Stress and Coping Mechanisms

Stress & Coping

• A stressor is any internal or external event that triggers a physiological or psychological response.
• Stress is the body's physical and psychological response to a stressor, whether acute or chronic.
• Appraisal is when an individual evaluates a stressor to determine significance and coping ability.
• A crisis is when coping mechanisms fail, leading to inability to function normally.

Allostatic Load

• Allostatic load is the cumulative effect of chronic stress on the body, causing wear and tear.
• Long-term, high allostatic load can lead to cardiovascular disease, hypertension, obesity, diabetes, cognitive decline, and immune suppression.

Adrenal Gland and Sympathetic Nervous System

• Glucocorticoids (e.g., cortisol) increase glucose metabolism, suppress immune function, and aid in stress adaptation.
• Mineralocorticoids (e.g., aldosterone) regulate sodium and potassium levels, influencing blood pressure.
• Catecholamines (epinephrine & norepinephrine) increase heart rate, blood pressure, and glucose availability, preparing the body for "fight-or-flight."

PTSD vs. STS

• PTSD is a psychiatric disorder following a traumatic event, with symptoms like flashbacks and hyperarousal.
• STS (Secondary Traumatic Stress) is emotional distress experienced by those indirectly exposed to trauma, similar to PTSD.

Types of Stress/Crisis

• Developmental (Maturational) Crisis relates to normal life transitions like puberty or retirement.
• Situational Crisis is caused by unexpected life events such as job loss or illness.
• Disasters/Adventitious Crisis results from unpredictable, large-scale events like natural disasters or terrorism.

Assessing Patients

• Non-verbal cues such as facial expressions and body language can indicate stress levels.
• Appearance clues such as hygiene and posture can provide insights into coping abilities.

Older Adults and Stressors

• Common stressors for older adults (65+) include retirement, loss of independence, chronic illness, loss of loved ones, cognitive decline, and financial concerns.

Positive Coping Strategies

• Effective coping strategies include problem-solving, social support, relaxation techniques, mindfulness, exercise, and professional counseling.

Sleep

Sleep Deprivation and Effects of Sleep

• Symptoms of sleep deprivation include fatigue, irritability, cognitive impairment, and a weakened immune system.
• Positive effects of sleep include enhanced memory consolidation, mood regulation, immune function, and cardiovascular health.

Hypothalamus and Factor S

• The hypothalamus controls circadian rhythms and regulates sleep via neurotransmitters such as GABA and orexin.
• Factor S is a sleep-promoting substance that accumulates with wakefulness and signals the need for sleep.

Stages of Sleep

• The deepest sleep occurs in Stage 3 (Slow-wave sleep) and is restorative.
• Vivid dreaming occurs in REM (Rapid Eye Movement) sleep.

Sleep Disorders

• Insomnia is difficulty falling or staying asleep.
• Sleep-related breathing disorders include sleep apnea.
• Hypersomnias of central origin are excessive sleepiness not due to circadian rhythms (e.g., narcolepsy).
• Parasomnias are abnormal behaviors during sleep (e.g., sleepwalking, night terrors).
• Circadian rhythm sleep disorders are disruptions in the sleep-wake cycle (e.g., shift work disorder, jet lag).
• Sleep-related movement disorders include restless leg syndrome.

Sleep Requirements by Age Group

• Neonates: 16-18 hours
• Infants: 12-15 hours
• Toddlers: 11-14 hours
• Preschoolers: 10-13 hours
• School-age children: 9-11 hours
• Teenagers: 8-10 hours
• Adults: 7-9 hours
• Older adults: 7-8 hours
• Younger humans require more sleep for growth and brain development.

Factors Impacting Sleep

• Physical illness can disrupt sleep due to pain, respiratory issues, or hormonal imbalances.
• Drugs such as alcohol disrupt REM sleep, nicotine reduces sleep quality, caffeine delays sleep onset, and diuretics increase nighttime urination.
• Moderate exercise promotes sleep, but late-night exercise may interfere with falling asleep.
• Heavy meals before bed can disrupt sleep, whereas a balanced diet supports good sleep hygiene.

Assessing Sleep

• Sources of sleep information include patients, family members, and sleep partners.
• Assessment tools are sleep diaries, bedroom environment evaluations, and routine tracking.
• Intervention strategies include improving sleep hygiene, treating underlying illnesses, adjusting medications, and behavioral therapy.

Fluid & Electrolyte Balance

Body Fluid Locations

• Intracellular Fluid (ICF) is inside cells, making up about 2/3 of total body water.
• Extracellular Fluid (ECF) is outside cells and includes interstitial fluid (between cells) and intravascular fluid (plasma).
• Transcellular Fluid includes specialized fluids like cerebrospinal, pleural, peritoneal, and synovial fluid.

Components of Bodily Fluids

• Bodily fluids contain electrolytes (sodium, potassium, calcium, chloride), proteins (albumin, globulins), glucose, gases (O2, CO2), and hormones.

Third Spacing

• Third spacing is fluid accumulation in areas where it's not easily exchanged, such as ascites or edema in burns/trauma.

Cell Response to Solutions

• In a hypertonic solution, the cell shrinks because water moves out due to a higher solute concentration outside.
• In a hypotonic solution, the cell swells because water moves in due to a lower solute concentration outside.

Fluid Intake & Output

• Fluid intake comes from drinking fluids, eating food, IV fluids, and enteral feeding.
• Fluid output occurs through urine, sweat, feces, breathing (insensible loss), vomiting, and drainage.

Electrolyte Imbalances

• Hypernatremia is high sodium levels (>145 mEq/L), with symptoms including thirst and confusion.
• Hyponatremia is low sodium levels (
• Hyperchloremia means increased Chloride levels (> 106 mEq/L) Signs & Symptoms may include:
• Hypervolemia
• Hypernatremia
• Metabolic Acidosis
• Deep Rapid Breathing
• Hypocholremia means decreased Chloride levels (96 mEq/L) Signs & Symptoms may include:
• Hypovolemia
• Hypokalemia
• Metabolic Alkolosis
• Muscle Weakness & Spasms
• Hypercalcemia means elevated Calcium levels. (>5 mEq/L). Signs & Symptoms may include:
• Fatigue
• Weakness
• Lethargy
• Constipation
• Nausea & Vomiting
• Hypocalcemia means decreased Calcium levels ( 4.5 mEq/L) and symptoms include muscle weakness and arrhythmias.
• Hyperkalemia means increased Potassium levels. (>5.0 mEq/L). Signs & Symptoms may include:
• Arrhythmias
• Muscle Weakness
• Tingling and Numbness
• Hypokalemia means decreased Potassium levels, (<3.5 mEq/L) Signs & Symptoms may include:
• Arrhythmias
• Muscle Weakness
• Fatigue
• Cramping