Unit 3 Exam

Which hormone system produces the FAST stress response (seconds)?

SAM (sympathomedullary) system. Trick: SAM = Seconds.

Which hormone system produces the SLOW, sustained stress response?

HPA axis (hypothalamic-pituitary-adrenal).

Trick: HPA = Hang on.

Describe the pathway of the SAM system.

Amygdala → hypothalamus → sympathetic nervous system → adrenal MEDULLA → epinephrine, norepinephrine, dopamine.

Describe the pathway of the HPA axis.

Hypothalamus releases CRH → pituitary releases ACTH → adrenal CORTEX releases cortisol.

What does CRH stand for and where is it released?

Corticotropin-releasing hormone; released by the hypothalamus.

What does ACTH stand for and where is it released?

Adrenocorticotropic hormone; released by the pituitary gland.

Which part of the adrenal gland releases epinephrine and norepinephrine?

Adrenal MEDULLA (use medulla = epi/norepi).

Which part of the adrenal gland releases cortisol?

Adrenal CORTEX (cortex = cortisol).

What is the job of the SAM system?

Fight-or-flight response (fast, immediate reaction to a threat).

What is the job of the HPA axis?

Keeps the stress response going; regulates immunity and metabolism.

Which body system calms the body after the threat has passed?

Parasympathetic nervous system.

Which brain structure first detects a threat and starts the stress response?

Amygdala.

A client is startled by a loud noise. Which hormones are responsible for the immediate heart-pounding reaction?

Epinephrine and norepinephrine (SAM system, adrenal medulla).

Name the signs of the fight-or-flight response.

↑ heart rate, ↑ BP, fast breathing, dilated pupils, sweaty palms, tense muscles, ↑ glucose, slowed digestion, dry mouth, ↓ pain perception.

Why does digestion slow during fight-or-flight?

Blood and energy are diverted to muscles, heart, and brain for survival;

the GI system is not a priority.

Why does blood glucose rise during acute stress?

Epinephrine and cortisol release glucose to give the body quick energy for fight or flight.

Why is pain perception decreased during fight-or-flight?

The body releases chemicals (e.g., endorphins) so the person can keep fighting or fleeing despite injury.

What is cortisol and where is it made?

The main stress hormone, made by the adrenal cortex.

What is the effect of SHORT-term cortisol on immunity?

It boosts some immune functions.

What are the effects of CHRONIC high cortisol?

Suppressed immunity, inflammation, slowed wound healing, and increased risk of infection.

A client under chronic stress has a wound that is healing slowly and keeps catching colds. Which hormone best explains this?

Cortisol (chronic elevation suppresses the immune system and delays wound healing).

Define allostatic load.

The cumulative wear and tear on the body from chronic stress.

Name the cardiovascular conditions linked to chronic stress.

Hypertension, coronary artery disease, and stroke.

Name the metabolic/GI conditions linked to chronic stress.

Diabetes and gastric ulcers.

Name the immune conditions linked to chronic stress.

Immunosuppression, delayed healing, and autoimmune disorders.

Name the mental health/sleep conditions linked to chronic stress.

Anxiety, depression, PTSD, and sleep disorders.

Name the respiratory conditions affected by chronic stress.

COPD and asthma exacerbations.

Other conditions linked to chronic stress (besides CV, metabolic/GI, immune, mental health, respiratory)?

Osteoporosis, tension headaches, fibromyalgia, infertility/menstrual irregularity.

What ACE score indicates a much higher risk of chronic illness?

ACE (Adverse Childhood Experiences) score of 4 or higher.

Who developed the General Adaptation Syndrome (GAS)?

Hans Selye.

List the 3 stages of GAS in order.

1. Alarm 2. Resistance 3. Exhaustion.

GAS Stage 1: Alarm – what happens?

CNS mobilizes; catecholamines trigger fight-or-flight. Signs: ↑ BP, ↑ HR, ↑ glucose, ↑ alertness.

GAS Stage 2: Resistance – what happens?

Body fights back and the parasympathetic system calms, but balance is NOT fully restored. Signs: poor concentration, irritability, fatigue.

GAS Stage 3: Exhaustion – what happens?

Adaptation is used up. Signs: illness such as chronic hypertension, depression, autoimmune disease.

A client who has had months of work stress now reports irritability, poor concentration, and fatigue. Which GAS stage is this?

Resistance stage.

A client who has had years of chronic stress is now diagnosed with chronic hypertension and depression. Which GAS stage is this?

Exhaustion stage.

Does GAS occur with only negative stress?

No. It occurs with both eustress (good stress) and distress (bad stress).

Define eustress.

Positive, motivating stress (e.g., a wedding, a promotion).

Define distress.

Negative stress that overwhelms coping (e.g., job loss, illness).

Are stressors good or bad by nature?

Stressors are neutral. APPRAISAL (how the person perceives them) determines whether they cause stress.

What is a stressor?

Any event or stimulus that triggers a stress response.

What is the Transactional Theory of Stress and Coping (TTSC)?

Stress depends on how a person appraises a stressor and their ability to cope with it.

TTSC: What is PRIMARY appraisal?

"Is this a threat?" (evaluating whether the event is harmful or threatening).

TTSC: What is SECONDARY appraisal?

"Can I cope?" (evaluating available resources and coping options).

TTSC: What is REAPPRAISAL?

Re-evaluating the situation after responding; the cycle repeats.

What is problem-focused coping?

Coping that CHANGES the situation (e.g., making a plan, seeking info, fixing the problem).

What is emotion-focused coping?

Coping that changes how you RELATE to or feel about the situation (e.g., relaxation, reframing, venting).

A client who is told her job is ending makes a budget and applies for new jobs. Which type of coping is this?

Problem-focused coping.

A client uses deep breathing and prayer to manage anxiety about a diagnosis. Which type of coping is this?

Emotion-focused coping.

What does ASD stand for?

Acute Stress Disorder.

What does PTSD stand for?

Post-Traumatic Stress Disorder.

What is the duration of ASD?

Less than 1 month (3 days to 1 month after trauma).

What is the duration of PTSD?

Longer than 1 month.

What happens if ASD symptoms last longer than 1 month?

It becomes PTSD.

List the features of ASD.

Numbness, detachment, depersonalization, reliving the event, avoidance, easily startled, poor sleep.

List the features of PTSD.

Flashbacks, intrusive memories, nightmares, exaggerated startle response; onset may be delayed months or years.

Can PTSD symptoms start months or years after the trauma?

Yes. Onset can be delayed.

Do most people exposed to trauma develop PTSD?

No. Most trauma-exposed people do NOT develop PTSD.

A client has had flashbacks and nightmares for 6 weeks after a car accident. What is the likely diagnosis?

PTSD (symptoms longer than 1 month).

A client 10 days after an assault reports numbness, detachment, and trouble sleeping. What is the likely diagnosis?

Acute Stress Disorder (less than 1 month).

What are triggers in PTSD?

Sounds, smells, or unexpected changes that remind the client of the trauma and can set off symptoms.

What is trauma-informed care?

Care that recognizes the impact of trauma, identifies the client's triggers, and avoids retraumatizing them.

A nurse approaches a client with PTSD from behind to change a dressing. What is the problem?

Unexpected touch or approach can be a trigger. Tell the client what you are doing, approach from the front, and give choices.

List the 7 types of stress.

Acute (most common), episodic acute, chronic, traumatic, environmental, psychological, physiological.

Which type of stress is the most common?

Acute stress.

Define episodic acute stress.

Frequent episodes of acute stress.

Define chronic stress.

Constant stress that continues over a long period without relief.

Define a crisis.

A precipitating event that pushes a person beyond their ability to cope.

List the 4 types of crisis.

Developmental, situational, existential, psychiatric emergency.

What is a developmental crisis?

A crisis tied to a life stage transition (e.g., puberty, retirement).

What is a situational crisis?

A crisis from an external event (e.g., job loss, death, disaster).

What is an existential crisis?

A crisis involving meaning, purpose, or identity.

What is a psychiatric emergency crisis?

A crisis such as suicide attempt or psychosis.

A client loses a job and home in a fire. What type of crisis is this?

Situational crisis.

A 66-year-old becomes depressed after retiring. What type of crisis is this?

Developmental crisis.

A client is brought in after a suicide attempt. What type of crisis is this?

Psychiatric emergency.

Is crisis intervention action-focused or insight-focused?

Action-focused (short-term, practical problem solving).

List Roberts' 7 stages of crisis intervention.

1. Assess (suicide/homicide risk first) 2. Rapport 3. Define the problem 4. Explore feelings 5. Explore coping 6. Act 7. Follow up.

What is the FIRST step of crisis intervention?

Assess the client, including suicide and homicide risk.

What is the priority during the first stage of Roberts' crisis model?

Assessing lethality (suicide/homicide risk) and safety.

What is a defense mechanism?

An UNCONSCIOUS, automatic way of protecting oneself from anxiety or distress.

What is coping?

CONSCIOUS, deliberate effort to manage stress.

Key difference between defense mechanisms and coping?

Defense mechanisms are unconscious and automatic;

coping is conscious and deliberate.

Define denial.

Refusing to accept reality.

Define projection.

Blaming one's own unacceptable feelings or thoughts on others.

Define rationalization.

Justifying behavior with logical-sounding excuses.

Define regression.

Returning to childlike behavior under stress.

Define suppression.

DELIBERATELY pushing unpleasant thoughts out of mind (conscious).

Define repression.

UNCONSCIOUSLY burying painful thoughts or memories.

Suppression vs. repression: what is the difference?

Suppression is deliberate/conscious; repression is unconscious.

Define compartmentalization.

Walling off different areas of life so they do not affect each other.

Is humor a defense mechanism?

Yes, humor can be used as a defense mechanism (and can be adaptive).

A client with a new diabetes diagnosis says, "The lab made a mistake. I'm fine." Which defense mechanism is this?

Denial.

A client angry at himself yells that the nurse is incompetent. Which defense mechanism is this?

Projection.

A hospitalized 8-year-old starts bed-wetting and thumb-sucking. Which defense mechanism is this?

Regression.

A client who missed medications says, "I was just too busy, and it's not that important anyway." Which defense mechanism is this?

Rationalization.

What is adaptive coping?

Coping that helps in the short term AND long term (e.g., exercise, journaling).

What is maladaptive coping?

Coping that helps short-term but worsens things long-term (e.g., alcohol, drugs).

Does alcohol reduce stress long term?

No. Alcohol RAISES cortisol and is maladaptive coping.

Which is an example of maladaptive coping: journaling, exercise, or drinking alcohol?

Drinking alcohol.