Stress and Coping EVOLVE Flashcards
stress response can directly cause damage to
body tissues
stress can damage tissue by
increasing heart rate and blood pressure and causing the release of powerful stress hormones
third form of stress, sociocultural stress, occurs when
social systems are challenged by factors such as racism, economic hardship, or political upheaval
Stress is
autonomic psychological or emotional response to an internal or external environmental challenge, which is automatic and typically beyond a person’s resources or ability to respond
Bystritsky & Kronemyer definiton of stress
nonspecific response of the body to any demand made upon it.
A stressor is
an event or stimulus that disrupts the person’s sense of equilibrium
Stress appraisal is
process by which the person interprets a stressor as either a threat or a challenge
People react to stress in different ways
true or false
true
The way a person responds to stress determines
its impact on the person’s attitude and physiologic response
Stress also may trigger
inflammatory bowel disease
cardiovascular disease
chronic pain
autoimmune diseases such as rheumatoid arthritis
In Roy’s theory, people adapt to stress by
meeting their physiologic needs
developing a positive identity
performing social role functions
balancing dependence and independence
Stressors disrupt the person’s
equilibrium resulting in illness
homeostasis is
the body’s regulation of systems to maintain a steady state
fight-or-flight response is activated by
excitement or threat
fight-or-flight activates
autonomic nervous system
auntonomic nervous system activation result in
increase in heart rate, blood pressure, and respirations along with pupil dilation and a decrease in gastric motility and blood flow to the skin
When experiencing the fight-or-flight response, people report
rapid heartbeats
palpitations
nausea
anxious feelings.
general adaptation syndrome (GAS) is
body responds in the same way to any demand, whether it is physical, emotional, pleasant, or unpleasant
GAS is evoked when
the stimulation or stressor is strong enough to activate the autonomic nervous branch of the central nervous system, eliciting an adaptive response
distress is
negative stress
eustress is
positive stress
GAS consists of three stages:
alarm reaction
resistance
exhaustion
Most stressful events involve
only the first two stages
when is third stage of stress activatied
ongoing demands can exceed the body’s resources and lead to the final stage of exhaustion
when is the alarm stage activated?
when homeostasis is threatend
In the alarm stage, the following are activated
hypothalamic
pituitary
adrenal
autonomic nervous systems
In the resistance stage the body
attempts to adapt to the stressor
some of the initial responses are lessened as
the parasympathetic nervous system reverses the sympathetic stimulation and stabilization occurs
When resources are depleted and the body is unable to continue the efforts of adaptation, the body
cannot maintain physical function and death may result at a cellular or systemic level
what can stop the body from dying at the last stage
medication, nutritional support, or other therapies
tissues of the body more directly affected by stress demonstrate
local adaptation syndrome (LAS),
local adaptation syndrome (LAS) is felt as
inflammation, reflexive response to pain, or hypoxia secondary to catecholamine release
Hypoxia can negatively affect
wound healing as well as the ability to think clearly at times of severe anxiety
GAS and LAS are closely related, but the effects of LAS are most notably manifested by
activities in the immune system.
allostasis is
alternate term for the stress response
allostasis is
how homeostasis is reestablished
the purpose of allostasis
is to assist the body in maintaining stability
Chronic high levels of stress can
produce atrophic changes in the brain
Richard Lazarus and his colleagues developed a theory of
cognitive mediation within emotion
appraisal is
unconscious assessment of a demand or stressor
appraisal occurs in how many stages
two stages
first stage of appraisal
The person measures what is at stake in the stressful encounter
first stage of appraisal factors
immediacy of the threat and the degree of ambiguity
second stage of appraisal
coping options are evaluated
Primary and secondary appraisals determine whether
the stressful situation or transaction is a threat or a challenge
A threat invokes the possibility of
harm or loss
challenge holds the possibility of
benefit
Current related research is focused on
the concepts of conscientiousness and responsibility
sense of coherence (SOC) is
characteristic of personality that references one’s perception of the world as comprehensible, manageable, and meaningful
Comprehensible means
that the demands of the internal and external environments are understandable and predictable
manageable means
that the person recognizes resources that are available to meet these demands
meaningful is
the person’s interpretation of the demands as worthy of engagement
Coping has been defined as
the dynamic cognitive and behavioral efforts to manage demands that are appraised as exceeding immediately available resources
Examples of bad type of coping
denial
suppression
excessive use of alcohol and other drugs
Defense mechanisms are
predominantly unconscious, protective coping methods that people may apply in response to a perceived threat
Defense Mechanisms
Defense Mechanisms
denial
displacement
intellectualization
projection
rationalization
reaction formation
regression
repression
sunlimitation
Compensation is
Focusing on strengths rather than perceived weaknesses
Denial is
Ignoring aspects of reality that induce anxiety or contribute to a loss of self-esteem
Displacement is
Redirecting negative emotions perceived as unacceptable or threatening to a safer focus
Intellectualization is
Overthinking a challenging situation or impulse to avoid dealing with the emotions it elicits
Projection is
Attributing one’s own motives, values, desires, situational responses, and personality traits to another person
Rationalization is
Explaining personal actions in a way that enhances one’s own self-image
Reaction formation is
Responding to negative thoughts or feelings by demonstrating opposite emotions and actions
Regression is
Reverting to behavior associated with an earlier stage of development when challenged by thoughts and stressors
Repression is
Blocking unacceptable thoughts and feelings from consciousness
Sublimation is
Channeling unacceptable emotions or impulses into acceptable actions or responses
Problem-focused coping techniques are aimed at
altering or removing the stressor
Studies have shown that successful coping usually involves
problem-focused and emotion-focused efforts
Coping strategies may be chosen on the basis of
personal experience of success with other mechanisms
the degree of threat
availability of social resources
responses to stress may be understood if the three major systems of the body are recognized what are they
The nervous, endocrine, and immune functions
physical signs of stress are
those of sympathetic nervous system stimulation
The cerebral cortex interprets
somatic, auditory, visual, and other sensory input
temporal areas of the cerebral cortex, when stimulated produce
a sensation recognized as fear
Corticotropin-releasing hormone (CRH) released by the hypothalamus stimulates the pituitary to release adrenocorticotropic hormone (ACTH)
what are the effects of these hormones
increase the heart rate, resulting in increased cardiac output and elevated blood pressure
A consequence of hypothalamic activation is sympathetic stimulation triggers
epinephrine and norepinephrine release from the adrenal medulla
The combined effect of epinephrine and norepinephrine is known as
sympathoadrenal response
Psychological as well as physiologic stressors can activate the
hypothalamic-pituitary-adrenal complex
Endorphins are known to act as
analgesics, reducing the sensation of pain
ACTH stimulates the secretion of
corticosteroids and aldosterone
Corticosteroids are important in the stress response because
they increase serum glucose levels and inhibit the inflammatory response
Catecholamines also have an effect on
blood vessels
Catecholamines protect the muscles and organs by
increased clotting time functions that protect circulation to vital organs when blood loss occurs
physiologic changes caused by stress
age
nutritional status
genetic inheritance
Social Readjustment Rating Scale used to identify
stressors and estimate a person’s degree of stress
Everyday Hassles Scale is
a stress scale
Perceived Stress Scale (PSS)-14 is
a stress scale
Most stress assessment tools are limited due to
insensitivity to age, gender, or sociocultural differences
Resilience is
the ability to adapt and persevere in adverse or challenging situations
Resilient people ____ but do not _____ under stress and use a variety of coping strategies
bend, break
characteristics of resilient people include
moral compass
altruism
realistic optimism
social connectedness
commitment to a meaningful cause
belief in something greater than the individual
cognitive and emotional flexibility
Coping style refers to a
pattern of measures taken to relieve stress
Effective coping is validated when
adaptive mechanisms maintain stress within manageable limits
enhance physical recovery
and preserve psychological well-being
How well each person copes will vary and may be influenced by
number of and intensity of stressors
the duration of exposure
past experiences
personality factors
availability of resources.
Anxiety is
response to stress that causes apprehension or uncertainty
Anxiety may manifest as
vague nervousness or as a feeling of dread
Mild anxiety can be
motivational, foster creativity, and actually increase the ability to think clearly
Moderate anxiety
narrows focus, dulls perception, and may challenge the person to pay attention or use appropriate problem-solving skills
what are the normal types of anxity
mild and moderate anxiety are considered normal
Severe anxiety results in
inability to make decisions or solve problems
panic is
the highest level of anxiety
panic is associated with
multitude of physiologic changes as well as subjective feelings of extreme dread or terror
Panic causes the affected person to become
immobilized—unable to concentrate, communicate, or think in a rational manner
Panic attacks may be manifested as physical signs—such as
diaphoresis, chest pain, difficulty breathing, and palpitations
Many types of anxiety are recognized, including
generalized anxiety disorder (GAD)
social anxiety disorder
obsessive-compulsive disorder
posttraumatic stress disorder (PTSD)
GAD is characterized by
unrealistic levels of worry and tension with or without an identifiable cause
Social anxiety involves
fear of being judged by others and overwhelming self-consciousness in social situations
Obsessive-compulsive disorder can
be immobilizing or interfere with daily activities by causing the affected person to repeat ritualistic behaviors in an effort to avert unrealistic concerns about harm
PTSD is
very serious mental health condition characterized by flashbacks and erratic behaviors that results from exposure to a horrifying experience
PTSD may develop when
person’s ability to cope is exceeded by the trauma that was experienced
Anger is
an emotion that involves antagonism toward another person or situation
Unresolved anger may be expressed through
violent, abusive behavior
chronically suppressed anger may lead to
physiologic changes, such as high blood pressure and gastrointestinal upset, or depression
Depression sometimes is described as
anger turned inward
depression results from
experience of loss
People experiencing depression may feel
worthless
guilty
hopeless
depressed person may have
difficulty getting out of bed
experience insomnia
lack energy for activities of daily living (ADLs)
display a flat affect
act chronically tired or withdrawn
appear disheveled
If initial feelings of depression are not addressed what will happen
clinical depression may develop leading to suicide attempts or loss of life
Prolonged or severe stress can have
physical effects on the body
when parasympathetic is the primary even it would cause
increased gastrointestinal motility and bronchial constriction may occur, resulting in stress-induced conditions such as irritable bowel syndrome or asthma
body immune system response could be altered because of
stress
Stress has accelerated the progression
human immunodeficiency virus (HIV) infection toward active acquired immune deficiency syndrome (AIDS)
stress has a positive correlation with high viral loads, making
highly active antiretroviral therapy (HAART) less effective
High stress levels are known to
exacerbate multiple sclerosis and other autoimmune diseases
The unrelieved exposure to some stress hormones can lead to
organ failure
standard for laboratory assessment of physiologic stress
Measurement of cortisol found in the blood
urine and saliva
what hormone rise in males when there physically stressed
Testosterone
Nonverbal behaviors of stress include
irritability, agitation, anxiety, and poor eye contact
Stress may be caused by
loss of a job
the death of a family member or friend
the diagnosis of an illness
finances
relationships
International Classification for Nursing Practice (ICNP) nursing diagnoses for stress and coping include
Difficulty Coping
Anxiety
Caregiver Stress
Examples of goals that address concerns related to stress and coping are:
- Patient will discuss possible coping strategies with psychiatric counselor.
- Patient will report increased ability to concentrate on care instructions before discharge.
- Caregiver will use respite care for his loved one once a week for the next month.
Delegation Approaching Stress-Related Concerns Holistically
- A dietitian can be consulted to assess the patient’s nutritional needs and develop a nutritional plan.
- To identify appropriate services and resources, a social worker is incorporated into the plan of care.
- Family members and assistive personnel may be involved in care planning to ensure a comprehensive approach.
- Pastoral care plays a significant role in addressing stress and anxiety issues when the patient has a preferred religion or strong faith background.
- If coordination of care between multiple health care disciplines is needed, a case manager is used.
- Patients with mental health issues related to current health problems or with chronic mental health or psychiatric issues need a referral to a psychologist, psychiatrist, or advanced practice psychiatric nurse.
Stress management interventions
relaxation therapies and
mind-body therapy
Integrating relaxation and mind-body techniques into one’s daily routine has been found to
decrease pain
decrease blood pressure
increase a sense of well-being
improve quality of life
and increase the sense of coherence
Strategies for stress management must focus on the principles of
balance,
relaxation
nutrition
The attainment of relaxation is accomplished through
active and passive activity
exercise
yoga
biofeedback
guided imagery
When stress results from overwhelming perceived work and/or personal responsibilities what is a good intervention
time management
time management interventions include
prioritizing tasks
setting goals
increasing concentration skills
decreasing distractions,
avoiding procrastination
setting boundaries
maintaining self-discipline
anger management interventions include
expressing feelings in a calm and nonconfrontational manner
exercising
identifying potential solutions,
taking a time-out
forgiving
diffusing the situation with humor,
“owning” the negative feelings
doing deep-breathing exercises
stress impact on nurtition
stress often leads to unhealthy food choices that affect mood and impact a person’s response to inflammation
Stress puts people at a greater risk for
infection and delayed wound healing
Increasing the intake of? can enhance both psychological and physical responses to stress
fruit,
vegetables
legumes
fish
poultry
whole grains
support group is
an effective intervention to reduce stress related to specific life circumstances
Complementary therapies frequently are used in
conjunction with medical therapies
Alternative therapies are used in
place of medical treatment
Complementary and Alternative Therapies are useful when
patients are experiencing physiologic and psychological responses to stress
When coping mechanisms are ineffective or nonexistent it could cause
stress-related illnesses (such as gastrointestinal problems, pain, and heart disease)
Relaxation techniques decrease
the physiologic response by decreasing heart rate
respiratory rate
gastrointestinal motility
Psychological responses to relaxation techniques include
increased sense of well-being and a decrease in depression and anxiety
Benefits of mind-body therapies
improved sleep
relaxation
decreased pain
Relaxation therapy incorporates
the use ofnonpharmacologic techniques to reduce psychological or physiologic distress
Relaxation therapy do what
increases awareness of muscle tension and incorporates interventions to decrease tension
Progressive relaxation is implemented by
having patients focus on muscles that are tensed and then intentionally relax those muscle groups
Exercise has been found to
decrease stress level and cortisol levels and increase a sense of well-being in patients of all ages
Other benefits of exercise include
improved muscle tone
weight management
improvement of cardiovascular and pulmonary functioning
Research supports the use of relaxation therapies to treat a variety of conditions, including:
- Anxiety associated with biopsy procedures, dental treatment, cancer, and chronic illnesses, such as heart disease
- Insomnia
- Pain during labor and cancer treatment
- Nausea during chemotherapy treatment
- Chronic headaches
- Chronic pain in children and adolescents
- Anxiety in older adults
Disturbances in sleep patterns can lead to
irritability
fatigue
depression
tiredness
decreased ability to concentrate
immunosuppression
Nurses can implement interventions to facilitate sleep including
limiting interruptions during the night and controlling the environment
lighting
noise
room temperature
limiting screen time 2 hours before sleep.
Guided imagery focuses on
positive external images, such as a patient’s favorite vacation spot, to create a relaxed state
Guided imagery is
verbal form of instruction by the nurse or another clinician that directs the patient’s attention away from upsetting thoughts
Well-conducted guided imagery improves
physiologic functions
such as heart rate
respiratory rate
blood pressure
gastrointestinal motility
hormonal levels
Guided imagery can be incorporated into care to
boost the immune system
decrease pain
develop positive feelings
The practice of yoga includes
physical exercises, controlled breathing exercise (pranayama), position selection (asanas), and relaxation exercises to strengthen the body, mind, and soul
Engaging in yoga benefits
increases flexibility
improves endurance
decreases blood pressure
enhances breathing
promotes relaxation
and reduces stress
Meditation involves
bringing awareness to the body and the mind by directing one’s focus on a specific word, the breath, a sound, or image
During meditation, the breath
is the focus in order to bring awareness to the mind and body
Meditation can be used to
decrease stress and anxiety in adults
Meditation affects the _________ nervous system
sympathetic
Meditation lowers
lowering blood pressure, heart rate, breathing, metabolism, and blood flow to the muscles
mindfulness is
specific meditations and refers to a mental quality, a self-regulation of attention, a choice to respond rather than react to a situation
CBT is
a form of therapy that helps people become more aware of their thoughts, emotions, and motivating behaviors;
cbt benefits
reduce levels of anxiety, pain, insomnia, and depression
Biofeedback is
use of electronic devices to help the patient develop a learned awareness of the body’s physiologic responses to unconscious, involuntary stressors
in biofeedback The patient learns
the correlation between feelings, thoughts, and physiologic responses to stressors
Biofeedback is used to treat problems such as
stress
addictions
and back pain
Energy Therapy uses
the hands of the practitioner as a conduit to manipulate the negative energy fields of the patient and move the congestion or obstruction of the negative energy away from the energy field
Energy therapy has been shown to
decrease stress,
anxiety
acute and chronic pain
to promote a sense of well-being
Reiki is
an energy medicine technique in which the hands of the practitioner move and transfer energy from the practitioner to the patient
Reiki works by
restoring the body’s homeostasis
reiki helps patients manage
illness
anxiety
stress
The use of touch through hand motions enhances
energy fields to promote healing
Therapeutic touch benefits
decreases pain and anxiety
increases the sense of well-being
enhances the functioning of the immune system
promotes relaxation
reduces depressive symptoms
TCM stands for
Traditional Chinese medicine
TCM is based on the
balance of yin and yang
yin and yang are
two opposite forces of nature
Imbalance between yin and yang causes
illness and disease
TCM modalities examples
Herbal medicine, massage, acupuncture, and Feng Shui
Crisis intervention is
short-term assistance provided at a time of physical or emotional upheaval with the goal of helping the person in distress to regain equilibrium
Crisis intervention involves
immediate action to help reduce the impact of a traumatic event in the affected person’s life
Nurses, doctors, clergy, counselors, and community workers (such as firefighters and police) are
called on to provide crisis intervention
burnout is
mental or physical exhaustion due to constant stress or activity
