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  1. Short-term AAA and BBB responses to stress:
    • A) Hypothalamus-pituitary-adrenal cortex HYPAC
    • via ACTH (adrenocorticotropic hormone)
    • ↓ Fluid loss
    • ↑ Glucose by gluconeogenesis
    • ↓ Inflammation
    • ↓ Brain norepinephrine

    • B) Sympathetic-adrenal medulla SAM
    • via epinephrine, norepinephrine, etc.
    • ↑ Hear rate
    • ↑ Respiration
    • ↑ Plasma FFAs and sugar
    • ↑ Triglycerides
    • ↑ Platelet aggregation
    • ↓ Kidney clearance
    • ↑ Blood to skeletal muscles
    • ↑ Muscular tension
  2. Phases of GAS General Adaptation Syndrome
    • 1) Alarm or acute stress
    • 2) Resistance
    • 3) Exhaustion - not always present if stressor goes away during resistance phase

    Body cannot differentiate between positive and negative stressors, nor physical, Psychological or Social stressors
  3. Describe the Stressors cycle that evolves to affect the immune system
    • 1) Corticosteroids (generated by the adrenal cortex) in response to ACTH released in response to stress WILL inhibit reproduction, growth and immunity.
    • 2) Stress also causes the release of cytokines by immune cells, which activate and recruit other immune cells, which activate immunity.
    • 3) But the activation is limited since the cytokines also cause the further release of corticosteroids, which (from 1) inhibit immunity.
  4. T/F: Elevated cytokines and immune activation are often seen during episodes of deep depression.
  5. Stress causes serotonin synthesis to become more active, which would be consistent with antidepressive effects, i.e. more serotonin is "good". What mediates this and what is its effect?
    Corticosteroids also released by stressors is "believed" to impair serotonin receptor sites. Researchers don't fully understand the relationship, but Stress can lead to Depression.
  6. PMR (Progressive Muscle Relaxation) is used by...
    Tensing groups of muscles, beginning with the feet and ending with the face, as tightly as possible for 8 seconds and suddenly releasing them.

    Good for tension headaches and psychiatric disorders, especially those with an anxiety component.
  7. Benson's Relaxation Technique is...
    • 1) Relax all muscles starting at feet.
    • 2) TM on a word, like peace, joy, love for 10-20 minutes

    It quiets the sympathetic nervous system.
  8. Breathing exercises
    • Use abdominal or diaphragmatic breathing
    • Hold breath for 3 seconds and continue for 2-5 minutes
  9. Regular exercise helps with all psychiatric and comorbid conditions except...
    Bipolar disorder
  10. 4 months of regular aerobic exercise produces a similar relief from depression as does the same period with...
    a SSRI antidepressant
  11. Cognitive reframing techniques
    If I chose to study for this course, I will increase my chances of success.

    • What positive things came out of this situation?
    • What did I learn from this situation?
    • What would I do in a different way?
  12. Journaling
    Diary of daily events, noting which things put a strain on energy and time, which trigger anger or anxiety.
  13. LONG-TERM (CHRONIC)EFFECTS of Stress via HYPAC (Hypothalamus-Pituitary-Adrenal Cortex)
    • Immune system compromise
    • Atherosclerosis
    • Depression
    • High blood pressure
    • Insulin insensitivity
    • Obesity
    • High blood lipids
    • Protein breakdown
    • • Blood
    • • Bones (osteoporosis)
    • • Muscle (heart, too)
    • • Immunoglobulin
  14. LONG-TERM (CHRONIC)EFFECTS of Stress via SAM (Sympathetic-Adrenal-Medulla)
    • High resting heart rate
    • Heart disease
    • Platelet aggregation
    • Reactive high BP
    • High cholesterol
    • High triglycerides
    • Renal/hepatic problems
    • Glucose intolerance
    • Chronic muscle tension
    • Hyperventilation (chronic)
    • Digestive problems
    • Chronic anxiety/anger
  15. Hopi of North America express depressive states through
    feelings of guilt, shame, and sinfulness.
  16. Puerto Ricans and other Hispanics describe XXX as indicators of a depressive affect.
    irritability, rage, and "nervousness"
  17. The overwhelming majority of Asians, Africans, and Central Americans 
    "not only express subjective distress in somatic terms, but actually experience this distress somatically, such that psychological interpretations of suffering may not be much use cross-culturally."
  18. An effect of stress can attributed to the stimulation of the hypothalamus-pituitary-adrenal cortex and result in a short term increase in: 

    A. triglycerides
    B. gluconeogenesis
    C. heart rate
    D. brain norepinephrine
    B. gluconeogenesis

    Increase of gluconeogenesis stimulated by release of cortisol ensures increased amounts of glucose are available to the individual. Increased glucose levels heighten and maintain energy levels to meet the demands of a crisis or stressor. Text page: 196
    (this multiple choice question has been scrambled)
  19. Stress can be attributed to stimulation of the hypothalamus-pituitary-adrenal cortex and over the long term effect: 

    A. Digestive problems
    B. Chronic muscle tension
    C. High resting heart rate
    D. Insulin resistance
    D. Insulin resistance

    Insulin resistance and obesity are considered long-term sequalae of the high blood glucose levels incurred when the body responds to stress. Text page: 196
    (this multiple choice question has been scrambled)
  20. High-quality social support relationships have qualities that include 

    A. minor conflict.
    B. constructive criticism.
    C. reciprocal closeness.
    D. continuous feedback.
    C. reciprocal closeness.

    High-quality social support relationships are relatively conflict free, and are close, confiding, and reciprocal. Text page: 199
    (this multiple choice question has been scrambled)
  21. The relaxation response calls upon: 

    A. sympathetic activation.
    B. the adrenals to increase cortisol production.
    C. parasympathetic activation.
    D. brainstem deactivation.
    C. parasympathetic activation.

    Sympathetic activation prepares the individual for fight or flight response. Parasympathetic activation has the opposite effect. Text page: 204
    (this multiple choice question has been scrambled)
  22. An effective stress-reduction technique a nurse might teach an individual with performance anxiety is 

    A. diaphragmatic breathing.
    B. journal keeping.
    C. restructuring and setting priorities.
    D. assertiveness.
    A. diaphragmatic breathing.

    Changing breathing pattern can be highly effective in aborting or mitigating the high anxiety level associated with performance anxiety. Text page: 205
    (this multiple choice question has been scrambled)
  23. Which approach to reducing client stress is most effective in people with low to moderate hypnotic ability? 

    A. Biofeedback
    B. Breathing exercises
    C. Journal keeping
    D. Meditation
    A. Biofeedback

    Biofeedback is usually thought to be most effective in people with low to moderate hypnotic ability. For people with hypnotic ability, meditation, progressive muscle relaxation, and other cognitive-behavioral therapy techniques produce the most rapid reduction in clinical symptoms. Text page: 206
    (this multiple choice question has been scrambled)
  24. An advantage of the Miller and Rahe updated life event and social readjustment scale is that it 

    A. assesses stress threshold and potential for future illness.
    B. considers mediating factors.
    C. focuses on the presenting symptoms.
    D. identifies the client's perception of events.
    A. assesses stress threshold and potential for future illness.

    The scoring of this scale gives nurses the capability of predicting a person's potential for future stress-related illness. Text pages: 200, 202 and 203
    (this multiple choice question has been scrambled)
Card Set:
2013-03-11 14:48:36
nur210e1 Understanding Responses Stress

Understanding Responses to Stress
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