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Human Systems > Stress > Flashcards

Stress Flashcards

1
Q

What are the definitions of stress

A

To emphasise certain words in speech​

A force applied to a body causing deformation or strain​

emotional or mental pressure

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2
Q

What can be classed as stressors

A

PHYSICAL

Injury, surgery
Infection, shock
Pain
Exposure to cold
Sustained exercise​

THREATS

Imprisonment, torture
Exams …

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3
Q

What body systems interact to cause stress

A

Nervous
Endocrine
Immune

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4
Q

What do the effects of stress depend on

A

Duration and severity of the stressor
The effectiveness of any responses

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5
Q

What are the stages of stress

A

Alarm reaction
Resistance phase
Exhaustion phase

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6
Q

What is the name of the stages in stress

A

The General Adaption Syndrome

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7
Q

What does the alarm reaction involve

A

Fight, flight, fright response

Physiological effects

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8
Q

What is the resistance phase

A

Adapting to stressor

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9
Q

What does the exhuastion phase refer to

A

Severe, persistent stress​

Responses futile; systems fail​

Pathological effects

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10
Q

What components are responsible for producing the alarm reaction

A

Neural: Sympathetic nervous system​

Hormonal: adrenal glands:​

Adrenaline (adrenal medulla)​

Corticosteroids (adrenal cortex)

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11
Q

What affects on the cardiac and metabolic systems does the alarm reaction cause

A

Increased cardiac output​
-increase HR, increase ventricular contractility​

Redistribution of cardiac output​
-increase flow to muscle; decrease flow to gut, kidney​

Metabolic​
-Glycogen breakdown - glucose release​
-Mobilisation of fat stores (release of free fatty acids)​

Stimulation of adrenaline release

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12
Q

Why is adrenaline released in the alarm stress reaction

A

Adrenaline release augments and prolongs the action of the sympathetic nerves:​
-Increased cardiac output​
-Redistribution of cardiac output​
-Metabolic effects

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13
Q

What hormones are involved in the alarm reaction

A

Adrenaline
Glucocorticoids (cortisol)

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14
Q

What is the main ‘stress hormone’

A

Cortisol

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15
Q

Why may cortisol have harmful effects

A

If secretions are persistently high

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16
Q

What are the actions of cortisol

A

Metabolic
-Increased energy production from glucose, amino acids and fats
-Increased protein breakdown

Enhances the actions of adrenaline​
-This is called a ‘permissive effect’

Anti-inflammatory actions​

Immunosuppression

17
Q

What happens under long term corticosteroid therapy

A

negative feedback on ACTH

down regulation in number of receptors

Leads to suppression of stress response

18
Q

What actions do glucocorticoids have on the immune response

A

Glucocorticoids have anti-inflammatory and immunosuppressant actions​

They can inhibit release of prostaglandins and leukotrienes​

They inhibit macrophages and helper T lymphocytes​

Many patients receive corticosteroid drug therapy​

Increased incidence of illness at times of stress

19
Q

When is corticosteroid therapy considered in dental practice

A

Some patients take corticosteroids as anti-inflammatory drugs (e.g. arthritis)​

Long-term corticosteroid therapy can disrupt the normal control mechanisms​

The drug will suppress CRH and ACTH release, and the natural stress response is suppressed​

Such individuals are at risk during surgical procedures, including dental extractions​

Another reason why the Medical History is so important

20
Q

What is the process of cortisol release

A

Stressor
Hypothalamus
CRH (corticotrophin RH)
Anterior pituitary
ACTH (adrenocorticotrophic hormone)
Adrenal cortex
Cortisol
Actions

21
Q

What is stress analgesia

A

Pain is dimished during physical stress e.g. sports, battle

22
Q

What causes stress analgesia

A

Due to release of endogenous opioid peptides, endorphins, enkephalins in the CNS​

These suppress nociception and pain – decreased perception of pain

23
Q

What factors increase stress in patients

A

Stress evident in anticipation of treatment​

Severity:​
-Oral Surgery > scaling​

Effects greater in anxious patients and even greater in ‘dental phobics’​

Pain increases the amount of stress​

Local anaesthesia is stressful​

Noise of dental instruments (e.g. drills) can contribute to the stress​

Masks and gowns add to the stress
-less human (power imbalance)

24
Q

Who is affected most by stress

A

Children

25
Q

What can the size of stress induced effects be

A

Range of changes:​
-Systolic BP + 5-20mmHg​
-Diastolic BP + 4-8mmHg​
-Heart rate up to +20​

One report of 2 patients who received painful treatment without LA:​
-SBP >210mmHg​
-DBP >115mmHg

26
Q

When might dentists experience stress

A

Oral surgery: tooth extraction:​
-Increased HR, BP​

Effects are greater:​
-When standing​
-With complex/difficult procedures​
-With anxious patients​
-When supervising a student’s first extraction

27
Q

What happens when stressors are constant

A

Either they ‘cope’ (Adaptation phase)

Or they don’t (Exhaustion phase)

28
Q

What brings about the adaption (resistance) stress phase

A

With persistent exposure to the stressor(s), an individual’s stress response diminishes​

The individual has ‘adapted’​

The stressor is no longer a ‘threat’​

The individual has become ‘resistant’ to the stressors​

This generally happens if the individual’s responses are effective in removing the stressor (or its perceived threat)

29
Q

What can happen if the acute stress response fails to diminish the stressor

A

Adrenal failure​

Immunosuppression​

Peptic ulcers​

CVS disease​

Death can result in extreme cases

30
Q

What are Type A and B individuals in relation to stress

A

Type ‘A’ individuals: hard-driving, competitive individuals are more prone to high blood pressure and CHD than:​

Type ‘B’ individuals, who tend to be more relaxed and less impatient

Human Systems (34 decks)

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