S T R E S S

Michael Emman D. Orbe, RN

 STRESS
 A disruptive condition that
occurs in response to adverse
influences from the internal or
external environments
 Is a non-specific response of the
body to any demand placed
upon it. (By Hans Selye)
General Adaptation Syndrome
(GAS)
 Enlargement of the following
organs:
 Adrenal cortex, shrinkage of the
thymus, spleen, lymph nodes,
and other lymphatic system
 Deep bleeding ulcer in the
stomach and duodenum
 PHASES of
GENERAL ADAPTATION
SYNDROME (GAS)
 Alarm
 When we are surprised or threatened, we
have an immediate physical reaction, often
called the Fight-or-Flight reaction.
 This prepares the body for life-threatening
situations, channeling away resources
 The digestive and immune system to more
immediate muscular and emotional needs..
Physical Changes
Fight or flight effects include
 Our senses sharpening. Pupils
dilate (open out) so we can see
more clearly, even in darkness.
Our hairs stand on end, making
us more sensitive to our
environment (and also making
us appear larger, hopefully
intimidating our opponent).
 The cardio-vascular system
leaping into action, with the
heart pump rate going from one
up to five gallons per minutes
and our arteries constricting to
maximize pressure around the
system while the veins open
out to ease return of blood to
the heart.
 The respiratory system joining in
as the lungs, throat and
nostrils open up and
breathing speeding up to get
more air in the system so the
increased blood flow can be
re-oxygenated
 The blood carries oxygen to the
muscles, allowing them to work
harder. Deeper breathing also
helps us to scream more loudly!
 Fat from fatty cells and
glucose from the liver being
metabolized to create instant
energy.
 Blood vessels to the kidney and
digestive system being
constricted, effectively shutting
down systems that are not
essential
 reduction of saliva in the
mouth.
 The bowels and bladder may
also open out to reduce the
need for other internal actions
 Endorphins, which are the
body's natural pain killers, are
released (when you are fighting,
you do not want be bothered
with pain–-that can be put off
until later.)
 The natural judgment system
is also turned down and more
primitive responses take over–
this is a time for action rather
than deep thought.
 Sweat glands also open,
providing an external cooling
liquid to our over-worked
system. (this makes the skin
look pale and clammy).
 Resistance
 As we become used to the stress levels
 we initially become more resistance to
disease, which leads us to believe we
can easily adapt to these more stressful
situations
 However, this is only the immune system
fighting to keep up with demands and
expectations, but requires it to work at
abnormally high levels.
 Exhaustion
 Our bodies give up on trying to
maintain a high level of stress.
Parts of the body literally start to
break down and we become
very unwell
 Local Adaptation Syndrome
 Small and Topical injuries
 Inflammatory response
 Repair processes
 General Adaptation Syndrome
 Involves two (2) body systems:
 Nervous System
 Endocrine System
 Nervous System involves:
 Sympathetic Nervous System
 Parasympathetic Nervous
system
 Endocrine System involves:
 Adrenal Glands
 The Adrenal Gland is
composed of:
 Adrenal Medulla
 Adrenal Cortex
 Adrenal Medulla releases
Adrenaline or Fight or Flight
Hormones:
 Epinephrine
 Norepinephrine
 Effects of Adrenaline
 Increases Cardiac Rate
 Response to increased
metabolic rate and oxygen
demand
 Increases Respiratory Rate
 Response to increased
metabolic rate and oxygen
demand
 Bronchodilation
 Vasoconstriction
 Increased Peripheral Resistance
 Increased Cardiac Workload
 Increased Blood Pressure
 Decreased Renal Perfusion
 Decreased Renal Output
 Pale, Cool, Clammy Skin
Adrenal Gland is composed of:
 1. Adrenal Medulla
 Releases adrenalins
 2. Adrenal Cortex
 Releases the following:
 Mineralocorticoids
 Aldosterone

 Glucocorticoids
 Cortisol
 A potent vasoconstrictor
 Mineralocorticoids
 Increased Aldosterone levels
 Increases sodium retention and
water retention
 Increases circulating blood
volume
 Increases cardiac workload (due
to vasoconstriction)
 Glucocorticoids
 Increased hyperglycemia
(transient)
 Increased glycogenolysis
 Increased neogenesis
 Increases blood sugar
 Increases osmotic pressure
 Increases fluid retention
(glucose is a colloid which
attracts water and adheres to it)
 Increases cardiac workload
 Concept:
 Complications of Stress:
 Cerebrovascular Attack
 Increased Diabetic Ketoacidosis
(if patient is diabetic)
 Hypertension leading to cardiac
arrest
 Local Adaptation Syndrome
 Also known as non-specific inflammatory
response
 Bradykinin
 Activates inflammatory response
 Activates histamine

 Histamine
 Activates the following:
 Prostaglandin
 Serotonin

 Concept:
 Bradykinin, Histamine, Prostaglandin, and
Serotonin all increase swelling
 Key Concept!
 Hans Selye
 Author of Physiologic Response to Stress
 Lazarus
 Stress is a transaction
 Stress resulted from interaction of man
with his environment and fellowman
 Therefore, Lazarus describes the
SOCIAL ASPECT OF STRESS
 Also an adopted PHYSIOLOGIC
RESPONSE
 Key Concept!
 The most comprehensive concept of
stress is the stress concept of
LAZARUS as it combines Physiologic
and Social aspects of stress.
 Statements about Stress
 Stress is NOT a nervous energy
 Man, whenever he encounters
stress, tends to adopt
 Are you going around all stress?
ANSWER IS NO!!! because
stress is not always to be
avoided and stress is not always
undesirable
 Stress may lead to another
stress
 A single stress does not lead to
a disease
 Concepts:
 Adaptation to stress comprises
of adjustments made in order to
cope with a stressor
 Concepts:
 Adaptation to stress comprises
of adjustments made in order to
cope with a stressor
 Man is holistic in his adaptation
to stress
 It involves the totality of man:
 Physiologic

 Psychologic

 Social
Indicators of Stress
 Restlessness, Depression, Dry
mouth, Fatigue, Loss of interest
in daily activities, Hyperactivity,
Nausea and vomiting, change in
appetite, tremors.
 Difficulty of sleeping, Excessive
perspiration, increased of
tobacco consumption.
 Headache, Diarrhea,
Nursing Implication

 Identification of both physiologic

and psychological stressors.
 STRESS Management
Nursing Intervention
 Promoting a healthy lifestyle
 Enhancing coping strategies
 Teaching relaxation technique
 Educating about stress management
 Enhancing Social support
 Recommending support and therapy
group
 “GOOD LUCK!!!!!
FUTURE NURSE’S”