NURS 123 Stress

jasmine's version from 2016-01-31 06:42

Section 1

Question Answer
Stress Begins with a stimulus that the brain perceives as stressful, which in turn promotes adaptational and survival-related physiologic responses; These responses can become dysregulated and cause pathophysiologic conditions (Mind, Body, Emotions, and Behavior)
Characteristics of Stress in relation to the mind Worrying, foggy thinking impaired judgement, hasty decisions, negativity, indecisions
Characteristics of Stress in relation to the body Fatigue, headaches, constricted breathing, frequent infections, skin irritations, and taut muscles
Characteristics of Stress in relation to the emotions Irritability, depression, loss of confidence, apprehension, indifference, insomnia
Characteristics of Stress in relation to the behavior Insomnia, restlessness, loss of appetite, substance abuse, accident prone, and loneliness
Another definition of stress Involves short- or long-term stressors and a discussion of the physiologic responses to these different types of events
Stress causes psychologic and physical responses
Stress has been more usefully defined as a Transactional, or interactional concept
Transactional, or Interactional Stress Viewed as the state of affairs arising when a person relates to (i.e., interacts or transacts with) situations in certain ways. For example: People are not disturbed by situations per se, yet by the ways they appraise and react to situations. In general, a person experiences stress when a demand exceeds a person’s coping abilities, resulting in reactions such as disturbances of cognition, emotion, and behavior that can adversely affect well-being
Psychological Stressors Can elicit reactive or anticipatory stress responses
Reactive Stress Response Physiologic response derived from psychological stressors. For example, the stress of an examination may produce an increased heat rate and dry mouth in the unprepared student
Anticipatory Stress Response Occurs when physiologic responses develop in anticipation of disruption of the optimal steady-state, also known as homeostasis
Conditional Response One learns that a specific stimuli (i.e., objects or situational context) are associated with danger, and as such anticipation of subsequent encounters with the stimulus produces a physiologic stress response. Psychologic disorders such as phobias may develop if untreated. PTSD may develop in response to the memory, as opposed to the anticipation of traumatic events
Stress can Precipitate disease such as cardiac disease, and can worsen existing diseases such as irritable bowel disease, asthma, autoimmune diseases, and human immunodeficiency virus (HIV) progression
Acute Stress Immunoenhancing (protective) through glucocorticoids such as cortisol
Chronic Stress Immunosuppressive (destructive) through glucocorticoids such as cortisol
Stress-induced chronic inflammation Suggested as being important in the functional decline that leads to frailty, disability, and untimely death; cardiovascular disease; and infectious diseases
Systemic responses to stress... May cause a decrease in innate immunity by suppressing the Th1 cell activity, causing a Th1 to Th2 shift, and enhance adaptive immunity by promoting Th2 activity; Th1 and Th2 cells are involved in adaptive immunity
Local responses to stress... Under certain conditions can induce pro-inflammatory activities that may influence the onset and cause of infectious, autoimmune/inflammatory, allergic, and neoplastic (New growth; an abnormal tissue that grows by cellular proliferation more rapidly than normal and continues to grow after the stimuli that initiated the new growth ceases; any abnormal growth, whether malignant or benign: all types of cancer fall into the category of malignant neoplastic diseases) diseases

Section 2

Question Answer
Walter Cannon (1871-1945) Theory of emotion; Used the term stress to encompass both physiologic and psychologic ideas by applying the concept of stress and strain in a physiologic context and believed that emotional stimuli also were capable of causing stress
Acute emotional distress Suggested important effects such as the death of a loved one, on the heart muscle include three area: Left ventricular contractile dysfunction, myocardial ischemia, and disturbances of heart rhythm
Hans Selye (1907-1982) Endocrinologist (study of hormones and the actions and disorders of the hormones in the body); Proposed the General Adaptation Syndrome (GAS), alternately known as the stress syndrome where the body confronts noxious agents (stress)
General Adaptation Syndrome (GAS) Also known as the stress syndrome; Selye’s concept; Consists of 3 universal stages of Coping: Alarm Reaction, Stage of Resistance (Adaptation), and Stage of Exhaustion
Alarm Reaction The body prepares itself for fight or fight response or arousal of body defenses in preparation for fight or fight response; Stressor triggers the hypothalamic-pituitary-adrenal (HPA) axis, activating the sympathetic nervous system (SNS)
Stage of Resistance (Adaptation) Mobilization that contributes to fight or flight ensues and a resistance to the stress is built; Begins with the actions of adrenal hormones: Cortisol, epinephrine, and norepinephrine
Stage of Exhaustion (Allostatic overload) If or when the stress continues and adaptation is not successful and/or is sufficiently long, the body eventually enters this stage, which is considered a sort of aging “due to wear and tear.” It is considered a progressive breakdown of compensatory mechanisms that may lead to the onset of disease
The stage of resistance in Selye’s general adaptation syndrome includes: Mobilization that contributes to the fight or flight response

Section 3

Question Answer
Psychoneuroimmunologic More holistic and complex model of health and disease states that involves the biochemical relationships of the central and autonomic nervous systems, the endocrine system, and the immune system and their relationships to stress-elicited coping behaviors, such as smoking and poor diet, that can also modify the integrity of the immune system; These complex links have led to the creation of the field of psychoneuroimmunology; The study of the effect of the mind on health and resistance to disease; A branch of medicine that deals with the influence of emotional states (as stress) and nervous system activities on immune function especially in relation to the onset and progression of disease
Psychoneuroimmunology (PNI) Interactions of consciousness, the brain and spinal cord, and the body’s defense mechanisms; The stressors (i.e., pain, cold, trauma, malnutrition, excitement, drugs, surgery, etc) elicit a stress response or stress system through actions of the nervous and endocrine systems
Psychoneuroimmunology assumes that All immune-mediated diseases result from interrelationships among psychosocial, emotional, genetic, and behavioral factors with the neurologic, endocrine, and immune systems;
The immune system is Integrated with other physiologic processes and is sensitive to changes in CNS and endocrine functioning, such as those that accompany psychologic states
Stress Response Is initiated by the central nervous system and the endocrine system
Hypothalamus Secretes corticotropin-releasing hormone (CRH), which binds to specific receptors on pituitary cells that, in turn, produce adrenocorticotropic hormone (ACTH). ACTH is then transported through the blood to the adrenal glands located on the top of the kidneys. After binding to specific receptors on the adrenal glands, the glucocorticoid hormones (primarily cortisol; from the adrenal cortex) are released, and cortisol initiates a series of metabolic changes
Corticotropin-releasing hormone (CRH)Is released from the hypothalamus, and is peripherally released at inflammatory sites; Can be released when under stress and more releasing neurons in male brains; Made by hypothalamus (controls body temp. hunger, and thirst) that stimulates the release of corticotropin (also known as adrenal corticotropin hormone [ACRH]) by the anterior pituitary gland and travels to the adrenal cortex, stimulating growth and secretion of cortico steriods; CRH decreases production of GnRH from the hypothalamus, and GnRH is one mechanism through which a stress response can suppress various aspects of the reproductive system; CRH is normally released by mother and embryo soon after embryo implants in uterus womb. CRH appears to protect the embryo from immunologic rejection by mother. Without CRH, the embryo may be rejected by the mother, resulting in miscarriage
Stressor Can be a perceived or real threat
Norepinephrine hormone Promotes arousal, increased vigilance, increased anxiety, and other protective emotional responses. It also raises blood pressure by constricting the peripheral vessels; dilates the pupils of the eyes; causes piloerection (involuntary erection or bristling of hairs due to a sympathetic reflex usually triggered by cold, shock, or fright or due to a sympathomimetic agent); and increases sweat gland action in the armpits and palms
Epinephrine Has a greater influence on cardiac action (inotropic [modifies force or speed of contraction of muscles] and chronotropic [chrono-time and tropos-a turn; those that change the heart rate]); vasodilation occurs; and metabolic regulation occurs, increasing the glucose level
AllostasisConsidered an adaptive physiologic response to stressful events
Chronic or dysregulated Allostatis Long-term or chronic exaggerated responses to stress that can lead to disease
Allostatic Load Individualized cumulative amounts of stressors that exist in an individual’s life and that influence his or her physiologic responses; The brain is influential in determining when allostatic overload has been reached
Allostatic Overload Exaggerated pathophysiologic responses to stress
Which information indicates the nurse has a good understanding of epinephrine? Epinephrine actions include a(n): Increase of serum glucose concentration
Glucocorticoid Cortisol Is activated by adrenocorticotropic hormone (ACTH); Stimulates gluconeogenesis; Elevates the blood glucose level; Has a protein anabolic effect (build up) in the liver and a catabolic effect (breakdown) in other tissues
A client has stress and releases cortisol. The nurse realizes that cortisol Increase the rate of protein synthesis in the liver
Hormones of the female reproductive system Luteinizing hormone, estradiol, and progesterone, hypothalamic gonadotropin-releasing hormone, estrogen, and leptin
Luteinizing hormone, estradiol, and progesterone Cortisol suppresses the release of these hormones
Stress suppresses The hypothalamic gonadotropin-releasing hormone
Estrogen stimulates The hypothalamic-Pituitary-Adrenal (HPA) axis
Leptin inhibits The HPA axis
Hypothalamic-Pituitary-Adrenal (HPA) axisAlso known as the limbic-hypothalamic-pituitary-adrenal axis; The interactions among these organs constitute the HPA axis, a major part of the neuroendocrine system that controls reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality, and energy storage and expenditure. It is the common mechanism for interactions among glands, hormones, and parts of the midbrain that mediate the general adaptation syndrome (GAS)-Responsiveness greater in women than that in men
Adrenocorticotropic Hormone (ACTH) A hormone that is produced by the anterior pituitary gland and that stimulates the secretion of cortisone, aldosterone, and other hormones by the adrenal cortex
Steroid Hormones Produced mainly in vertebrates, the physiological role of the HPA axis and corticosteroids in stress response is so fundamental that analogous systems can be found in invertebrates and monocellular organisms as well
Neural recognition and response to real or predicted stressors Limbic system points ---> Brainstem (including locus ceruleus) ---> Sympathetic nervous system ---> Adrenal medulla (epinephrine); Also Limbic system ---> brain regions receiving sensory information ---> Paraventricular nucleus of the hypothalamus (CRH) release ---> Sympathetic nervous system
Locus ceruleus Principle site for brain synthesis of norepineprine (noradrenaline);
Locus ceruleus-norepineprine system The locus coeruleus and the areas of the body affected by the norepinephrine it produces; Provides positive input to the reproductive system, which is frequently altered by the stress-activated hypothalamic-pituitary-adrenal (HPA) axis