality and delusions or hallucinations since it might cause accidents to the client if not supervised. |
| Allow the client to verbalize his or her feelings and emotions. Practice good and healthy therapeutic communication. | In helping and addressing the client’s trauma, he or she must be aware of the damage and cause it brings to him or her. Self-awareness is the first step to recovery. This will go a long way, but with guidance from the nurse and a strong support system from family and friends, the client will be on their way to recovery. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.
