All YOU EVER WANTED TO KNOW ABOUT STRESS Psychiatric Mental Health Nursing Eve Karpinski, APHN-BC, RN-BC Lecture 1

Your psychiatric book does not have a chapter on Stress Adaptation. Review notes below. Visit youtube. LEARNING OBJECTIVES After reading this chapter, the student will be able to: 3. Explain the relationship between stress and “diseases of adaptation.” 2. Identify physiological responses to stress. 1. Define adaptation and maladaptation. 5. Explain the concept of stress as a transaction between the individual and the 4. Describe the concept of stress as an environmental event. KEY TERMS CORE CONCEPTS 6. Discuss adaptive coping strategies in the management of stress. environment. “fight or flight syndrome” adaptation predisposing factors precipitating event stressor general adaptation syndrome maladaptation I. Introduction CHAPTER OUTLINE/LECTURE NOTES homeostasis to the internal environmental system. This includes responses B. Adaptation as a healthy response to stress has been defined as restoration of A. The word stress lacks a definitive definition. directed at stabilizing internal biological processes and psychological preservation integrity of the individual is disrupted. C. Maladaptive responses are perceived as negative or unhealthy and occur when the of self-identity and self-esteem. A. This definition of stress is a result of research by Hans Selye. He defined stress II. Stress as a Biological Response syndrome.” syndrome of physical symptoms has come to be known as the “fight or flight as a “non-specific response by the body to any stressor placed upon it.” This B. Selye called this general reaction of the body to stress the general adaptation “fight or flight” syndrome are initiated. 1. Alarm reaction stage. During this stage, the physiological responses of the syndrome (GAS). He described the reaction in three distinct stages: first stage as a defense in the attempt to adapt to the stressor. If adaptation 2. Stage of resistance. The individual uses the physiological responses of the 3. Stage of exhaustion. Occurs when there is a prolonged exposure to the disappear. occurs, the third stage is prevented or delayed. Physiological symptoms may stressor to which the body has become adjusted. The adaptive energy is and, without intervention for reversal, exhaustion and even death can ensue. adaptation described in the first two stages. Disease of adaptation may occur, depleted, and the individual can no longer draw from the resources for 1. The initial stress response C. The “Fight or Flight Syndrome” b. The adrenal medulla releases epinephrine and norepinephrine into the turn stimulates the adrenal medulla. a. The hypothalamus stimulates the sympathetic nervous system, which in bloodstream. d. In the respiratory system, the bronchioles and pulmonary blood vessels are lacrimal glands. c. Changes in the eye include pupil dilation and increased secretion from the e. Changes in the cardiovascular system result in increases in force of dilated and the respiration rate is increased. secretions. Sphincters are contracted. f. The gastrointestinal (GI) system undergoes decreases in motility and contraction, cardiac output, heart rate, and blood pressure. g. Effects on the liver result in increased glycogenolysis and gluconeogenesis the sphincter relaxes. h. Ureter motility increases. In the bladder, the muscle itself contracts, while and decreased glycogen synthesis. j. The fat cells undergo lipolysis. i. There is increased secretion from the sweat glands. b. The pituitary gland releases adrenocorticotropic hormone (ACTH), which a. The hypothalamus stimulates the pituitary gland. 2. The sustained stress response (1) The adrenal cortex releases glucocorticoids, resulting in increased stimulates the adrenal cortex. (2) The adrenal cortex also releases mineralocorticoids, resulting in response. gluconeogenesis, immunosuppression, and an anti-inflammatory c. The pituitary gland releases vasopressin (antidiuretic hormone [ADH]), increased retention of sodium and water. effect on protein, carbohydrate, and lipid metabolism, resulting in d. The pituitary gland releases growth hormone, which produces a direct which results in increases in blood pressure and fluid retention. increased levels of serum glucose and free fatty acids. f. The pituitary gland releases gonadotropins, the initial response of which is the thyroid gland, resulting in an increase in the basal metabolic rate. e. The pituitary gland releases thyrotropic hormone (TTH), which stimulates secretion is suppressed, resulting in decreased libido or impotence. an increase in secretion of sex hormones. Later, with sustained stress, physiological and psychological responses in an individual. The event is one that A. This concept defines stress as a “thing” or “event” that triggers the adaptive III. Stress as an Environmental Event creates change in the life pattern of the individual, requires significant adjustment B. Easily measured by the Miller and Rahe Recent Life Changes Questionnaire. positive or negative. in lifestyle, and taxes available personal resources. The change can be either illness or actually precipitates it, but there does appear to be a clear causal link. C. It is not known for certain whether stress overload merely predisposes a person to and available support systems at the time of the life change. the individual’s personal perception of the event or his or her coping strategies D. A weakness in the Miller and Rahe tool is that it does not take into consideration IV. Stress as a Transaction Between the Individual and the Environment her resources and endangering his or her well-being. the environment that is appraised by the individual as taxing or exceeding his or A. This definition of stress emphasizes the relationship between the individual and and perceived by the individual in a specific manner. B. Precipitating event. A stimulus arising from the internal or external environment 1. Primary appraisal. The individual makes a judgment about the situation in undergoes a primary appraisal and a secondary appraisal of the situation. C. Individual’s perception of the event. When an event occurs, an individual one of the following ways: b. Benign-positive. This type of event is perceived as producing pleasure for significance for the person. a. Irrelevant. When an event is judged irrelevant, the outcome holds no c. Stress appraisal. These types of event include harm/loss, threat, and the individual. individual. (1) Harm/loss. Refers to damage or loss already experienced by the challenge. (2) Threatening. These types of events are perceived as anticipated harms potential for gain or growth, rather than on risks associated with the (3) Challenges. With these types of events, the individual focuses on or losses. 2. Secondary appraisal. This type of appraisal is an assessment of skills, event. and the secondary appraisal of available coping strategies determines the 3. The interaction between the primary appraisal of the event that has occurred resources, and knowledge that the person possesses to deal with the situation. individual’s quality of adaptation response to stress. and existing conditions. responds to a stressful event. They include genetic influences, past experiences, D. Predisposing Factors. Elements that influence how an individual perceives and through heredity (e.g., family history of physical and psychological 1. Genetic influences. Circumstances of an individual’s life that are acquired an individual’s adaptation response (e.g., previous exposure to the stressor, 2. Past experiences. Occurrences that result in learned patterns that can influence conditions). learned coping responses, and degree of adaptation to previous stressors). adaptive demands (e.g., current health status, motivation, developmental individual’s physical, psychological, and social resources for dealing with 3. Existing conditions. Vulnerabilities that influence the adequacy of the resources, age, existing coping strategies, and a support system of caring maturity, severity and duration of the stressor, financial and educational A. Stress management is the utilization of coping strategies in the response to V. Stress Management others). B. Adaptive coping strategies protect the individual from harm and restore physical stressful situations. goes unresolved or intensifies. C. Coping strategies are considered maladaptive when the conflict being experienced and psychological homeostasis. interpersonal communication with a caring other, problem solving, pets, music, D. Some adaptive coping strategies include awareness, relaxation, meditation, and many others.

Youtube sites to review Stress and Memory http://www.youtube.com/watch?v=OHl7BewJ0yU How the Body Works : Center of Emotion and Memory http://www.youtube.com/watch?v=lZ4mdXAtnEs How the Body Works : Physical Responses to Emotion http://www.youtube.com/watch?v=SS_qMHPI0XM Stress and Stressors http://www.youtube.com/watch?v=bCtLTVFlhz4 Stress Management 1 - Stress Exhaustion http://www.youtube.com/watch?v=sEq7fB9jDyQ

Question 1 How stress are you now? 1. Not at all. 2. Mildly 3. Moderately 4. Severely What are you feeling related to your stress level? Decribe the systems you are experiencing?

Stress The word stress lacks a definitive definition. 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.

Stress as a Transaction Between the Individual and the Environment Individual’s perception of the event: The way you interpreted the event is how you respond to the event. Primary appraisal – a judgment about the situation in one of the following ways: Secondary appraisal – Precipitating event –

The physiological of stress . “Fight or Flight” Response When the body encounters a stressor, it prepares itself for “fight or flight.” Identify the adaptation responses that occur in the initial stress response in each of the physical components listed. Physical component Adaptation Response Adrenal medulla Eye Respiratory system Cardiovascular system Gastrointestinal system Liver Urinary system Sweat glands Fat cells

Releases norepinephrine and epinephrine. Pupils dilate. Secretion is increased from lacrimal glands. Bronchioles dilate. Respiration rate is increased. Increased force of cardiac contraction Increased cardiac output Increased heart rate Increased blood pressure Decreased gastric and intestinal motility Decreased secretions Sphincters contract Increased glycogenolysis and gluconeogenesis Decreased glycogen synthesis Increased ureter motility Bladder muscle contracts Bladder sphincter relaxes Increased secretion Lipolysis

Stress Mastery Stress Mastery is the utilization of coping strategies in the response to stressful situations. Adaptive coping strategies protect the individual from harm and restore physical and psychological homeostasis. Coping strategies are considered maladaptive when the conflict being experienced goes unresolved or intensifies.

Effects of chronic Stress Increase Gluconeogenisis Decrease Immune Decrease inflammatory response Retention of sodium and water Decrease in libido, frigidity and impotence Increase in blood pressure Discuss the wt of the bottle.

The parasympathetic nervous system Relaxation Body repair and restoration Lower heart rate Lower blood pressure Lower glucose and insulin Blood directed to digestion Decrease in oxygen consumption CO2 elimination.

Unhealthy Coping Strategies Smoking Drugs Alcohol Over eating/poor eating habits. What other unhealthy coping strategies can you think of?

Healthy Coping Strategies Awareness Relaxation Meditation communication with caring other Problem-solving Pets Exercise Your own thoughts Laughter Aromatherapy Massage Journaling Music Hydro-therapy

What are your coping strategies? Are they healthy strategies?

From the following case study, identify the predisposing factors (genetic influences, past experiences, and existing conditions) that influence Robert’s adaptation response. What is the precipitating stressor in this situation? Robert, age 56, was admitted to the emergency room of a large hospital at 2:00 a.m. after vomiting a large amount of blood. In doing the admitting assessment, the nurse learned the following about Robert: His father and brother are both recovering alcoholics. B. Robert had his first drink at age 12 and has been continually increasing the amount and requency of drinking since that time C. His mother died of lung cancer when Robert was 23. She was a heavy smoker. Robert smokes three packs of cigarettes a day. D. He has been hospitalized only once before, about 3 months ago, and diagnosed with an ulcer. The doctor told him at that time he must stop drinking and smoking in order for the ulcer to heal. E. Robert is married and has three children. He has a long history of moving from one job to another, staying only until his drinking interferes with his work performance and attendance. He was fired from his job yesterday and spent the evening and nighttime hours drinking two fifths of bourbon. He was engaged in this activity at the time the hematemesis began. F. Because of the erratic job history, Robert and his wife experience severe financial difficulties. His wife shows much concern for Robert’s condition and stays by his side during the emergency admission. She states to the nurse, “I want so much for our marriage to work, but he is drinking more and more all the time and still doesn’t see his drinking as a problem. Every time he gets fired, he blames his boss.”