CHAPTER 10: Stress & Coping Mechanisms

🌪️ CHAPTER 10: Stress & Coping Mechanisms 🔹 Definitions ●​ Stress: Body’s non-specific response to any demand.​ ●​ Stressors: Physical (injury, illness) or psychological (divorce, exams) triggers.​ ●​ Fight or Flight: Body’s survival response.​ ●​ Eustress vs. Distress: Eustress = good, motivating stress; Distress = bad, overwhelming stress.​ 🔹 Stress Theories ●​ Hans Selye’s General Adaptation Syndrome (GAS):​ 1.​ Alarm – Fight or flight.​ 2.​ Resistance – Body tries to return to homeostasis.​ 3.​ Exhaustion – Prolonged stress leads to breakdown (illness, fatigue).​ ●​ Lazarus: How we perceive stress determines the outcome.​ 🔹 Stress Response ●​ Acute Stress: ↑ HR, ↑ BP, ↑ glucose, decreased appetite, temporary.​ ●​ Chronic Stress: Weight changes, sleep issues, lowered immunity, ↑ risk for MI/stroke.​ 🔹 Immune System ●​ Prolonged stress = ↓ immune response.​ 🔹 Coping ●​ Healthy Coping: Flexible, realistic, social support.​ ●​ Unhealthy Coping: Avoidance, withdrawal.​ 🔹 Tools ●​ Holmes & Rahe Stress Scale:​ ○​ 300+: high illness risk.​ ○​ 150–299: moderate risk.​ ○​ <150: low risk.​ 🔹 Nursing Interventions ●​ Cognitive reframing: Change negative thoughts.​ ●​ Relaxation techniques: Deep breathing, muscle relaxation, prayer, journaling.​ 🔹 Defense Mechanisms (with examples) Mechanism Definition Example Denial Refusing reality "I’m not sick." Rationalization Logical excuses "I failed because the test was unfair." Displacement Transferring emotions Yelling at spouse instead of boss. Projection Attributing own feelings "She hates me" (when you dislike her). Regression Reverting to earlier behavior Temper tantrum in adult. Sublimation Channeling unacceptable impulses Running to release anger. ⚡ CHAPTER 13: Bipolar Disorders 🔹 Bipolar Types ●​ Bipolar I: Full manic + depressive episodes (more common in men).​ ●​ Bipolar II: Hypomania + depression (more common in women).​ ●​ Cyclothymia: Milder mood swings over years.​ 🔹 Causes ●​ Biological: ↑ Dopamine, ↑ Serotonin = mania; ↓ = depression.​ ●​ Genetic: Strong family link.​ ●​ Neuroendocrine: Thyroid dysfunction can contribute.​ ●​ Environmental: High stress, creative personalities, loss.​ 🔹 Manic Symptoms (DIGFAST) ●​ Distractibility​ ●​ Indiscretion (risky behaviors)​ ●​ Grandiosity​ ●​ Flight of ideas​ ●​ Activity ↑​ ●​ Sleep ↓​ ●​ Talkative​ 🔹 Assessment ●​ Mood: Euphoria → Irritability​ ●​ Behavior: Hyperactive, spending, risky sex​ ●​ Speech: Clang associations, pressured​ ●​ Thoughts: Grandiosity, delusions​ 🔹 Phases of Treatment Phase Goal Acute Prevent injury Continuation Prevent relapse Maintenance Limit future episodes 🔹 Medications ●​ Mood Stabilizer: Lithium​ ○​ Therapeutic: 0.6–1.2 mEq/L​ ○​ Toxic: >1.5 mEq/L​ ○​ Long-term: Watch kidneys + thyroid​ ●​ Anticonvulsants: Valproate, Lamotrigine​ ●​ Antipsychotics: Risperidone, Olanzapine​ ●​ Anxiolytics: Lorazepam (Ativan), Clonazepam​ 🔹 Nursing ●​ Set limits, redirect energy, reduce stimuli​ ●​ Monitor for suicide, substance use, and mania risks​ 😰 CHAPTER 15: Anxiety & OCD 🔹 Anxiety Levels Level Description Mild Normal, productive Moderate Narrow focus Severe Difficulty thinking, physical symptoms Panic No focus, loss of reality, may be life-threatening 🔹 Disorders ●​ Separation Anxiety: Inappropriate distress when apart from loved one.​ ●​ Panic Disorder: Sudden attacks (palpitations, fear of dying).​ ●​ Agoraphobia: Fear of being trapped in public places.​ ●​ Social Anxiety: Fear of being judged in social situations.​ ●​ GAD: Chronic worry >6 months.​ 🔹 OCD Spectrum ●​ OCD: Obsessions (thoughts) + Compulsions (behaviors).​ ●​ Body Dysmorphic Disorder: Preoccupation with flaws.​ ●​ Hoarding: Difficulty discarding.​ ●​ Trichotillomania/Dermatillomania: Hair or skin picking.​ 🔹 Nursing Interventions ●​ Stay calm​ ●​ Short, clear sentences​ ●​ Reduce stimuli​ ●​ Build trust​ ●​ CBT: Challenge irrational thoughts​ ●​ Exposure therapy, desensitization​ 🔹 Meds ●​ SSRIs: First line (ex. fluoxetine)​ ●​ Benzodiazepines: Short-term​ ●​ Buspirone: Non-addictive​ 🧠 CHAPTER 16: Trauma, Stress, & Dissociative Disorders 🔹 Childhood Trauma ●​ PTSD signs: regression, nightmares, withdrawal.​ ●​ Reactive Attachment Disorder: Child is withdrawn.​ ●​ Disinhibited Social Engagement: Child overly friendly with strangers. 🔹 Dissociation ●​ Normal: Spacing out.​ ●​ Dissociation: Defense mechanism to avoid trauma. 🔹 Adult PTSD ●​ Intrusive thoughts, nightmares, avoidance, hyperarousal. 🔹 Dissociative Disorders Type Description Depersonalization Feeling detached from self Derealization Surroundings feel unreal Dissociative Amnesia Loss of memory (Localized, Selective, Generalized) Dissociative Fugue Travel + identity loss DID (Multiple Personality) Two or more identities; unaware of each other 🔹 Treatment ●​ SSRIs for PTSD​ ●​ Psychotherapy​ ●​ Somatic therapy​ ●​ Grounding techniques​ ●​ Safety is priority