Stress and Coping

Stress

Normal physiological process associated with regulation and homeostasis (can be positive or negative stress)

Coping

Methods/individual’s response to manage stress

Nursing Definition of Stress

Physical/psychological tension that threatens homeostasis that necessitates change/adaptation

Interrelated Concepts to Stress

Sensory Perception, Perfusion, Oxygenation

Interrelated Concepts to Coping

Metabolism, Mobility, Emotional Regulation, Cognition, Immunity

At-Risk Populations for Stress

Older adults (bc of weakened immune system), adolescents (not fully developed), children exposed to traumatic events early in life, individuals managing chronic illness

Acute Stress

Most common type of stress, occurs for a short period and caused by real/perceived threat

Episodic Acute Stress

Self inflicted stress (ex: taking on an unreasonable amount of work beyond the limits)

Chronic Stress

Sustained demanding pressure leading to decreased immune system

Psychological and Emotional Sign of Stress

Anxiety / Irritable

Physiological Sign of Stress

High BP, stomach ache

Behavior Sign of Stress

Negative coping behaviors (smoking, overeating)

General Adaptation Syndrome Stages

Alarm Stage (Reaction) → Stage of Resistance (Adaptation) → Stage of Exhaustion

Alarm Stage (Reaction) (GAS)

CNS aroused, body’s defences are mobilized (fight or flight)

Stage of Resistance (Adaptation) (GAS)

Mobilization contributes to the fight or flight

Stage of Exhaustion

Continuous stress causes the progressive breakdown of compensatory mechanisms and homeostasis

How does the alarm stage in GAS begin?

When a stressor activates the hypothalamus and sympathetic nervous system

What does the alarm stage include an increase of?

Increase in the secretion of glucocorticoids (cortisol) by adrenal cortex + increased secretion in epinephrine/norepinephrine from adrenal medulla

How does the stage of resistance begin in GAS?

Actions of the adrenal hormones cortisol, norepinephrine, and epinephrine

What happens during the stage of exhaustion?

Occurs if stress continues and adaptation is unsuccessful, causes an impairment in immune response and organ failure leading to death

Hypothalamic-Pituitary-Adrenal (HPA) Axis

Hypothalamus secretes CRH (binds to specific receptors on pituitary cells) → ACTH produced + transported through blood to adrenal glands → glucocorticoid (cortisol) hormone released

What does cortisol regulate?

Memory, cognition, mood and sleep

What is Cortisol’s action and what does it result in?

Carbohydrate Metabolism → leading to increased blood glucose levels energizing the body to combat the stressor

What does Cortisol effect?

Protein Metabolism

How does Cortisol secretion during stress exert beneficial effects?

By inhibiting the initial inflammatory effects

LC/NE System

Circulating catecholamines stimulate sympathetic nervous system (+ epinephrine/norepinephrine)

What does the LC/NE System stimulate?

Alpha-Adrenergic (A1/A2) and B-Adrenergic (B1/B2)

Norepinephrine

Regulates BP, promotes arousal and increases vigilance, anxiety and other protective emotional responses

What does Norepinephrine primarily bind to?

A Receptors

What does Epinephrine primarily bind to?

Both A and B Receptors

What does Epinephrine mobilize?

Fatty Acids + Cholesterol

What does Epinephrine cause?

Transient hyperglycemia and decreases insulin release from the pancreas

Epinephrine

Influences cardiac action by enhancing myocardial contractility, increasing HR and increasing venous return to the heart (increasing both cardiac output and BP)

What does Epinephrine dialate?

Blood vessels supplying skeletal muscles allowing for greater oxygenation

Homeostasis

Presence of an internal state of balance

Allostasis

Describes the continual state of fluctuation our body is in

Stress-Age Syndrome

Set of neurohormonal and immune (and tissue + cellular) alterations develops, alterations in limbic system and homeostasis

What does the Stress-Age Syndrome increase?

Increase in Catecholamines, ADH, ACTH, Cortisol

Acute Physiologic Stress Examples

Acute Renal Failure, Myocardial Infarction, Respiratory Failure, Sepsis, Trauma, Acute Pain

Chronic Physiologic Stress Examples

Cancer, COPD, CKD, Dementia, Diabetes, Heart Failure, Obesity, Chronic Pain

Coping

Making an effort to manage physical and psychological stress