45.14: Chapter 34

Unfolding Case Study

1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.