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Lecture 1

NSE 21A/B Lecture Notes - Lecture 1: Electrodermal Activity, Revised Version, Advance Healthcare Directive


Department
Nursing
Course Code
NSE 21A/B
Professor
Franklin Gorospe
Lecture
1

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Theory NSE21 – Week 1
Stress & Stress Management (Lewis & Retherford, 2014)
Stress
Subjective
Nonspecific response of the body to any demand made on it
Individuals perceive that they cannot adequately cope with demands being made on them or when their
well-being is threatened
What are some examples of stressors?
Physiological Emotional/Psychological
Burns
Chronic pain
Birth of a baby
Infectious diseases
Excessive noise
Inadequate nutrition
Running a marathon
Diagnosis of cancer
Martial problems
Failing an exam
Inadequate financial resources
Grieving
Prolonged period of caregiving
1) A woman becomes depressed and refuses to participate in normal self-care activities after a laparoscopic
hysterectomy. In this situation, the removal of her uterus is a great stressor because the woman perceives
it as a loss of her womanhood and femininity.
2) A patient who is told she has type 2 diabetes reacts with a smile. However, the patient is relieved
because for weeks she has been worrying that her symptoms were related to terminal cancer.
Stressors
Stress-inducing demands
oPhysiological or emotional/psychological
oPositive or negative stressors
oDaily hassles: experiences of daily living that are irritating, distressing or frustrating i.e. traffic,
waiting, misplacing things, deadlines
oMajor life events
oUplifts: positive experiences or temporary joys that occur in everyday life
oEustress: stress associated w/ positive events i.e. birth of a baby, falling in love, etc.
Require individuals to adapt to a situation
oBehavioral and physiological adaptive responses to stressors based on duration (acute or chronic)
and intensity of stress (mild, moderate or severe)
i.e. an individual dealing with the chronic stress of caring for a loved one may also be exposed to a
multitude of acute episodic stressors (e.g., car accident, influenza).
Stress Responses
Variations in perception of stressors & response to stressors
Internal Factors External Factors
Biology & Genetic predisposition (i.e. Age,
Health status, Personality)
Income & Social status
Social support i.e. Context (timing, number of
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Personal health practices (i.e. nutrition, sleep)
Coping skills (previous experiences,
resilience, self-efficacy)
stressors)
Culture (religion, spirituality, ethnicity)
Sense of coherence: optimistic view of the world & believe they can function optimally
oPromote well-being (i.e. coping with stress) rather than focusing on disease
Resilience: ability to be resourceful, flexible & recover from stressful situations and return to prior
levels of functioning
oHigher sense of purpose, self-determined, positive social support & meaningful interpersonal
relationships support resiliency
oResilient people use more effective coping strategies
Theories of Stress
1. General Adaptation Syndrome
Hans Selye’s work
Stressors from different sources produce a similar physical response
Stress is a response to a stressor that causes physiological changes to which a person may adapt
Two types:
oDistress – negative stress (unexpected)
oEustress – stress that mobilized the individual to effective performance
oi.e. slapping; distress – stranger randomly slaps you; eustress – UFC training, makes you
better
a. Alarm Reaction
- Person perceives stress physically or mentally & fight or flight response initiated
- If stressor intensifies to threaten homeostasis of person leads to physiological changes that promote
adaptation à decreases person’s resistance; may result in disease/death if stress prolonged & severe
b. Stage of Resistance
- Physiological reserves used to increase resistance to stress
- Adaptation may occur
- Amount of resistant to stress dependent on level of physical functioning, coping abilities, total #
& intensity of stressors i.e. person who’s been exercising regularly greater ability to adapt to stress of
surgery than a person who lives a sedentary lifestyle
- Allostasis: process of achieving homeostasis in the presence of challenge
- If internal & external resources adequate, person may successfully recover from stressor
- If homeostasis not achieved, allostatic response aren’t eliminated, no adaptation & person may
move to stage of exhaustion
c. Stage of Exhaustion
- Occurs when all energy for adaptation is used up
- Symptoms of alarm reaction may reappear in a final attempt to survive i.e. terminally ill pt who
becomes alert & has stronger VSs before death
- Person becomes ill and may die if assistance not available; can be reserved by external sources of
adaptive energy (i.e. medication or psychotherapy)
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2. Stress as a stimulus that causes a response
Originators
oHolmes and Masuda; and Miller and Rahe – developed the Social Readjustment
Rating Scale to assess effects of life changes on health
Assumption of theory is that frequent life changes (minor violations of the law to death of a
loved one) make people more vulnerable to illness
3. Transaction or Interaction Theory
Proponents of the theory were Lazarus and Folkman
Person-environment interactions
Cognitive appraisal
oJudgement or evaluative process of the stress and coping where person identifies
degree of stress & its effect on well-being; leads to use of coping strategies
Effects of Stress of Health
Acute Stress:
Associated with duration
Physiological changes that promote adaptation & survival
Excessive or Prolonged Stress:
Physiological changes can be maladaptive & lead to disease
Body defenses cannot meet demands
Cognitive functions:
oHippocampal damage affects long-term memory (d/t chronic release of corticosteroids)
oDeterioration in concentration, memory problems, sleep disturbances
oImpairment in decision-making
Behaviour
oWithdrawing, talkative, irritability, eating, substance use, fatigue
i.e. immune suppression (prone to infectious diseases, but also might exacerbate conditions such as MS,
RA, asthma. etc.)
Conditions associated with stress:
Hypertension
Angina
Insomnia
Sexual dysfunction
Headaches
Obesity
Immune suppression
Migraines
IBS
Ulcers
Back pain
Depression
Asthma
Coping
A person’s cognitive and behavioral efforts to manage stressors
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