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NURSING FOUNDATIONS II
~ STRESS AND ADAPTATION ~

COMMON STRESS-ASSOCIATED DISEASES

Diminished immunity Anxiety
Headache Depression
Fatigue Alcoholism
Weight gain Substance abuse
Dyslipidemia Insomnia
Hypertension Irritable bowel syndrome
Heart disease Fibromyalgia
Psoriasis-eczema Decreased sex drive
Digestive problems

How high stress can cause disease:

Stress  Biological Impact  Chronic Stress  Chronic Inflammatory Response

OVERVIEW OF TERMINOLOGY
• Stress – a state of disharmony, threat to homeostasis
o Physiological changes increase alertness, focus, and energy
o Perceived demands may exceed the perceived resources
• Coping – ability to maintain control, think rationally, and problem solve
• Resilience – resistant quality that permits a person to recover quickly and thrive in spite of adversity

WHAT IS STRESS?
• Our mental, physical, emotional, and behavioral reactions to any perceived demands or threats

FIGHT OR FLIGHT RESPONSE

• When situations seem threatening, our bodies react quickly to supply protection by preparing to act.
• Reactivity – physiological response to a stressor
o Physiological responses can accumulate and result in long-term wear on the body

WHAT MAKES SOMETHING STRESSFUL?

• Situations that have strong demands
• Situations that are imminent
• Life transitions
• Timing (Deviation from the norm)
• Ambiguity
• Desirability
• Controllability

TYPES OF STRESS
• Eustress – manageable stress, can lead to growth and enhanced competence
• Distress – uncontrollable, prolonged, overwhelming stress that is destructive
• Acute stress – immediate response to a threat or challenge
• Chronic stress – ongoing exposure to stress, may seem unrelenting

CAUSES OF STRESS
External Internal
Family, work, economics, work, school, major life changes, Worry, uncertainty, fear, attitudes, unrealistic expectations
unforeseen events, etc. (Can be brought upon by the illness that the person has)

SOURCES OF CLINICAL STRESS

For Patients For Nurses
Uncertainty, fear, pain, cost, lack of knowledge, risk for harm, Poor patient outcomes, risk for making an error, unfamiliar
unknown resources situations, excessive workload, inadequate resources

VULNERABILITY TO STRESS
• Some people are more vulnerable to stress than others

WHY DO WE STRESS OUT?

1. We perceive something as dangerous, difficult, or painful
 2. We don’t believe we have the resources to cope

STRESS WARNING SIGNALS

• What are your red flags or warning signs?
o Worried, agitated, tapping of foot, etc.

STAGES OF THE STRESS RESPONSE

By Hans Selye (General Adaptation Syndrome)

1. Alarm – when one feels threatened

a. Activation of the fight or flight reaction
2. Resistance – mobilization of resources to solve the problems
a. Continued stress causes adaptation
3. Exhaustion – adaptation fails and level of function decreases

ALARM – Activation of hypothalamic pituitary adrenal axis

Physiologic Effects
Catecholamines Cortical Steroids
• Increase CO • Elevate glucose
• Dilate airway • Increase AA
• Dilate pupil • Increase NA resorption
• Mobilize glucose • Increase ECF volume
• Cause vasomotor changes • Inhibit histamine and bradykinin
• Decrease digestions • Suppress immune response
• Enhance coagulation

RESISTANCE
• Adaptation occurs
o Activation of hypothalamic pituitary adrenal axis continues
• The stressor may be resolved
o The body returns to homeostasis
• May progress to exhaustion
o Stress continues as resources are depleted

EXHAUSTION
• Occurs when demands of stress exceeds ability to adapt
• Functioning declines
• May result in health problems
o Physical symptoms
o Mental symptoms

BIOBEHAVIORAL CHANGES IN STRESS

• What behavioral changes occur?
o Irritability, apathy, worrying, anger, silence, distracted

STRESS AND WEIGHT STATUS

NUERO-ENDOCRINE RESPONSES TO STRESS (Copy from Jil’s PPT)

The Brain
• Hippocampus (sounds the stress alarm)
• Cerebellum (body movement coordination)
• Pons (Sleep)
• Medulla Oblongata (heartbeat and respiration)

STRESS AND ITS PATHWAYS

• The hypothalamus activates the following under a stress response:
o ANS
 Immediate fight or flight
 Hormone balance/body temp/blood vessel width
o Endocrine
 Short-term and long-term response
 Hormones that regulate physiological functions
STRESS RESPONSE
• Operates via two interrelated systems:
o SAM (Sympathetic-adrenomedullary)
o HPA (Hypothalamic-pituitary-adrenocortical)
o Balances each other
o Both are triggered by the hypothalamus

FUNCTION
• Normal homeostasis (body temp, etc.) is maintained w/in relatively narrow limits
• By contrast, stress response maintains homeostasis over a far wider range of adaptive circumstances, and in responding
to challenges
• Allostasis
o Maintain stress and adaptive responses over long term, implies high levels of activation of the homeostatic
processes
 o Causes wear and tear, called “allostatic load”

NOTIONAL MODEL OF EMOTIONS THAT ARISE FROM THE BALANCE BETWEEN LEVEL OF CHALLENEGE AND A PERSON’S
COPING ABILITY