Ch 31 Stress & Coping

Front 1

Stressors

Back 1

- Are disruptive forces operating within or on any system
- When stress overwhelms a person’s existing coping mechanisms, disequilibrium occurs, and a crisis results
- If symptoms of stress persist beyond the duration of the stressor, a person has experienced a trauma

Front 2

Appraisal

Back 2

Is how people interpret the impact of the stressor on themselves, of what is happening, and what they are able to do about it

Front 3

Fight-or-flight response to stress

Back 3

- Arousal of the sympathetic nervous system
- Increases heart rate
- Diverting blood from intestines to the brain and striated muscles
- Increasing blood pressure, respiratory rate, and blood glucose levels
- Neurophysiological Responses function through negative feedback
- Senses an abnormal state such as lowered body temperature, and makes an adaptive response, such as initiating shivering to generate body heat
- 3 structures, the medulla oblongata, the reticular formation, and the pituitary gland, control the body’s response to a stressor

Front 4

Medulla Oblongata

Back 4

- Controls the heart rate, blood pressure and respiration
- Heart rate increases in response to impulses from sympathetic fibers and decreases with impulses from parasympathetic fibers

Front 5

Reticular Formation

Back 5

Continuously monitors the physiological status of the body through connections with sensory and motor tracts

Front 6

Pituitary Gland

Back 6

- Produces hormones necessary for adaptation to stress, such as adrenocorticotropic hormone (ACTH) which produces cortisol
- Regulates the secretion of thyroid, gonadal, and parathyroid hormones

Front 7

General Adaptation Syndrome (GAS)

Back 7

- 3 stage reaction to stress
- Body responds to stressors:
- Alarm reaction
- Resistance stage
- Exhaustion stage
- Gas is triggered either directly by a physical event or indirectly by a psychological event
- Gas involves the autonomic nervous system and the endocrine system
- Communicates with the - Hypothalamus which secretes endorphins
- Endorphins are hormones that act on the mind like morphine and opiates, produce a sense of well-being and reduce pain

Front 8

Alarm Reaction

Back 8

- Rising hormone levels result in increased blood volume
- Blood glucose levels
- Epinephrine and norepinephrine amounts
- Heart rate
- Blood flow to muscles
- Oxygen intake
- Mental alertness
- Pupils of the eyes dilate to produce a greater visual
- Can last from 1 minute to many hours

Front 9

Resistance Stage

Back 9

- Body stabilizes and responds in an opposite manner to the alarm reaction
- Hormone levels, heart rate, blood pressure, and cardiac output return to normal, and the body repairs any damage that has occurred

Front 10

Exhaustion Stage

Back 10

- Occurs when the body is no longer able to resist the effects of the stressor and when the body has depleted
- Body cannot defend itself against the impact of the event, physiologically regulation diminishes, if stress continues death results


Front 11

Stress makes people ill as a result of:

Back 11

- Increased levels of powerful hormones that change our bodily processes
- Coping choices that are unhealthy, such as not getting enough rest or a proper diet or use of tobacco, alcohol, other substances, or caffeine
- Neglect of warning signs of illness or failure to adhere to prescribed medicines or treatments

Front 12

Reaction to Psychological Stress:
Primary Appraisal

Back 12

- Evaluating an event for its personal meaning
- Appraisal of an event or circumstance is an ongoing perceptual process

Front 13

Reaction to Psychological Stress:
Secondary Appraisal

Back 13

If stress is present secondary appraisal focuses on possible coping strategies

Front 14

Coping

Back 14

- Is the person’s effort to manage psychological stress
- Effectiveness of coping strategies depends on the individual’s needs
- Combination of problem-focused coping and emotion-focused coping strategies


- Coping behaviors constantly change as individuals perceive new information

Front 15

Ego-Defense Mechanisms

Back 15

- Purpose of which is to regulate emotional distress and thus give a person protection from anxiety and stress
- Help a person cope with stress indirectly
- Offer psychological protection from a stressful event


Front 16

Distress

Back 16

Damaging stress

Front 17

Eustress

Back 17

Stress that protects health
Is motivating energy, such as happiness, hopefulness, and purposeful movement

Front 18

Developmental Crises and Situational Crises

Back 18

- Developmental stage is a marriage, birth of child, retirement
- Situational crisis can be provoked by an external source like a job change, vehicle accident, death, or severe illness
- “What does this mean to you; how is it going to affect your life?”

Front 19

Neuman Systems Model

Back 19

- Nursing theory views nursing as being responsible for developing interventions to prevent or reduce stressors on the client or to make them more bearable for the client
- Every person develops a set of responses to stress that constitute the “Normal line of defense”
- Stresses the importance of accuracy in assessment and interventions that promote optimal wellness using primary, secondary, and tertiary prevention strategies

Front 20

Primary Prevention

Back 20

Goal of primary prevention is to promote client wellness by stress prevention and reduction of risk factors

Front 21

Secondary Prevention

Back 21

Secondary prevention occurs after symptoms appear

Front 22

Tertiary Prevention

Back 22

Tertiary prevention begins when the client system becomes more stable and recovers

Front 23

Situational Factors

Back 23

- Job changes, relocation
- Adjusting to chronic illness leads to situational stress

Front 24

Maturational Factors

Back 24

Self-esteem issues, changing family structure due to divorce or death of a parent

Front 25

Sociocultural Factors

Back 25

Environmental and social stressors lead to developmental problems

Front 26

Goals and Outcome

Back 26

- Primary level of prevention
- You direct nursing activities to identifying individuals and populations who are possibly at risk for stress
- Secondary level Interventions
- Include actions directed at symptoms, such as protecting from self-harm
- Tertiary Level Interventions
- Have the purpose of assisting the client in readapting and will possibly include relaxation training and time management training

Front 27

Setting Priorities

Back 27

- “What is happening in your life that you needed to come today?”
- Assess the client’s perception of the event, available situational supports, and what the person usually does when there is a problem the client cannot solve
- Determine if the person is suicidal
- “Are you thinking of killing yourself or someone else?”

Front 28

Health Promotion

Back 28

Three primary modes of intervention for stress are to decrease stress-producing situations, increase resistance to stress, and learn skills that reduce physiological response to stress

Front 29

Burnout

Back 29

Occurs as a result of chronic stress
Is a syndrome of emotional exhaustion, depersonalization of others, and perceptions of reduced personal accomplishment, resulting from intense involvement with people in a care-giving environment

Front 30

Crisis Intervention

Back 30

- Is a specific type of brief psychotherapy with prescribed steps
- More directive than traditional psychotherapy or counseling, and any member of the health care team who has been trained in its techniques can use it

- Crisis intervention aims to return the person to a precrisis level of functioning and to promote growth