Stress

Question 1

Stress is…

Answer 1

◆ Normal and useful, often perceived as negative but can be positive
–> Appraisal (assessment) of Stressors
◆ If it becomes excessive during early life can profoundly affect lifelong functioning
◆ Stress has long been associated with the development or exacerbation of symptoms of mental illness

Question 2

What are the 2 stress response factors?

Answer 2

person/relationship to the environment & appraisal

Question 3

What are the two Antecedents to Stress?

Answer 3

• -> a.k.a. precursors to stress
  1. Person-Environment Relationship
  2. Interaction with Environment

Question 4

Antecedents to Stress: Person-Environment Relationship

Answer 4

• Beliefs, values, goals & commitment

* Personality and behavior patterns

Question 5

Antecedents to Stress: Interaction with Environment

Answer 5

• Social networks (closeness, give & take)
• Social support (emotional, resources, information)
• Demands and constraints (physical environmental demands, beliefs & resources)
• Sociocultural factors (employment, gender roles)
• Life events

Question 6

What are the three types of Appraisal?

Answer 6

◆ Cognitive appraisal: increased commitment to a goal that is being threatened means increased stress
–> ex. wanting to be a nurse but unable to vs. NOT wanting to be a nurse and unable to

◆ Primary appraisal: the person evaluates the events as a threat, harm, or challenge

◆ Secondary appraisal: the person explains the outcome of events
–> figure out it isn’t dangerous

Question 7

Coping

Answer 7

a deliberate, planned, and psychological activity; it may inhibit or override the innate urge to act

Question 8

What are the two types of coping?

Answer 8

1. Problem-focused: attacks the source of the stress and solves the problem
   - -> make changes to affect outcome
2. Emotion-focused: reinterpreting the situation to change the meaning
   - ->change importance of stressor, may not change outcome

Question 9

Adaptation

Answer 9

capacity to survive and flourish, affects
• Health and illness
• Psychological well-being
• Social functioning

Question 10

Allostasis

Answer 10

regulating process maintaining homeostasis through adaptation achieved through autonomic nervous system

Question 11

Allostatic Load

Answer 11

High load = increase in biological parameters (lab, BP etc), consequence of wear & tear on body & brain leading to ill health
–>figure page 272

Question 12

Life Change Units

Answer 12

◆  Holmes & Rahe- research on changes within 12 months- frequent examples below (see page 270)
◆  Change in work hours or conditions 30
◆  Change in residence 33
◆  Begin or end school 32
◆  Vacation 29
◆  Change eating habits 29
◆  Change school 28
◆  Christmas 26
◆  Total above = 207

250-400 LCU/yr = minor illness
Over 400 = major illness

Question 13

Physical Response to Stress

Answer 13

◆ General Adaptation Syndrome (GAS) (Hans Selye)
1. Alarm stage

2. Resistance stage
3. Exhaustion stage

Question 14

GAS: Alarm Stage

Answer 14

– Threat is perceived
– Prepares a person for “fight or flight”
– Endocrine and immune systems respond creating physical and mental alertness

Question 15

GAS: Resistance Stage

Answer 15

– Threat continues, attempts are made to adapt

Question 16

GAS: Exhaustion Stage

Answer 16

– If threat continues, adaptive hormones are depleted and body succumbs to illness (high allostatic load, ex abuse, lead poisioning)

Question 17

Hypothalmic/Pituitary/Adrenal

Answer 17

◆ Sympathetic nervous system activates the HPA axis
• Hypothalamus secretes corticotropin-releasing hormone
• Pituitary increases adrenocorticotropic hormone (corticotropin) which stimulates adrenocortical stimulation of cortisol
Immune response to increased cortisol-initially adaptive but over time depresses immune system
Continuous activation of the sympathetic nervous system leads to problems in memory, immunity, cardiovascular & metabolic function.

Question 18

Stress Physiological Response (Sympathetic)

Answer 18

• release of epinephrine
  • Respirations deepen, shortness of breath
  • Rapid heart rate & increased BP
  • Blood glucose level rises, hyper-reflexia
  • Immune response to increased cortisol

Question 19

Stress Physiological Response (Parasympathetic)

Answer 19

– rare opposite
• Pulse & BP decrease, shallow breathing
• Hyperventilate, feel faint, dizzy
• Decreased digestion, nausea, heartburn, diarrhea, need to urinate

Question 20

Hildegard Peplau RN Levels of Anxiety: Mild

Answer 20

Mild (day-to-day tensions)
◆ Alertness, minimal distortion, restless, irritable
◆ Motivates learning, produces growth, creativity

Question 21

Hildegard Peplau RN Levels of Anxiety: Moderate

Answer 21

Moderate (selective inattention)
◆ Reduced ability to see & hear, grasps less information
◆ Notices physical discomfort

Question 22

Hildegard Peplau RN Levels of Anxiety: Severe

Answer 22

Severe (focuses on specific details)

◆ Focus on relieving physical and emotional discomfort,

Question 23

Hildegard Peplau RN Levels of Anxiety: Panic

Answer 23

Panic (loss of control)

◆ perceptions blown out of proportion, awe, dread, terror

Question 24

Goals for those with acute stress responses:

Answer 24

• Change the stressful person– environment situations (when possible)
• Reduce the stress response
• Develop positive coping skills

Question 25

Goals for those who are at high risk for stress:

Answer 25

* Recognize the potential for stressful situations | * Strengthen positive coping skills

Question 26

Nursing Management: Assessment

Answer 26

``` ◆ Review of body systems ◆ Physical functioning ◆ Pharmacological ◆ Coping strategies ◆ Severity of emotions ◆ Recent life changes ◆ Social network ```

Question 27

Nursing Management: Diagnosis

Answer 27

``` ◆ Imbalanced nutrition ◆ Ineffective coping ◆ Powerlessness ◆ Ineffective role performance ◆ Ineffective parenting ◆ Disabled family coping ```

Question 28

Nursing Interventions

Answer 28

``` ◆ Relaxation ◆ Imagery ◆ Positive self talk ◆ Request support ◆ Humor ◆ Spirituality ◆ Problem solving strategies ◆ Nutrition, exercise ◆ Support family functioning ◆ Assist to expand social network ◆ Patient and family education ```

Question 29

Outcomes of Stress Intervention

Answer 29

◆ Individual, family & network- Improved health, well-being & social functioning ◆ Family- Improved communication or social support ◆ Social network- Modification to improve support