Stress Flashcards
Stress is…
◆ 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
What are the 2 stress response factors?
person/relationship to the environment & appraisal
What are the two Antecedents to Stress?
- -> a.k.a. precursors to stress
1. Person-Environment Relationship
2. Interaction with Environment
Antecedents to Stress: Person-Environment Relationship
- Beliefs, values, goals & commitment
* Personality and behavior patterns
Antecedents to Stress: Interaction with Environment
- 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
What are the three types of Appraisal?
◆ 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
Coping
a deliberate, planned, and psychological activity; it may inhibit or override the innate urge to act
What are the two types of coping?
- Problem-focused: attacks the source of the stress and solves the problem
- -> make changes to affect outcome - Emotion-focused: reinterpreting the situation to change the meaning
- ->change importance of stressor, may not change outcome
Adaptation
capacity to survive and flourish, affects
• Health and illness
• Psychological well-being
• Social functioning
Allostasis
regulating process maintaining homeostasis through adaptation achieved through autonomic nervous system
Allostatic Load
High load = increase in biological parameters (lab, BP etc), consequence of wear & tear on body & brain leading to ill health
–>figure page 272
Life Change Units
◆ 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
Physical Response to Stress
◆ General Adaptation Syndrome (GAS) (Hans Selye)
1. Alarm stage
- Resistance stage
- Exhaustion stage
GAS: Alarm Stage
– Threat is perceived
– Prepares a person for “fight or flight”
– Endocrine and immune systems respond creating physical and mental alertness
GAS: Resistance Stage
– Threat continues, attempts are made to adapt
GAS: Exhaustion Stage
– If threat continues, adaptive hormones are depleted and body succumbs to illness (high allostatic load, ex abuse, lead poisioning)
Hypothalmic/Pituitary/Adrenal
◆ 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.
Stress Physiological Response (Sympathetic)
- release of epinephrine
• Respirations deepen, shortness of breath
• Rapid heart rate & increased BP
• Blood glucose level rises, hyper-reflexia
• Immune response to increased cortisol
Stress Physiological Response (Parasympathetic)
– rare opposite
• Pulse & BP decrease, shallow breathing
• Hyperventilate, feel faint, dizzy
• Decreased digestion, nausea, heartburn, diarrhea, need to urinate
Hildegard Peplau RN Levels of Anxiety: Mild
Mild (day-to-day tensions)
◆ Alertness, minimal distortion, restless, irritable
◆ Motivates learning, produces growth, creativity
Hildegard Peplau RN Levels of Anxiety: Moderate
Moderate (selective inattention)
◆ Reduced ability to see & hear, grasps less information
◆ Notices physical discomfort
Hildegard Peplau RN Levels of Anxiety: Severe
Severe (focuses on specific details)
◆ Focus on relieving physical and emotional discomfort,
Hildegard Peplau RN Levels of Anxiety: Panic
Panic (loss of control)
◆ perceptions blown out of proportion, awe, dread, terror
Goals for those with acute stress responses:
- Change the stressful person– environment situations (when possible)
- Reduce the stress response
- Develop positive coping skills
Goals for those who are at high risk for stress:
- Recognize the potential for stressful situations
* Strengthen positive coping skills
Nursing Management: Assessment
◆ Review of body systems ◆ Physical functioning ◆ Pharmacological ◆ Coping strategies ◆ Severity of emotions ◆ Recent life changes ◆ Social network
Nursing Management: Diagnosis
◆ Imbalanced nutrition ◆ Ineffective coping ◆ Powerlessness ◆ Ineffective role performance ◆ Ineffective parenting ◆ Disabled family coping
Nursing Interventions
◆ 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
Outcomes of Stress Intervention
◆ Individual, family & network- Improved health, well-being & social functioning
◆ Family- Improved communication or social support
◆ Social network- Modification to improve support
