Unit 3 Review

Stress

The body's response to real or PERCEIVED changes that upset homeostasis; occurs when demands are greater than a person's resources to meet them

Homeostasis

The body's normal state of balance

Stressor

Anything that causes stress;

stressors are neutral (Selye), and the person's appraisal decides if it becomes good or bad stress

Eustress

Positive, motivating stress (starting a dream job, winning a race)

Distress

Negative, harmful stress, especially when long-lasting (eviction notice, loved one's serious illness)

Which brain structure (the fear center) alerts the hypothalamus when danger is sensed?

Amygdala

What hormone does the hypothalamus release to start both stress pathways?

CRH (also called CRF; same hormone, two names)

What are the two hormone "highways" of the stress response?

SAM system (fast) and HPA axis (slow but lasting)

SAM system stands for

Sympathetic-adrenal-medullary system

SAM system: speed, path, and chemicals

Seconds; hypothalamus → sympathetic nervous system → adrenal MEDULLA; releases epinephrine, norepinephrine, and dopamine (catecholamines); causes immediate fight-or-flight

HPA axis stands for

Hypothalamic-pituitary-adrenal axis

HPA axis path

Hypothalamus (CRH) → pituitary (ACTH) → adrenal CORTEX (cortisol)

HPA axis: purpose

Sustains the stress response as long as the threat lasts; regulates immunity, metabolism, and the autonomic nervous system

A client narrowly avoids a car crash and has a pounding heart within seconds. Which system caused this?

SAM system (fast, epinephrine and norepinephrine from the adrenal medulla)

Memory trick for SAM vs. HPA

SAM = Seconds. HPA = Hang on (it lasts). Medulla = fast adrenaline hormones. Cortex = cortisol (both start with "cort")

Which part of the adrenal gland makes cortisol?

Adrenal cortex

Which part of the adrenal gland makes epinephrine and norepinephrine?

Adrenal medulla

Fight-or-flight: cardiovascular changes

Heart rate and blood pressure go UP (more blood to muscles, brain, and vital organs)

Fight-or-flight: respiratory changes

Airways widen and breathing speeds up (more oxygen)

Fight-or-flight: eye and alertness changes

Pupils dilate and alertness increases

Fight-or-flight: metabolic changes

Glucose and fat are released into the blood for quick energy

Fight-or-flight: digestive changes

Digestion slows and mouth becomes dry (saves energy for the emergency)

Fight-or-flight: skin, muscle, pain, and clotting changes

Sweaty palms, tense muscles, decreased pain perception, and blood clots more easily

Which nervous system returns the body to a calm state after the threat passes?

Parasympathetic nervous system

Cortisol

The body's main stress hormone, released by the adrenal cortex at the end of the HPA axis; regulates stress response, immunity, metabolism, blood sugar, and the autonomic nervous system

Short-term effect of cortisol

Boosts some immune functions and raises blood glucose for energy

Long-term (chronic) effect of high cortisol on immunity

Suppresses the immune system and causes inflammation; more infections and slow wound healing

Glucocorticoid resistance

In chronic stress, immune cells stop responding to cortisol, so inflammation and infection risk increase

How does high cortisol raise diabetes risk?

It makes it harder for insulin to move sugar into cells, raising risk of type 2 diabetes

How does good sleep affect cortisol?

Good sleep LOWERS cortisol

Allostasis

The body's ability to adapt to new challenges

Allostatic load

Wear and tear on the body from constant adjusting when stress lasts too long; leads to heart, metabolic, and immune problems (like a phone battery that never fully charges)

A client has chronic stress. Which disease categories are at higher risk? (core five)

• Heart disease/hypertension,

• stroke,

• type 2 diabetes,

• digestive problems/gastric ulcers,

• depression and anxiety

Other conditions linked to chronic stress

Autoimmune disorders, immunosuppression and delayed wound healing, COPD and asthma flare-ups, tension headaches, TMJ disorder, fibromyalgia, low back pain, osteoporosis, infertility, menstrual irregularities, PCOS, PTSD, sleep disorders

Adverse childhood experiences (ACEs)

Traumatic events in childhood; an ACE score of 4 or more is linked to much higher risk of chronic illness as an adult

General Adaptation Syndrome (GAS)

Hans Selye's three-stage model of how the body tries to keep its balance when stress disrupts it

Name the three stages of GAS

Alarm → Resistance → Exhaustion

GAS Stage 1: Alarm

Fight-or-flight switches on; catecholamines flood the body; increased BP, heart rate, blood glucose, alertness; dilated pupils

GAS Stage 2: Resistance

Body works to cope; parasympathetic tries to calm things but balance is not restored while the stressor remains; irritability, fatigue, trouble concentrating (looks okay but running on empty)

GAS Stage 3: Exhaustion

Body's ability to adapt is used up; long exposure leads to illness (allostatic load: chronic hypertension, depression, autoimmune disorders)

A client under stress for weeks is irritable, fatigued, and cannot concentrate. Which GAS stage?

Resistance

Memory trick for GAS

A-R-E you stressed? Alarm, Resistance, Exhaustion (fire station: siren, firefighters battle blaze, run out of water)

Transactional theory of stress and coping

Stress depends on how a person appraises a situation, and the appraisal keeps changing

Primary appraisal

"Is this a threat to me?" If no, there is no stress response

Secondary appraisal

"Do I have the resources to cope?" (support, skills, past successes vs. demands)

Reappraisal

"Is my plan working? Has anything changed?" The cycle repeats

Two clients have the same diagnosis but very different stress levels. What should the nurse do?

Ask, do not assume

Acute stress (type)

Most common; brief, one event (car accident); usually no lasting harm

Episodic acute stress

FREQUENT bouts of acute stress; people who take on too much and feel rushed

Chronic stress (type)

Constant and prolonged; nervous system never switches off; leads to anxiety, depression, heart disease

Traumatic stress

Events that overwhelm coping (disaster, violence); can lead to PTSD

Environmental stress

Noise, pollution, crowding, unstable housing, food insecurity

Psychological stress

Something a person INTERPRETS as threatening (school, money, divorce)

Physiological stress

Illness, injury, pain, extreme temperatures

Acute stress disorder (ASD) duration

Less than 1 month

Posttraumatic stress disorder (PTSD) duration

More than 1 month; symptoms can be delayed months or years

A client has flashbacks and nightmares 3 weeks after a trauma. ASD or PTSD?

ASD (less than 1 month)

A client still has flashbacks and nightmares 6 weeks after a car crash. ASD or PTSD?

PTSD (more than 1 month)

ASD symptoms

Numbness, feeling detached (depersonalization), disrupted sleep, irritability, easily startled, reliving the event, avoiding reminders

PTSD symptoms

Intrusive memories, flashbacks, nightmares, sweating, fast heart rate, exaggerated startle response to triggers

Trigger (PTSD)

A sound, smell, or event that brings back the trauma

Typical causes of ASD vs. PTSD

ASD: death of a loved one, threat of serious injury, war or violence.

PTSD: accident, sexual abuse, natural disaster

Do most people exposed to trauma develop PTSD?

No, most do not

Crisis

A major event (precipitating event) that pushes a person beyond their ability to cope

Developmental (maturational) crisis

Normal life transitions (puberty, retirement, menopause, starting a family)

Situational crisis

Something happens TO you from outside (job loss, death, disaster, illness, domestic violence)

Existential crisis

Inner struggle with meaning and identity ("Who am I? What is my purpose?")

Psychiatric emergency (crisis type)

Immediate danger to safety (suicide attempt, psychosis, severe depression)

Crisis intervention focus

Action- and situation-focused: identify the trigger event, use skills and support systems, make a plan for now and the future

Roberts' 7 stages of crisis intervention

1) Assess (including suicide and homicide risk), 2) build rapport, 3) define the problem, 4) explore feelings, 5) explore coping options, 6) act on a plan, 7) follow up

What does the nurse do FIRST in a crisis?

Assess safety, including suicide and homicide risk

Coping

CONSCIOUS, deliberate effort to handle a stressful situation (a choice)

Defense mechanism

UNCONSCIOUS, automatic reaction that protects self-esteem and lowers anxiety

Which is conscious: coping or defense mechanisms?

Coping

Reactive coping

After the stressor happens (putting out the fire)

Proactive coping

Ahead of time to prevent stress (installing smoke detectors)

Problem-focused coping

Change the situation (make a schedule)

Emotion-focused coping

Change how you feel about it (reframe, self-talk)

Adaptive coping

Helps short AND long term (exercise, journaling)

Maladaptive coping

Helps now but hurts later (drug or alcohol misuse)

Why is alcohol a classic maladaptive coping example?

It feels calming but actually raises cortisol and worsens stress over time

A client says, "The test result must be wrong." Which defense mechanism?

Denial

Denial

Refusing to accept reality

Projection

Blaming your own feelings on others (angry person says, "You're the one who's mad")

Rationalization

Making a logical-sounding excuse ("I skipped my pills because I felt fine")

Suppression

DELIBERATELY pushing thoughts away ("I'll think about it tomorrow")

Repression

UNCONSCIOUSLY burying memories (not remembering part of a trauma)

Regression

Going back to earlier behavior (potty-trained hospitalized child wets the bed)

Disavowal

Not admitting distressing feelings ("I'm not upset" while clearly upset)

Suppression vs. repression memory trick

Suppression = on purpose. Repression = not on purpose

A hospitalized 5-year-old who was potty-trained starts wetting the bed. Defense mechanism?

Regression

Burnout, compassion fatigue, and moral distress (nurse stressors)

Burnout = exhaustion from work stress; compassion fatigue = cumulative stress from being unable to relieve others' suffering; moral distress = actions taken differ from what the nurse believes is ethically right

What helps nurses with moral distress?

Ethics committees, debriefings, peer support, ANA Code of Ethics

Healthy Nurse, Healthy Nation (HNHN)

ANA program to improve the nation's health by strengthening nurses' well-being

Name the five HNHN domains

Quality of life, safety, physical activity, sleep, nutrition

Memory trick for the HNHN domains

Q-S-P-S-N: Quiet Shifts Promote Sleep and Nutrition

Perceived Stress Scale (PSS)

Self-report tool asking how unpredictable, uncontrollable, and overwhelming life has felt over the PAST MONTH

Trauma-informed care

Ask "what happened to you?" instead of judging behavior; avoid retraumatizing the client

What theory says culture shapes how people appraise and cope with stress?

Leininger's Culture Care Theory

First step in helping a stressed client

Build trust (rapport, safe and confidential setting), then assess, including safety and suicide risk