Stress & Mental Health

Question 1

Stress

Answer 1

A transactional process

Arises from actual or perceived environmental demands (internal or external) that are appraised as benign or threatening

Question 2

Stressors

Answer 2

Physical or psychological factors that produce stress
- Can be (+) or (-)

Question 3

Resilience

Question 4

Diathesis-Stress Model

Answer 4

Nature versus nurture

Suggests that psychological disorders/mental illness arise from the interaction of an underlying/innate predisposition or vulnerability (diathesis) and external stressors.

Combination of the diathesis and adverse life events triggers its manifestation as a disorder.

The greater the diathesis, the less amount of stress that may needed to cause ‘overflow’.

Question 5

What are examples of diatheses?

Answer 5

Genetic predisposition

Question 6

Physiological Responses to Stress

Answer 6

Homeostasis – body’s attempt to resist physiological change

When the brain interprets an event as a threat, it signals the secretion of stress hormones (adrenaline, cortisol, and epinephrine).
- These hormones activate the sympathetic nervous system (SNS), physiological stability is challenged, and a “fight or flight” response occurs.
- Heart rate, blood pressure, and blood glucose typically increase, and energy is mobilized for survival.
- As the sympathetic system is activated, the parasympathetic system is muted.
- After the need for more energy is no longer needed and the threat is over, the body returns to a state of homeostasis (unless a maladaptive response occurs).

With stress, physiological changes are automatic but differ based on type, duration and intensity of stress; depend on appraised risk of situation

“Fight or flight” response – Stress hormones secreted → sympathetic nervous system activated and parasympathetic muted

Question 7

Physiological Responses to Chronic Stress

Answer 7

Chronic stress & illness
Hans Selye’s General Adaptation Syndrome (GAS) –
(body’s response to ↑’ d demand stressors create)
3 stages (Videbeck, Ch. 14, p. 223):
1. Alarm reaction – “fight or flight” response
-Stress hormones released for added fuel; glycogen stores reconverted to glucose

2. Stage of resistance
   - digestive system reduces function; lungs take in more air; heart beats faster and harder (to defend and protect the body); then use coping mechanisms to try and reestablish homeostasis – if adaptive response, body relaxes, refuel, and return to baseline (body functions ‘normalize
   3. Stage of exhaustion
      
      • Occurs if homeostasis is not achieved; body stores are depleted (may result in overload, burnout, maladaption – limited reserve capacity

Allostasis (dynamic regulation of homeostasis through adaptation) and allostatic load (effects of stress are cumulative
- Consequence of wear and tear on the body and brain  ill health

EFFECTS OF STRESS ARE CUMULATIVE.
- The greater the allostatic load, the greater the state of chronic stress and ultimately, the more negative changes in health.

Question 8

Allostasis

Question 9

Allostatic Load

Question 10

Signs & Symptoms of Acute Stress

Answer 10

“Fight or Flight”
Apprehensive
Unhappy or sorrowful
↓ appetite & digestion
↑ RR, HR, BP, cardiac output, metabolism, & serum glucose
Return to homeostasis when threat is over
Depressed immune system
Muted PSNS

Question 11

Signs & Symptoms of Chronic Stress

Answer 11

Maladaptive response
Depressed, chronic pain, disturbed sleep
Weight gain or loss
↑ Risk for MI or stroke
Poor control of diabetes, HTN, fatigue, irritable, impaired concentration
↑ Infection risk

Question 12

Examples of Factors that Affect Stress Response

Answer 12

Age, gender, culture, life experiences, lifestyle

Question 13

Protective Factors

Answer 13

Positive elements that counteract the effects of diathesis (vulnerability) and stress to prevent the onset of a disorder

May not be effective or appropriate for everyone

As nurses, we should assess what factors are present, and for those that are absent, promote/encourage those that are appropriate.

Question 14

Examples of Protective Factors that Increase a Person’s Ability to Resist Effects of Stress

Answer 14

Physical health
Strong sense of self
Spiritual or religious beliefs
Optimism
Hobbies/outside interests
Positive interpersonal relationships
Humor
Strong social support systems

Question 15

Biophysical NSG Assessment

Answer 15

Include elements such as:
- Health history
- Review of systems
- Physical functioning
- Pharmacologic
- Emotions
- Coping strategies
- Recent life changes
- Social network and social support - assess for reciprocity

May use standardized screening tools to collect some data