Stress & Exemplars

Stress

physical or emotional strain in response to a perceived or actual threat

Stressor

anything perceived as challenging, threatening, demanding

Stress

physical or emotional strain in response to a perceived or actual threat

Stressor

anything perceived as challenging, threatening, demanding

Acute Stress

most common; short-lived stress which resolves with the removal of the stressor

Chronic Stress

sustained threat which is harmful to ones health

Episodic

repetitive, self-inflicted stress

Physiologic Stress Sequence

stressor; hypothalamic response; corticotropin releasing factor; sympathetic nervous activation, a and p pituitary activation

Results of Stress

increased BP, HR, CO, MSK perfusion, bronchodilation, pupil dilation, increased blood glucose, increased sodium and water retention, increased protein synthesis, immunosuppression, increased inflammatory response

Nursing Assessment of Stress

patient interview, collection of data, review of systems, physical exam, diagnostics

Burnout

response to physical or emotional stress leading to exhaustion, self-doubt, cynicism, ineffectiveness

PTSD

chronic stress which occurs after a traumatic event

Manifestations of PTSD

flashbacks, high anxiety, nightmares, memory less, survivors guilt, anger and aggression

Manifestations of PTSD in Children

bedwetting, lack of talking, acting out, clinginess

Manifestations of PTSD in Adolescents

disruptive, destruction, disrespectful behavior, guilt

Nursing Interventions PTSD

ensure patient safety, psychotherapy, medications, referral to community resources

Trauma Informed Care

approach that understands and values awareness, effects and circumstances surrounding the trauma

The 4 Rs of Trauma Informed Care

realization, recognition, responding, resist

Realization

impact of trauma and path to recovery

Recognition

signs and symptoms of trauma

Responding

integration of knowledge, policies, procedures, practices

Resist

re-traumatization

Ready

resources meet demands of stress; positive coping mechanisms in place

Reacting

stress resolves quickly; person maintains confidence and competence

Injured

additional resources are needed to manage stress; often longer term; can relate to burnout

Ill

exceeds normal coping; might be linked to more severe mental health conditions

HPA Axis

hypothalamic-pituitary-adrenal axis; neuroendocrine system that regulates the body's response to stress

Hormones of the HPA Axis

CRH (hypothalamus), ACTH (pituitary), cortisol (adrenal gland)

Hans Selye

endocrinologist who discovered general adaption syndrome and the HPA axis as it relates to chronic stress; distinguished positive and negative stress

Eustress

positive stress

Distress

negative stress

What are the three stages of stress according to Selye?

alarm, resistance, exhaustion

Lazarus and Folkman

founded the transactional theory of stress

Transactional Theory of Stress

stress arises from the interaction between a person and their environment

How pertinent is burnout in nurses?

2/3

What is the leading cause of death in children over 1?

cancer

Terminal Illness

disease or condition that will lead to death

Substance Use Disorder

disorder characterized by continued substance craving and use despite significant life disruption and/or physical risk

How does substance abuse in nurses compare to the general population?

nurses have higher rates of substance abuse (15-20% of nurses abuse)

Addiction is a ________.

chronic illness

What is the progression of substance abuse?

tolerance, compulsion, withdrawal, health risks, death

What are some risk factors for substance abuse?

high stress, high pressure, access to drugs, grief

Binge Drinking (Men)

4+ drinks per day

Binge Drinking (Women)

3+ drinks per day

What work-related symptoms might indicate substance abuse in a nurse?

volunteering to pass meds, coming early/staying late, discrepancy in pyxis, patient does not experience relief, large amounts of waste

What are some behavioral symptoms that might indicate substance abuse?

poor attendance, unreliability, neglecting health or hygiene

What are some physical symptoms the might indicate substance abuse?

weight loss, nodding off, pupil size, track marks

Diversion

the switch of a drug's final location

How do nurses divert drugs?

waste, signing out more than needed, signing out for unassigned patients, taking unused PRNs, siphoning from IV bags, used patches, manipulation of pyxis, substitution

What is the most developmentally appropriate place for a child with special healthcare needs?

at home

At what age should children start to be a part of the decision making process?

older than 5

Adaptation

the change that takes place as a result of the response to a stressor

Autoimmune Disorders Associated with Stress

hyperthyroidism, myasthenia gravis, psoriasis, rheumatoid arthritis, lupus, ulcerative colitis

CV Disorders Associated with Stress

CAD, HTN, sickle cell

GI Disorders Associated with Stress

constipation, diarrhea, GERD

Respiratory Disorders Associated with Stress

asthma

Local-Adaptation Syndrome

localized response of the body to stress only involving specific body parts

Parasympathetic Nervous System

function under normal conditions and at rest

Actions of the PSNS

slows HR, improves digestion, increases peristalsis, improves glucose uptake by cells

Autonomic Nervous System

the part of the peripheral nervous system which has sympathetic and parasympathetic divisions

Sympathetic Nervous System

functions under stress conditions

Actions of SNS

increases HR, CO, contractility, increased muscle strength, increased mental alertness, increased blood glucose levels

Effects of Stress on Physiologic Needs

changes in appetite, activity, sleep, elimination patterns, pulse, respirations, blood pressure

Effects of Stress on Safety and Security Needs

feeling threatened or nervous, ineffective coping, inattentiveness

Effects of Stress on Love and Belonging Needs

withdrawn, isolated, blames others, aggressive behavior, over dependence on others

Effects of Stress on Self-Esteem

becomes a workaholic, exhibits attention-seeking behaviors

Effects of Stress on Self-Actualization Needs

refusing to accept reality, centering on own problems, lack of control

What are some stress defense mechanisms?

compensation, denial, displacement, dissociation, introjection, projection, rationalization, reaction formation, regression, repression, sublimation, undoing

Introjection

integrating the beliefs and values of another individual into one's own ego structure

Reaction Formation

development of conscious attitudes and behaviors that are opposite to what they really want to do

Sublimation

redirecting a poor behavior into a context where it is socially accepted; healthy

Crisis

disturbance caused by a precipitating event in which normal coping is ineffective

Resilience

the ability to withstand or adapt to adversity, stress, or trauma

Subjective Data with Stress & Anxiety

heart palpitations, difficulty breathing, problems with appetite/sleep, changes in sexual desire, negative feelings

Objective Data with Stress & Anxiety

dry mouth, increased perspiration, tremors, tachycardia, increased BP, dilated pupils, lack of facial expression, rapid speech

Defense Mechanisms

can be used as a way to manage conflict in response to anxiety; reversible

Maladaptive Defense Mechanisms

interfere with functioning, relationships, orientation to reality

Conversion

responding to stress through unconscious development of physical manifestations

Splitting

demonstrating an inability to reconcile negative and positive attributes of self or others

Toxic Stress Response

biological and neurological changes resulting from sustained stress

Factors Influencing Ability to Cope

number, duration, intensity of stressors, past experiences, support system, available resources

Ego Defense Mechanisms

assist a person during a stressful situation or crisis by regulating emotional distress

General Adaptation Syndrome (GAS)

stress syndrome; Selye's 3 stage theory of stress reaction

GAS Stages

alarm, resistance, exhaustion

Anticipatory Grief

grief experienced prior to a loss

Complicated Grief

extensive or prolonged grief