Stress Adaptation Exam 1

Name some adaptive behaviors (3)? name some maladaptive behaviors (4)? Do psychiatric patients handle their stress and why (2)? how will maladaptation of stress manifest in psychiatric pt's? what do psychiatric nurses treat (2)?

- Adaptive: exercising, breathing techniques, relaxation techniques - Maladaptive: smoking, overeating, sleeping too much or too little, and drinking - Side note: when you are looking at psychiatric patients, they have not handled their stress appropriate due to a biochemical imbalance, a stress maladaptation - these patients are in states of anxiety that causes them to not be able to adapt to stress correctly o This maladaptation to stress will manifest itself in certain behaviors o We treat behaviors as psychiatric nurses - we get them to better adjust their lifestyles

What is cognitive appraisal? explain what a stressful event precipitates (2)?

- Cognitive appraisal: an individual's evaluation of the personal significance of the event or occurrence (what is their perception of the situation?) - The event precipitates a response on the part of the individual and the response is influenced by the individual's perception of the event.

When are coping mechanisms considered maladaptive (2)? what occurs to the individuals energy levels and what is the consequence? In regards to adaptive coping strategies, explain what is awareness (3)? what is relaxation (3)? what is mediation and what is the positive aspect about it (2)?

- Coping strategies are considered maladaptive when the conflict being experienced goes unresolved or intensifies - Energy resources become depleted - Resulting in an increase vulnerability to physical and psychological illness - Awareness: Stress can be controlled only when one recognizes that it is being experienced. As one becomes aware of stressors, they can omit, accept or avoid them. - Relaxation: Individuals experience relaxation in different ways. Some individuals relax by engaging in large motor activities, such as sports, jogging, and physical exercise. Still others use techniques such as breathing exercises and progressive relaxation to relieve stress. - Meditation: - Practiced 20 minutes once or twice daily, meditation has been shown to produce a lasting reduction in blood pressure and other stress-related symptoms - Meditation involves assuming a comfortable position, closing the eyes, casting off all other thoughts, and concentrating on a single word, sound, or phrase that has positive meaning to the individual.

In regards to predisposing factors, explain existing conditions and give the example? what is the one thing a person has control over and give the example?

- Existing conditions: Vulnerabilities that influence the adequacy of the individual's physical, psychological and social resources for dealing with adaptive demands - Examples: Current health status, motivation, developmental maturity, severity and duration of stressors, financial and educational resources, age, existing coping strategies, and a support system of caring others - If you are physically sick/condition, or depressed - then pt will not handle the stress as well as someone who is physically healthy - Side Notes: The one thing someone has control over is "your own attitude towards a situation" - Ex. Dr. Shaw had to get a doctorate to continue working at nova. When she started, she was angry/sad/anxious when back at school, but when she changed her attitude towards the situation, she enjoyed It more and the experience changed

How does Hans Selye define stress? Is the initial stress response helpful and what is the example given? is sustained stress response helpful?

- Hans Selye defined stress as "the state manifested by a specific syndrome that consists of all the nonspecifically induced changes within a biologic system." - The Fight-or-Flight Syndrome - Initial stress response - helpful at first especially during dangerous situations; "you don't lose your cool" - Gave example regarding friend home being broken into, the burglar said he was going to rape and kill her, the friend said very calmly no you're not, and the burglar said she was a crazy lady (also hit her) and left out the window - Sustained stress response - not good for you, depending on the situation

What are the two appraisals of an individual's perception of a stress event?

- Individual's perception of the event (important to find out the individual's perception of the situation) - The cognitive response consists of a primary and secondary appraisal

Adaptive coping strategies, what is interpersonal communication with caring other (2)? what is problem-solving (2)? what is the problem solving decision making model (8)?

- Interpersonal communication with caring other: - The strength of one's available support systems is an existing condition that significantly influences the adaptability of coping with stress. - Sometimes just "talking the problem out" with an individual who is empathetic is sufficient to interrupt escalation of the stress response. - Writing about one's feelings in a journal or diary can also be therapeutic. - Problem-solving: View the situation objectively (or to seek assistance from another individual to accomplish this if the anxiety level is too high to concentrate) - Problem/solving/ decision making model: - Assess the facts of the situation - Formulate goals for resolution of the stressful situation - Study the alternatives for dealing with the situation - Determine the risks and benefits of each alternative - Select an alternative - Implement the alternative selected - Evaluate the outcome of the alternative implemented - If the first choice is ineffective, select and implement a second option

What is uncertain in regards to stress overload? what can it cause (2)? what can add to stress overload? What is the weakness in the RLCQ (3)? what can positive coping mechanisms or support system do (2)?

- It is not certain whether stress overload merely predisposes a person to illness or actually precipitates it, but there does appear to be a clear causal link - could be physical illness or mental illness - How you perceive the event/environment/stressor - can add to the stress overload (sometimes it's not as bad as you think it is) - A weakness in the Miller and Rahe tool is that it does not consider: - The individual's personal perception of the event - His or her coping strategies and available support systems at the time of the life change - Positive coping mechanisms and strong social or familial support can reduce the intensity of the stressful life change and promote a more adaptive response.

What are maladaptive responses perceived as (2)? what is integrity? what are some examples of maladaptive responses (5)? what will occur if the individual doesnt respond to stress appropriately? what is important to perserve (1)? what can maladaptive responses do to self-esteem? what is the definition of maladaptation?

- Maladaptive responses are perceived as negative or unhealthy and occur when the integrity of the individual is disrupted (my integrity is my psychological well-being) - Ex. alcohol, drugs, inappropriate anger, overeating, shop, suppression, delusion etc. o If you don't adapt appropriately, you will get sick; we need to preserve our self-identity and esteem - maladaptive responses can lower the self-esteem of the individual - Maladaptation occurs when an individual's physical or behavioral response to any change in his or her internal or external environment results in disruption of individual integrity or in persistent disequilibrium.

When does fight or flight syndrome occur (3)? explain what occurs? Which stressors are resolved more quickly than others and therefore what is the consequence?

- Occurs in response to psychological or emotional stimuli, just as physical stimuli - Response elicited in emergency situations, used in the preservation of life and followed by the restoration of the compensatory mechanisms to pre-emergent condition (homeostasis). - Psychological or emotional stressors are often not resolved as rapidly as some physical stressors, and therefore the body may be depleted of its adaptive energy more readily than it is from physical stressors.

What can an overwhelming amount of stress do? give the example?

- Overwhelming amount of stress can lead to physical debilitation - leading to the patients impending death - Ex. man was extremely stressed about his wife returning to school (with covid-19 pandemic still happening), that essentially, he ends up getting covid and gets hospitalized. The man is stressed and arranging all the accounts and wills bc the Dr. said things don't look good for him. In addition to the stress, that his family cannot go and see him Within 24 hrs he passed away - the stress contributed to the death

Adaptive coping strategies, explain how pets is an adaptive coping strategy (2)? what are the positive outcomes of having a pet (2)? explain how is music a adaptive coping strategy (4)?

- Pets: Studies show that those who care for pets, especially dogs and cats, are better able to cope with the stressors of life. - The physical act of stroking or petting a dog or cat can be therapeutic. It gives the animal an intuitive sense of being cared for and at the same time gives the individual the calming feeling of warmth, affection, and interdependence with a reliable, trusting being. - One study showed that among people who had had heart attacks, pet owners had one-fifth the death rate of those who did not have pets. - Another study revealed evidence that individuals experienced a statistically significant drop in blood pressure in response to petting a dog or cat. - Music: - It is true that music can "soothe the savage beast." Creating and listening to music stimulate motivation, enjoyment, and relaxation. - Music can reduce depression and bring about measurable changes in mood and general activity.

In regards to stress, why is predisposing factors important? What are the predisposing factors (3)? Explain genetic factors (2) and give example? Explain past experience factor (2)? what is important to maintain in regards to stress (2)? what can be told to a pt who cannot control themselves? what will you evaluate in regards to past experiences (2)? what is a way to decrease stress?

- Predisposing factors (Biopsychosocial): strongly influence whether the response is adaptive or maladaptive (elements influence how an individual perceives and responds to a stressful event) - Factors: genetics, past experiences, and existing conditions - Genetic influences: circumstances of an individual's life that are acquired through heredity - Examples include family history of physical and psychological conditions (strengths and weaknesses) and temperament (behavioral characteristics present at birth that evolve with development). - Ex. Shaw is normally calm; Brahim is compulsive/anxious, wants things perfect all the time and if mistakes happen then she flips out (this is something that is genetic, bc she's born like that) - Past experiences: occurrences that result in learned patterns that can influence an individual's adaptation response - Pervious exposure to the stressor or other stressors - Degree of adaptation to pervious stressors - Learned coping responses --> maintaining calm and control is important - Professors have had patient in which they tell them "if you cannot control yourself, then I'm going to have to control you" - What did you do then that worked/didn't work? You can utilize those coping skills from previous experiences - Another way to decrease level of stress is saying "well I survived this "thing" in the past, I can survive this one too"

What is primary appraisal? what is irrelevant and give example (2)? what is benign-positive and give example (2)? what is stress appraisal (3)? Explain the example of car stolen in regards to benign positive and harm/loss appraisal?

- Primary appraisal: a judgment about the situation in one of the following ways - Irrelevant: when the outcome holds no significance for the individual - Ex. When someone else's boyfriend break up with them - Ex. Natural disasters occurring in other parts of the world that doesn't affect you - Benign-positive: an outcome that is perceived as producing pleasure for the individual - Ex. a husband leaving is better for that person - Example given, patient was in therapy with her parents and suddenly mother passes away, when telling the patient "I'm sorry for your loss", she reacted "oh that's the best thing to happen" - Stress appraisal: include harm/loss, threat and challenge - Example of benign positive - person has their car stolen, but is happy because they haven't had the courage to get sell it and get a new car - Whereas someone else, may be stressed bc it may affect their way to get to work, or financially (this would be harm/loss appraisal)

What do adaptive responses maintain? How are adaptive responses viewed as (1)? what is the goal of adaptive responses to stress (2)? what are some examples of healthy behaviors towards stress (5)?

- Roy (1976) defined adaptive response as behavior that maintains the integrity of the individual. - Adaptation (adaptive) is viewed as positive and is correlated with a healthy response to stress · Responses directed at stabilizing internal biological processes and preserving self-esteem can be viewed as healthy adaptations to stress. · Healthy behaviors towards stress - ex. meditation, exercising, healthy eating, adequate sleeping, hobbies

What is secondary appraisal? what will the individual evaluate (3)? What is the ultimate purpose of the interaction between primary and secondary appraisal? If the pt has primary appraisal of irrelevant or benign positive, what is the next step?

- Secondary appraisal: an assessment of skills, resources, and knowledge that the person possesses to deal with the situation - Individual evaluates: - Which coping strategies are available to me? - Will the option I choose be effective in this situation? - Do I have the ability to use that strategy in an effective manner? - The interaction between the primary appraisal of the event that has occurred, and the secondary appraisal of available coping strategies determines the individual's quality of adaptation response to stress. - If the patient has a primary appraisal of irrelevant or benign-positive, then no plan of care is needed bc they're not having a problem with it

How is stress measured? what does a high score mean? when is this completed? what does the questionnaire include (5)? what are two common findings on the RLCQ? what is the numbers in regards to 6 month stress and 1 yr stress?

- Stress is measured by the Miller and Rahe Recent Life Changes Questionnaire. o A high score on the RLCQ places the individual at greater susceptibility to physical or psychological illness. o Complete questionnaire within a 6 month- 1year period o Questionnaire Includes: health, work, personal and social, home and family, and financial life changing events o Common Findings o Women react to life stress events at higher levels than men o Unmarried people gave higher scores than married people for most events o High levels of stress: o 6 months totals equal to or greater than 300 life change units (LUCs) o 1-year totals equal to or greater than 500 LCU (indicative of high level of recent life stress, increasing the risk of illness for the individual)

What is stress management? is it possible to avoid stress? what can help with stress management (3)? are temper tantrums normal in adults? What does adaptive coping strategies do for the individual (3)? what does adaptive responses restore (2)? what are some examples of adaptive coping strategies (4)?

- Stress management is the use of effective & appropriate coping strategies in the response to stressful situations. - It is impossible to avoid stress, but it is possible to manage stress effectively and motivated to use better coping mechanisms to overcome those challenges present. - May or may not have a support system available, but through learning different coping mechanisms and adequate perceptions of the situation, identifying vulnerabilities and insecurities/ self-esteem --> this will all help with stress management - Temper tantrums in adults is NOT an appropriate reaction (not healthy) - Adaptive coping strategies protect the individual from harm and restore physical and psychological homeostasis - and strengthens the individual's ability to meet challenging situations o Adaptive responses help restore homeostasis to the body and impede the development of disease of adaptation. o Adaptative coping strategies may include - relaxation therapy, meditation, being aware that you are losing control or become angry, reassuring yourself to calm down

Does stress have a definition? how can stress affect different people? how do you speak to a psych patient that is in a state of high stress and what is that called? is stress always negative? what is the difference between stress and anxiety?

- The word stress lacks a definitive definition. - What may be stressful to one person, may not be stressful to another - When speaking to a psych patient in a state of high stress, you speak to them in a low voice (not high) --> this is called de-escalation - Stress can come from a positive event (Ex. wedding planning) or negative event - What is the difference between stress and anxiety? Stress is an event, something that's happening externally or internally. Anxiety is experienced either physiological or psychological.

Stress as an environment event, how does this concept define stress? what does the event create (3)? what are the taxing effects of covid? what are the prolonged effects of taxing (2)?

- This concept defines stress as a "thing" or "event" that triggers the adaptive physiological and psychological responses in an individual. The event is one that: - Creates change in the life pattern of the individual - The change can be either positive, such as outstanding personal achievement, or negative, such as being fired from a job. - The emphasis here is on change from the existing steady state of the individual's life pattern. - Requires significant adjustment in lifestyle - Taxes available personal resources - Taxing effects of covid - loss of family, friends; loss of mobility, financial issues, interpersonal issues - These taxing effects can become very overwhelming and cause depression/suicide

Stress as a transaction between the individual and the environment, how does this concept define stress? what is this no longer viewed as and what does illness depend on? What is a precipitating event? what is the determinant in regards to person-environment relationship to stress?

- This definition of stress emphasizes the relationship between the individual and the environment, which is appraised by the individual as taxing or exceeding his or her resources and endangering his or her well-being. - No longer a causation viewed solely as an external entity; whether or not illness occurs depends also on the receiving organism's susceptibility - Precipitating event: a stimulus arising from the internal or external environment and perceived by the individual in a specific manner (what has occurred that causes the individual to perceive a situation) - Determination that a particular person-environment relationship is stressful depends on the individual's cognitive appraisal of the situation.

When behavior disrupts the integrity of the individual what is that called? what is an example of maladaptation (1)? What is an example in regards to COVID? what may have increased during COVID (3)?

- When behavior disrupts the integrity of the individual, it is perceived as maladaptive. - Ex. the individual consuming large amounts of alcohol (maladaptive response to stress = negative) - At home environment - pt may have been depressed, overweight, worsening mental health; homeostasis was disturbed internally and externally during this covid-19 pandemic - Domestic violence, abuse, suicide increased

What are the important key points of being mentally healthy (5)?

-Having the ability to cope, ability to engage in activities, ability to communicate and express yourself (Test reality), rationalization, empathy (ability to give love and receive love)

What is adaptation? what is maladaptation?

o Adaptation: Said to occur when an individual's physical or behavioral responses to any change in his or her internal or external environment results in preservation of individual integrity or timely return to equilibrium. o Maladaptation: Occurs when an individual's physical or behavioral response to any change in his or her internal or external environment results in disruption of individual integrity or in persistent disequilibrium.

What is the base of all mental illness? What is the end goal of adaptation (3)?

o Anxiety is the base of all mental illness - Adaptation is defined as restoration of homeostasis to the internal environmental system. - Adaptation includes responses directed at stabilizing internal biological processes and psychological preservation of self-identity and self-esteem.

Explain the third stage of Selye's General Adaptation Syndrome? what is the consequence of this (7)?

o Stage of Exhaustion - This stage occurs when there is a prolonged exposure to the stressor to which the body has become adjusted. - The adaptive energy is depleted, and the individual can no longer draw from the resources for adaptation described in the first two stages. - Diseases of Adaptation may occur · Chronic response that maintains the body in the aroused condition for extended periods of time that promotes susceptibility to diseases of adaptation · Headaches, mental disorders, coronary artery disease, ulcers, colitis. · Without intervention for reversal, exhaustion, and in some cases even death ensues.

What can stress be viewed as? and what are the different forms of stress (3)? How is stress different for individuals (4)? what are some examples of physical stress (3)? what are some examples of mental stress (3)?

o Stress may be viewed as an individual's reaction to any change that requires an adjustment or response, which can be physical, mental, or emotional. o Stress is different for all, your stress is how you define, how you handle it, there are normal adaptation on how to adapt and handle it, but sometimes there is maladaptation o Example of physical stress - hair loss, increased BP, weight gain/loss o Example of mental stress - delusions, depression, agitated, anxious

What is a stressor? what kind of response may stress be? what kind of event may stress be? what may stress be a transaction between (2)?

o Stressor: A biological, psychological, social, or chemical factor that causes physical or emotional tension and may be a factor in the etiology of certain illnesses. o Stress as a biological response o Stress as an environmental event o Stress as a transaction between the individual and the environment

In regards to stress appraisal, explain harm/loss, threatening and challenging? does challenging appraisal produce stress and what may be needed (1) and give an example (1)? what two appraisals can go hand in hand? when stress appraisal occurs, what is the next step?

· Harm/loss appraisals: damage or loss already experienced by the individual. · Threatening appraisals: perceived as anticipated harms or losses. · Challenging appraisals: when the individual focuses on potential for gain or growth, rather than on risks associated with the event. o Challenge produces stress even when though the emotions a/w it are viewed as positive and coping mechanisms must be called upon to face the new encounter o Ex. nursing students preparing for finals is challenging · Challenge and threat may occur together when the individual experiences the positive emotions along with fear and anxiety over possible risks a/w the challenging events · When stress is produced in response to harm/loss, threat and/or challenge --> a secondary appraisal is made by the individual

What is Selye's general adaptation syndrome and name them (3)? Explain what occurs in the first stage? how long can you be in flight mode? Explain what occurs in the second stage and what may occur to the symptoms?

· Selye's General Adaptation Syndrome - general reaction of the body to stress - Stages: Alarm reaction stage, stage of resistance, and stage of exhaustion o Alarm Reaction Stage - During this stage, the physiological responses of the "fight or flight" syndrome are initiated; ñHR, ñRR, sweating, increased BP · You cannot be in a "flight syndrome" for super long periods of time bc biologically and psychologically you'll break down o Stage of Resistance - The individual uses the physiological responses of the first stage as a defense in the attempt to adapt to the stressor. - If adaptation occurs, the third stage is prevented or delayed. - Physiological symptoms may disappear.