Quiz 2: Stress Management

When reticular activating system (RAS) is stimulate, it

increases its output of impulses, leading to wakefulness. Stress usually increase the degree of wakefulness and can led to sleep disturbances.

Psychoneuroimmunology (PNI) is an

interdisciplinary science that studies the interactions among psychologic, neurologic, and immune responses.

Contributors to acute stress

Being involved in a motor vehicle accident Experiencing the loss of a loved one Being a victim of a crime

The stress hormone

Cortisol, which is released by the Adrenal Glands

Factors affecting the response to stress can be?

Internal and External influences

Contributors to chronic stress

Living in a dysfunctional family Living in poverty Living with a prolonged illness Exposure to racism

Psychologic stress may increase one's risk for developing the

common cold

Stress affects the control of metabolic conditions, such as

diabetes mellitus

Steps of the nursing process when helping clients cope with stress

ADPIE; Assessment Diagnosis Planning Implementation Evaluation

Distress refers to

negative or unhealthy stress

Types of stress

Physical Emotional (mental) Intellectual Social Spiritual

What is stress?

The inability to cope with perceived demands or threats to one's mental, emotional, and spiritual well-being.

Corticosteroids play an important role in

- "turning off" or blunting the stress response, which if uncontrolled, can become self-destructive. - Support the body's adaptive response to a stressor - Suppress an overzealous and potentially self-destructive response - Short term

Endocrine System physiologic effects of cortisol:

- Increased blood glucose levels - Intensifying the action of catecholamine action on blood vessels - Inhibits the inflammatory response

Cerebral Cortex

- Involved in the control of cognition, affect, and movement influence how we perceive stressors - Evaluates the stressor considering past experiences and future consequences. - Perception of and response to a stressor. Gives us some control over our response to stress - The motor areas also send signal to the adrenal medulla that directly relate to how stressor are managed

Limbic System

- Is an important mediator of emotions and behavior - When the limbic system is stimulated, emotions, feelings, and behaviors can occur that ensure survival and self-preservation.

Other conditions that are precipitated or worsened by stress include

- Migraine headaches - Irritable bowel syndrome - Peptic ulcers - Depression - Dyspepsia - Eating disorders - Fatigue - Fibromyalgia - Insomnia - Low back pain - Menstrual irregularities - Sexual dysfunction

Relaxation strategies that reduce stress

- Relaxation breathing (often used in times of anxiety and distress) (primary use of the diaphragm and less use of the upper chest and shoulders - Biofeedback (Electrodes attached to the skin or in some cases hand-held, helps a person become more aware of involuntary body responses such as breathing, heart rate, and muscle activity) - Meditation (concentrated focus on a sound, object, visualization, the breath, or movement) - Imagery (use of one's mind to generate images that have a calming effect on the body) - Massage (range of techniques that manipulate the soft tissues and joints of the body) - Music - Prayer

Stress affects immune function by

- decreasing number and function of natural killer cells - decreasing lymphocyte proliferation - altering production of cytokines (soluble factors secreted by white blood cells and other cells, e.g. , interferon, interleukins) - decreasing phagocytosis by neutrophils and monocytes

Place the physiological responses that occur during the three stages of the General Adaptive Syndrome (GAS) in order.

1. A perceived stressor arouses the Central Nervous System (CNS). 2. Hormones released from the adrenal cortex create a state of readiness (fight-or-flight response). 3. Rising hormone levels result in increased blood pressure and heart rate, blood glucose levels, oxygen intake, pupil dilation, and mental alertness. 4. The Parasympathetic Nervous System (PNS) attempts to return physiological functions to normal levels 5. The body remains on alert while hormonal and other bodily functions return to normal. 6. If the body is unable to effectively resist or adapt to the stressor, or if resources become exhausted, prolonged exposure to stress may result in illness or disease.

The stress response involves increases in

1. cardiac output (resulting from the increased heart rate and increased stroke volume) 2. blood glucose levels 3. oxygen consumption 4. metabolic rate

Symptoms of chronic stress

Anxiety, depression, cardiovascular disease, cancer, and suicide.

A nurse is caring for a client who has migraine headaches and reports that they are "getting worse." Which of the following questions should the nurse ask the client to determine if the headaches are a stress-related disorder? (Select all that apply.) A. "What is the intensity of your migraine headaches?" B. "How often do the migraine headaches occur?" C. "Are you eligible for workers' compensation due to the migraine headaches?" D. "What type of support is available to you when you have a migraine headache?" E. "What coping strategies do you use when you experience a migraine headache?"

A. "What is the intensity of your migraine headaches?" B. "How often do the migraine headaches occur? D. "What type of support is available to you when you have a migraine headache?" E. "What coping strategies do you use when you experience a migraine headache?"

A nurse in a community clinic is interviewing a client who is distressed and reports being unable to sleep following a neighborhood fire several days ago. The client has hypertension, tachycardia, and is diaphoretic. The nurse should identify that the client is experiencing which of the following types of stress? A. Acute stress B. Post-traumatic stress disorder (PTSD) C. Episodic acute stress D. Chronic stress

A. Acute stress Rational: The nurse should identify that the client is experiencing acute stress. Most episodes of acute stress do not have lingering health effects; however, if an individual experiences severe or prolonged stress levels, this condition could lead to mental health issues.

A nurse is caring for a client whose partner was recently hospitalized with COVID-19. The client is experiencing manifestations related to the alarm stage of general adaptation syndrome (GAS). For which of the following manifestations should the nurse monitor? (Select all that apply.) A. Hypertension B. Dilated pupils C. Increased state of arousal D. Bradycardia E. Lethargy

A. Hypertension B. Dilated pupils C. Increased state of arousal

Examples of complementary and alternative therapies for stress

Aromatherapy Art therapy Exercise Humor Journaling Pet therapy Social support Herbal Medicine Acupuncture Massage Biofeedback Meditation

A nurse is assessing a client who was sexually assaulted 6 months ago and has been diagnosed with post-traumatic stress disorder (PTSD). Which of the following manifestations should the nurse expect? (Select all that apply.) A. Intrusive memories of the event B. Flashbacks of the event C. Poor work relationships D. Exaggerated startle response when reminded of the event E. Frequent episodes of diarrhea

A. Intrusive memories of the event B. Flashbacks of the event D. Exaggerated startle response when reminded of the event

A nurse is providing discharge teaching about health promotion to a client who has a new diagnosis of type 2 diabetes mellitus. Which of the following instructions should the nurse include? (Select all that apply). A. Practice mindful breathing. B. Start each day with a to-do list. C. Include simple carbohydrates in the diet. D. Develop habits to mitigate stress. E. Preserve energy by reducing physical activity

A. Practice mindful breathing. B. Start each day with a to-do list. D. Develop habits to mitigate stress.

A nurse is talking about implementing self-care strategies to cope with the stress of caregiving with the partner of a client who has dementia. Which of the following strategies reported by the partner should the nurse identify as an example of effective cooping? A. Practicing deep breathing while sitting outside B. Sitting by the client's bedside and drinking coffee C. Going out onto the patio to smoke a cigarette when feeling stressed D. Drinking a glass of wine every night before falling asleep

A. Practicing deep breathing while sitting outside Rational: Eating nutritious meals, participating in active exercise, and engaging in mindfulness activities such as deep breathing are examples of health coping.

A nurse is caring for a client who has been charged with partner violence against their spouse. The client is angry, pacing, and yells out, "I wouldn't lose my temper if my spouse would just leave me alone. It's their fault." The nurse should identify the client is displaying which of the following defense mechanisms? A. Projection B. Compartmentalization C. Repression D. Regression

A. Projection Rational: Projection involves attributing negative or uncomfortable thoughts, feelings, or motives onto another individual to avoid dealing with them as one's own.

People with a positive attitude view situations differently from those with negative attitudes. A person's attitude also influences how he or she manages stress. To some extent, positive emotional attitudes can prevent disease and prolong life. This is which of the key personal characteristics that buffer the effects of stress?

Attitude

The SNS stimulates what to release epinephrine and norepinephrine (catecholamines)

Adrenal Medulla

The hormone released by the anterior pituitary during the stress response

Adrenocorticotropic hormone (ACTH)

Internal stressors

Age, Attitude, Genetic background, Hardiness, Health status, Optimistic outlook, Personality characteristics, Previous experience with stressors, Resilience, and Sleep status.

Name sources of psychological stress

An event, situation, comment, condition, or interaction that an individual interprets as negative or threatening, such as work or academic pressures, financial difficulties, change in marital status, or being a victim of a natural catastrophe.

A nurse in a health clinic is interviewing a client who is upset and reports that their stress "is too much to handle." The client is unemployed, a single guardian to young children, and has periodic asthma attacks. Which of the following stress-related conditions is the client experiencing? A. Post-traumatic stress disorder (PTSD) B. Allostatic load C. Chronic illness D. Alarm stage

B. Allostatic load Rational: Chronic exposure to elevated or fluctuating endocrine or neural responses causes excessive wear and tear on the body organs, resulting in allostatic load. The nurse should identify that the client's constant stress may be manifesting itself in physical aliments such as periodic asthma attacks.

A nurse is caring for a client who reports experiencing stress over an upcoming surgical procedure. Which of the following statements describes the characteristics of stress? A. Stress is an easily defined phenomenon regardless of viewpoint and discipline B. Stress is a condition in which the body responds to physical, emotional, or environmental changes affecting one's state of equilibrium. C. Stress only affects the individual and does not affect the person's family, friends, or other associates. D. The lack of definition regarding stress does not pose a problem for the client or the nurse.

B. Stress is a condition in which the body responds to physical, emotional, or environmental changes affecting one's state of equilibrium. Rational: Stress can be caused by physical, emotional, environmental, or mental changes, which can be positive or negative depending on the person's perception or appraisal of the stressor.

What is the key personal characteristics that buffer the effects of stress by reducing a person's chances of developing stress-related illnesses and can help them cope more effectively with stress.

Being optimistic: When optimistic people do become ill, they tend to recover more quickly.

A nurse is caring for a college student admitted for acute alcohol intoxication. The client reports feeling overwhelmed and expresses an inability to cope with stressors at school. Which of the following statements should the nurse make? A. "Drinking too much alcohol is not the best choice. I suggest you stop drinking." B. "I can see why you're using alcohol to cope; you've got a lot going on." C. "Let's talk about the coping methods that have worked for you in the past." D. "I've been stressed before too, but I tell myself that I can handle it."

C. "Let's talk about the coping methods that have worked for you in the past." Rational: The nurse is using therapeutic communication techniques and building on the client's strengths to improve coping skills. Nurses use several therapeutic communication techniques to build a trusting relationship including active listening, asking open-ended questions, seeking clarification, and offering observations.

Acute and chronic stress can cause

immunosuppression

A nurse is caring for a client who has delivered a healthy newborn. The client tells the nurse that while they are somewhat stressed about being a new parent, they are thrilled by the birth of their child. The nurse should identify that the client is experiencing which of the following types of stress? A. Allostatic load B. Distress C. Eustress D. Fight-or-flight response

C. Eustress Rational: Positive stress, or eustress, is often associated with accomplishment or achievement and generally produces feelings of well-being, inspiration, and motivation.

A nurse is conducting an educational session for clients who report experiencing stress-related disorders. A client asks the nurse which part of the body activates the stress response. Which of the following responses should the nurse provide? A. Sympathetic nervous system (SNS) B. Adrenal glands C. Hypothalamus D. Adrenocorticotropic hormone

C. Hypothalamus Rational: The hypothalamus activates the stress response. When a stress response is triggered, the hypothalamus sends signals to the pituitary and adrenal glands.

Stress is linked to leading causes of death, including

Cancer Accidents Suicides

Long-term exposure to catecholamines resulting from excessive SNS activaion may increase the risk for

Cardiovascular diseases such as atherosclerosis and hypertension

Coping and Coping strategies

Coping is a person's efforts to manage stressors (can be positive or negative) and Coping strategies are what you do (your behaviors and actions) to help deal with stress.

Stress causes the body to produce greater levels of?

Cortisol, often called the stress hormone

External stressors

Cultural and ethnic influences, Number of stressors already experiencing, Religious or spiritual influences, Socioeconomic status, Social support, and Timing of stressors.

A nurse is interviewing a client who recently experienced an act of workplace violence when an armed person held the workers at gunpoint before police intervened. The client now reports being anxious and fears the gunman might return. The nurse should identify that the client is experiencing which of the following types of crisis? A. Situational B. Cultural C. Maturational D. Adventitious

D. Adventitious Rational: Adventitious crises occur from natural disasters such as floods, hurricanes, or fire; or from acts of war, criminal activity, or terrorism.

A nurse is caring for a client who has pancreatic cancer that is unresponsive to treatment. The client is experiencing significant weight loss and fatigue, but when the nurses asks how they are feeling, they respond with , "Great! I'm going to beat this cancer." Which of the following defense mechanisms is the client using? A. Regression B. Projection C. Repression D. Denial

D. Denial Rational: Denial refers to the refusal to acknowledge or accept reality about a situation, despite what might be obvious to others, to avoid the emotional impact.

Chronic stress can have a long-term effect on our overall health by changing our

DNA and accelerating the rate at which our cells age - Link between stress and telomere length, alter DNA

Cortisol has what effects?

immunosuppressive and anti-inflammatory effects

Coping strategies are divided into 2 broad categories;

Emotion-focused coping Problem-focused coping

Once the hypothalamus is activated in response to stress, what becomes in involved?

Endocrine system becomes involved

What prepares the body for the fight-or-flight

Epinephrine and norepinephrine

A combination of 3 characteristics: commitment, control, and openness to change. These 3 together give the courage and motivation needed to turn stressful circumstances from potential calamities into opportunities for personal growth. This is which of the key personal characteristics that buffer the effects of stress?

Hardiness

Parts of the nervous and endocrine system involved in the stress response.

Hypothalamus Sympathetic Nervous System Pituitary Glands Adrenal Glands

When a person perceives a stressor, what sends signals that initiate both nervous and endocrine responses to the stressor (sounds the alarm)?

Hypothalamus which lies at the base of the brain just above the pituitary gland.

The fight-or-flight response causes an?

Increase in heart rate, oxygen intake, blood pressure, and cardiac output, and blood glucose levels Mental alertness Dilation of bronchial airways Pipil Dilation

Name sources of physiological stress

Injury or illness such as exposure to extreme temperatures, trauma, injury, illness, or pain.

Symptoms of acute stress

Irritability, chest tightness, headache, gastrointestinal disturbance, sweaty palms, and shortness of breath.

Stress-induced immunosuppression may worsen or increase the risk for progression of immune-related diseases such as

Multiple sclerosis Asthma Rheumatoid arthritis Cancer

Examples of adventitious stressors

Natural disasters such as floods, hurricanes, fire and earthquakes; acts of war and acts of terrorism; criminal activity; interpersonal disasters such as physical or sexual assault.

What systems of the body are primarily involved in the stress response?

Nervous, Endocrine, and Immune systems

Catecholamines released from the Sympathetic Nervous System during the stress response.

Norepinephrine Epinephrine Dopamine

What are the 3 stages of the General Adaptation Syndrome (GAS)?

Phase 1: Alarm reaction (mobilize resources) Phase 2: Resistance (cope with stressor) Phase 3: Exhaustion (reserves depleted)

Defense mechanisms

Psychological strategies that help individuals separate from and put distance between themselves and unpleasant events, feelings, or thoughts.

What are the 4 key personal characteristics that buffer the effects of stress?

Resilience Hardiness Attitude Being Optimistic

Being resourceful and flexible and having good problem-solving skills, is which of the key personal characteristics that buffer the effects of stress?

Resilience: People who have a high degree of resilience are not as likely to perceive an event as stressful.

The fight-or-flight response is an important and necessary adaptive mechanism of the body to acute stress, what symptoms associated with it

Rising hormone levels result in increased blood pressure and heart rate, blood glucose levels, oxygen intake, pupil dilations, and mental alertness.

Symptoms of episodic acute stress

Short-tempered, irritable, anxious, headaches, hypertension, migraines, pessimistic outlook and a negative worldview.

What makes the relationship and interconnectedness among the parts that make up a person: mind, body, and spirit?

The mind-body-spirit connection - it is important in your life and in determining who you are

What contains the reticular activating system (RAS), which sends impulses contributing to alertness to the limbic system and cerebral cortex.

The reticular formation which is located between the lower end of the brainstem and thalamus

True or False What is is considered stressful varies form person to person and from one situation to another True

True

What are the three important variables that can influence a person's response to stress?

Type (Physiologic or Emotional/Psychologic) Duration (Acute or Chronic) Intensity (Mild, Moderate, or Severe)

When does a stress response occur?

When perceived demands (stress) exceed resources to meet those demands.

The relaxation response is

a state of physiologic and psychologic rest. - Opposite of the stress response - Characterized by decreased sympathetic nervous system activity which leads to decreased heart and respiratory rate, decreased blood pressure, decreased muscle tension, decreased brain activity, and increased skin temperature - Can be elicited through a variety of relaxation strategies - An effective treatment for a wide range of stress-related disorders, including chronic pain, insomnia, and hypertension.

At a cellular level, stress may promote earlier onset of

age-related diseases

Endorphins have

analgesic-like effects and blunt pain perception during stress situations involving pain stimuli.

Developmental, or Maturational Crisis occurs

as individuals move through the stages of life. - when a person experiences a new stage of development and is challenged to adapt to the new experience. - Vary throughout the lifespan - Older adults may experience stressors related to health problems and changes in mobility and cognition.

Problem-focused coping involves

attempts to resolve the problems causing the stress. - If you can change or control a problem, this strategy is the most helpful. - The primary purpose of problem-focused coping strategies is to allow a person to look at a challenge objectively, act to address the problem, and thereby reduce the stress. - Examples: Setting priorities, collecting information, and seeking advice

Projection involves:

attributing negative or uncomfortable thoughts, feelings, or motives onto another individual to avoid dealing with them as one's own.

How does the hypothalamus send signals to the response of a stressor?

by sending signals via nerve fibers to stimulate the sympathetic nervous system (SNS) and by releasing corticotropin-releasing hormone (CRH), which stimulates the pituitary to release adrenocorticotropic hormone (ACTH)

Compartmentalization refers to

categorizing life experiences into separate segments to avoid facing the anxieties while in that mindset.

Stress can have effects on

cognitive function, including poor concentration, memory problems, distressing dreams, sleep disturbances, and impaired decision making. It can also have a wide variety of changes in behavior

Repression refers to

concealing unpleasant or painful thoughts, memories, or beliefs in hopes of forgetting about them entirely.

Emotional/Psychologic Stressors

diagnosis of cancer death of spouse caring for disabled child marital problems

Situational Crisis commonly stem from events such as

divorce, job loss, and unexpected event, or a change in circumstance. - They are typically stem from personal, family, and work-related issues.

Hypothalamus

has many functions that aid in adaptation to stress. Stress activates the limbic system, which in turn stimulates the hypothalamus

Chronic inflammation can be responsible for the development and exacerbation of?

immune-related disorders such as cardiovascular disease, arthritis, psoriasis, inflammatory bowel disease, and various cancers.

Cultural Crises or stressors occur when one is

living within a society in which they have different cultural practices and/or receive care that ignores their cultural beliefs.

Emotion-focused coping involves

managing the emotions that a person feels when a stressful event occurs. - When a situation is unchangeable or uncontrollable, emotion-focused coping may predominate. - The primary purpose of emotion-focused coping is to help decrease negative emotions and create a feeling of well-being. - Examples: discussing feelings with a friend or taking a hot bath

Regression refers to

moving back to a more comfortable developmental time in life when faced with stress or anxiety.

Adventitious Crises occur from

natural disasters such as floods, hurricanes, or fire; or from acts of war, criminal activity, physical assault, or terrorism.

The hypothalamus secretes

neuropeptides that regulate the regulate the release of hormones by the anterior pituitary, it is central to the connection between the nervous and endocrine systems in responding to stress

Physiologic Stressors

pain excessive noise starvation infection

Eustress refers to

positive stress, it is often associated with accomplishment or achievement and generally produces feelings of well-being, inspiration, and motivation.

Socioeconomic stressor are typically related to factors such as

poverty, low socioeconomic status , and homelessness

Corticosteroids are essential for the

stress response

The hypothalamus plays a primary role in the stress response by regulating the function of both the

sympathetic and parasympathetic branches of the autonomic nervous system.

The effect of catecholamines and the activation of the SNS, including the response of the adrenal medulla, is referred to as the

sympathoadrenal response