Chapter 37: Stress and Coping Flashcards
Equally important, _________ also experience stressful events that occur in the course of clinical practice and in their own lives. Nurses need to recognize the signs and symptoms of stress and understand stress management techniques to aid personal coping and design stress management interventions for their patients and families.
health care professionals
People use the term stress in many ways. It is an experience to which a person is exposed through a stimulus or stressor. Stressors are tension-producing stimuli operating within or on any system (Neuman and Fawcett, 2011). It is also the appraisal, or perception, of a stressor. Appraisal is how people interpret the impact of the stressor on themselves or on what is happening and what they are
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able to do about it (Lazarus, 2007). Finally stress is a physical, emotional, or psychological demand that often leads to growth or overwhelms a person and leads to illness (Varcarolis and Halter, 2010). Stress refers to the consequences of the stressor and the person’s appraisal of it.
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People experience stress as a consequence of daily life events and experiences. It stimulates thinking processes and helps people stay alert to their environment. It results in personal growth and facili- tates development. How people react to stress depends on how they view and evaluate the impact of the stressor, its effect on their situ- ation and support at the time of the stress, and their usual coping mechanisms. When stress overwhelms existing coping mecha- nisms, patients lose emotional balance, and a crisis results. If symptoms of stress persist beyond the duration of the stressor, a person has experienced a trauma.
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The fight-or-flight response to stress, which is arousal of the sympathetic nervous system, prepares a person for action (Fig. 37-1). Neurophysiological responses to stress function through negative feedback. The process of negative feedback senses an abnormal state such as lowered body temperature and makes an adaptive response such as initiating shivering to generate body heat. Three structures, the medulla oblongata, the reticular forma- tion, and the pituitary gland, control the response of the body to a stressor
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The medulla oblongata, located in the lower portion of the brain- stem, controls heart rate, blood pressure, and respirations. Impulses traveling to and from the medulla oblongata increase or decrease these vital functions. For example, sympathetic or parasympathetic nervous system impulses traveling from the medulla oblongata to the heart control regulation of the heartbeat. The heart rate increases in response to impulses from sympathetic fibers and decreases with impulses from parasympathetic fibers.
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The reticular formation, a small cluster of neurons in the brainstem and spinal cord, continuously monitors the physiological status of the body through connections with sensory and motor tracts. For example, certain cells within the reticular formation cause a sleep- ing person to regain consciousness or increase the level of con- sciousness when a need arises
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The pituitary gland is a small gland immediately beneath the hypo- thalamus. It produces hormones necessary for adaptation to stress such as adrenocorticotropic hormone, which in turn produces cor- tisol. In addition, the pituitary gland regulates the secretion of thyroid, gonadal, and parathyroid hormones. A feedback mecha- nism continuously monitors hormone levels in the blood and regu- lates hormone secretion. When hormone levels drop, the pituitary gland receives a message to increase hormone secretion. When they rise, it decreases hormone production.
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to stress, describes how the body responds to stressors through the alarm reaction, the resistance stage, and the exhaustion stage. The GAS is triggered either directly by a physical event or indirectly by a psychological event. It involves several body systems, especially the autonomic nervous and endocrine systems, and responds immediately to stress (Fig. 37-2). When the body encounters a physical demand such as an injury, the pituitary gland initiates the GAS. During the alarm reaction rising hormone levels result in increased blood volume, blood glucose levels, epinephrine and norepinephrine amounts, heart rate, blood flow to muscles, oxygen intake, and mental alertness. In addition, the pupils of the eyes dilate to produce a greater visual field. If the stressor poses an extreme threat to life or remains for a long time, the person pro- gresses to the second stage, resistance. During the resistance stage the body stabilizes and responds in a manner opposite to that of the alarm reaction. Hormone levels, heart rate, blood pressure, and cardiac output return to normal; and the body repairs any damage that has occurred. However, if the stress response is chronically activated, a state of allostasis occurs. This chronic arousal with the presence of powerful hor- mones causes excessive wear and tear on the person and is called allostatic load. An increased allostatic load leads to chronic illness (Diamond, 2009/2010). A persistent allopathic load can cause long- term physiological problems such as chronic hypertension, depres- sion, sleep deprivation, chronic fatigue syndrome, and autoimmune disorders
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The exhaustion stage occurs when the body is no longer able to resist the effects of the stressor and has depleted the energy necessary to maintain adaptation. The physiological response has intensified; but with a compromised energy level, the person’s adaptation to the stressor diminishes
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The intensity and duration of the psychological threat and the number of other stressors that occur at the same time affect the person’s response to the threat. In addition, whether or not the person anticipated the stressor influences its effect. It is often more difficult to cope with an unex- pected stressor. Personal characteristics that influence the response to a stressor include the level of personal control, presence of a social support system, and feelings of competence.
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Evaluating an event for its personal meaning is primary appraisal. Appraisal of an event or circumstance is an ongoing perceptual process. If primary appraisal results in the person identifying the event or circumstance as a harm, loss, threat, or challenge, the person experiences stress. If stress is present, sec- ondary appraisal focuses on possible coping strategies. Balancing factors contribute to restoring equilibrium. According to crisis theory, feedback cues lead to reappraisals of the original percep- tion. Therefore coping behaviors constantly change as individuals perceive new information. Coping is the person’s effort to manage psychological stress. Effectiveness of coping strategies depends on the individual’s needs. A person’s age and cultural background influence these needs. For this reason no single coping strategy works for everyone or for every stressor. The same person may cope differently from one time to another. In stressful situations most people use a com- bination of problem- and emotion-focused coping strategies. In other words, when under stress a person obtains information, takes action to change the situation, and regulates emotions tied to the stress. In some cases people avoid thinking about the situation or change the way they think about it without changing the actual situation itself. The type of stress, people’s goals, their beliefs about themselves and the world, and personal resources determine how people cope with stress. Resources include intelligence, money, social skills, supportive family and friends, physical attractiveness. health and energy, and ways of thinking such as optimism.
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Coping mechanisms include psychological adaptive behaviors. Such behaviors are often task oriented, involving the use of direct problem-solving techniques to cope with threats. Ego-defense mechanisms regulate emotional distress and thus give a person protection from anxiety and stress. Ego-defense mechanisms help a person cope with stress indirectly and offer psychological protec- tion from a stressful event. Everyone uses them unconsciously to protect against feelings of worthlessness and anxiety. Occasionally a defense mechanism becomes distorted and no longer helps the person adapt to a stressor. However, people generally find them very helpful in coping and use them spontaneously (Box 37-1). Frequently short-term stressors activate ego-defense mechanisms. These usually do not result in psychiatric disorders
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Stress includes work, family, chronic, and acute stress; daily hassles; trauma; and crisis. One person looks at a stimulus and sees it as a challenge, leading to mastery and growth. Another sees the same stimulus as a threat, leading to stagnation and loss. The individual with family responsibilities and a full-time job outside the home can experience chronic stress. It occurs in stable conditions and from stressful roles. Living with a long-term illness produces chronic stress. Conversely, time-limited events that threaten a person for a relatively brief period provoke acute stress. Recurrent daily hassles such as commuting to work, maintaining a house, dealing with difficult people, and managing money further com- plicate chronic or acute stress
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Posttraumatic stress disorder (PTSD) begins when a person experiences, witnesses, or is confronted with a traumatic event and responds with intense fear or helplessness. Some examples of trau- matic events that lead to PTSD include motor vehicle crashes, natural disasters, violent personal assault, and military combat. Anxiety associated with PTSD is sometimes manifested by night- mares and emotional detachment. Some people with PTSD experi- ence flashbacks, or recurrent and intrusive recollections of the event. Responses may also include self-destructive behaviors such as suicide attempts and substance abuse.
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