NUR 256 CONCEPTS OF MENTAL HEALTH NURSING: MENTAL
EXAM 2
Unit 3
Chapter 10: Understanding and Managing Responses to Stress
• Introduction
o Definition of stress
o Stress responses and psychiatric disorders
o The interface between stress and all health alterations
▪ Hypertension, weight gain, effects healing/immune system (slow healing),
• Early Stress-Response Theories
o Walter Cannon
Fight-or-flight response
Body prepares for situation that individual perceives as threat to survival
New research indicates that men and women have different neural
responses to
Increases
stress BP, HR and cardiac output
o Hans Selye
▪ General adaptation syndrome (GAS)
• Three stages (pg 168)
o Alarm or acute stress stage
o Resistance or adaptation stage
o Exhaustion stage
• Psychological reactions (Lazarus)
Distress: bad
Eustress: good
• Neurotransmitter Stress Responses
o Serotonin synthesis more active
o May impair serotonin receptor sites and brain’s ability to use serotonin
▪ Can cause damage to serotonin receptor sites, can become resistant
to serotonin
• Immune Stress Responses
o Interaction between nervous system and immune system during alarm phase of
GAS
o Negatively affects body’s ability to produce protective factors
▪ More susceptible to infections (decreases immune system)
• Mediators of the Stress Response
o Stressors
▪ Physical
• Excessive heat and cold; hemorrhage
Psychological
Divorce; losing job – things that weight on you and cause mental
stres
Environmental
s conditions – trauma, extreme heat/cold
, o Perception (is it a big deal or isn’t it?)
o Individual temperament
▪ Temper tantrums
▪ Helps determine how you deal with stress
o Social support
▪ Support groups
▪ Culture
▪ Spirituality and religious beliefs
• Nursing Management of Stress Responses
o Measuring stress
▪ Social Readjustment Rating Scale (Holmes and Rahe, 1967, 1978, 1997)
• Measures level of positive and negative stressful life events over
a 1-year period
o Assessing coping styles
• Case Study
o A college student is experiencing stress in her life as she tries to manage her
schoolwork, job responsibilities, and single parenting.
o What attributes can this student develop to manage the stress?
▪ Time management, reward yourself, sleep, health sustaining
behaviors/activities, work/life balance (don’t get burnt out), social
support, healthy responses to stress
Managing Stress Through Relaxation Techniques
Deep breathing exercises
Progressive muscle relaxation
Start at one end of body and tighten area of body and release
Relaxation response
Meditation
Guided imagery (walking on a beach)
Biofeedback
Using technology to let us know we respond to stress (ex: increase HR)
Physical exercise
Cognitive reframing
Journaling
Humor
Chapter 15: Anxiety and Obsessive-Compulsive Related Disorders
• Anxiety
o Anxiety – Apprehension, uneasiness, uncertainty, or dread from real or perceived
threat
o Fear – Reaction to specific danger
o Normal anxiety – Necessary for survival
Levels of Anxiety
Mild anxiety
, See, hear and grasps more information
Heightened perceptual field
Moderate anxiety
perceptual field begins to narrow
Less able to pay attention
Severe anxiety
Perceptual field is greatly reduced
Focused on details or one specific detail
Attention is scattered
Panic
Erratic
Not able to accomplish much
Communication needs to be simple
Specific questions must be asked in order to answer
• Case Study
What behaviors might this parent be exhibiting that would indicate panic-level
anxiety?
Take person to safe place, where it is calm
DON’T LEAVE PERSON ALONE
Keep calm and focus on breathing
Focus on factual not false reoccurrence
Defenses Against Anxiety
• Defense mechanisms
o Automatic coping styles
o Protect people from anxiety
o Maintain self-image by blocking
▪ Feelings
▪ Conflicts
▪ Memories
o Can be healthy or unhealthy
DEFENCE MECHANISMS
o Denial - involved escaping unpleasant, anxiety-causing thoughts, feelings,
wishes or needs by ignoring their existence
▪ A man reacts to the death of a loved one by saying “No, I don’t
believe you”
o Displacement – the transference of emotions associated with particular
person, object or situation to another nonthreatening person, object or
situation
▪ A child yells at his teddy beat after being picked on by the school bully
o Rationalization – consists of justifying illogical or unreasonable ideas, actions or
feelings by developing acceptable explanations that satisfy the teller as well as the
listener
▪ An employee says “I didn’t get the raise because the boss doesn’t like me”
▪ “Can’t afford a $500 dress, but buy it anyways because I deserve it”
o Intellectualization – a process in which events are analyzed based on remote, cold
facts and without passion, rather than incorporating feeling and emotion into the
processing
EXAM 2
Unit 3
Chapter 10: Understanding and Managing Responses to Stress
• Introduction
o Definition of stress
o Stress responses and psychiatric disorders
o The interface between stress and all health alterations
▪ Hypertension, weight gain, effects healing/immune system (slow healing),
• Early Stress-Response Theories
o Walter Cannon
Fight-or-flight response
Body prepares for situation that individual perceives as threat to survival
New research indicates that men and women have different neural
responses to
Increases
stress BP, HR and cardiac output
o Hans Selye
▪ General adaptation syndrome (GAS)
• Three stages (pg 168)
o Alarm or acute stress stage
o Resistance or adaptation stage
o Exhaustion stage
• Psychological reactions (Lazarus)
Distress: bad
Eustress: good
• Neurotransmitter Stress Responses
o Serotonin synthesis more active
o May impair serotonin receptor sites and brain’s ability to use serotonin
▪ Can cause damage to serotonin receptor sites, can become resistant
to serotonin
• Immune Stress Responses
o Interaction between nervous system and immune system during alarm phase of
GAS
o Negatively affects body’s ability to produce protective factors
▪ More susceptible to infections (decreases immune system)
• Mediators of the Stress Response
o Stressors
▪ Physical
• Excessive heat and cold; hemorrhage
Psychological
Divorce; losing job – things that weight on you and cause mental
stres
Environmental
s conditions – trauma, extreme heat/cold
, o Perception (is it a big deal or isn’t it?)
o Individual temperament
▪ Temper tantrums
▪ Helps determine how you deal with stress
o Social support
▪ Support groups
▪ Culture
▪ Spirituality and religious beliefs
• Nursing Management of Stress Responses
o Measuring stress
▪ Social Readjustment Rating Scale (Holmes and Rahe, 1967, 1978, 1997)
• Measures level of positive and negative stressful life events over
a 1-year period
o Assessing coping styles
• Case Study
o A college student is experiencing stress in her life as she tries to manage her
schoolwork, job responsibilities, and single parenting.
o What attributes can this student develop to manage the stress?
▪ Time management, reward yourself, sleep, health sustaining
behaviors/activities, work/life balance (don’t get burnt out), social
support, healthy responses to stress
Managing Stress Through Relaxation Techniques
Deep breathing exercises
Progressive muscle relaxation
Start at one end of body and tighten area of body and release
Relaxation response
Meditation
Guided imagery (walking on a beach)
Biofeedback
Using technology to let us know we respond to stress (ex: increase HR)
Physical exercise
Cognitive reframing
Journaling
Humor
Chapter 15: Anxiety and Obsessive-Compulsive Related Disorders
• Anxiety
o Anxiety – Apprehension, uneasiness, uncertainty, or dread from real or perceived
threat
o Fear – Reaction to specific danger
o Normal anxiety – Necessary for survival
Levels of Anxiety
Mild anxiety
, See, hear and grasps more information
Heightened perceptual field
Moderate anxiety
perceptual field begins to narrow
Less able to pay attention
Severe anxiety
Perceptual field is greatly reduced
Focused on details or one specific detail
Attention is scattered
Panic
Erratic
Not able to accomplish much
Communication needs to be simple
Specific questions must be asked in order to answer
• Case Study
What behaviors might this parent be exhibiting that would indicate panic-level
anxiety?
Take person to safe place, where it is calm
DON’T LEAVE PERSON ALONE
Keep calm and focus on breathing
Focus on factual not false reoccurrence
Defenses Against Anxiety
• Defense mechanisms
o Automatic coping styles
o Protect people from anxiety
o Maintain self-image by blocking
▪ Feelings
▪ Conflicts
▪ Memories
o Can be healthy or unhealthy
DEFENCE MECHANISMS
o Denial - involved escaping unpleasant, anxiety-causing thoughts, feelings,
wishes or needs by ignoring their existence
▪ A man reacts to the death of a loved one by saying “No, I don’t
believe you”
o Displacement – the transference of emotions associated with particular
person, object or situation to another nonthreatening person, object or
situation
▪ A child yells at his teddy beat after being picked on by the school bully
o Rationalization – consists of justifying illogical or unreasonable ideas, actions or
feelings by developing acceptable explanations that satisfy the teller as well as the
listener
▪ An employee says “I didn’t get the raise because the boss doesn’t like me”
▪ “Can’t afford a $500 dress, but buy it anyways because I deserve it”
o Intellectualization – a process in which events are analyzed based on remote, cold
facts and without passion, rather than incorporating feeling and emotion into the
processing
