NCM 116 RLE 1 Psychologic/Emotional

Physiologic Stressors 
Stressors
Stress  Acute & chronic pain   Birth of child 
 Fatigue  Caregiving 
Stress – is a psychological and physiological reaction to an
 Trauma Injury  Change in health
event or condition that is considered a threat or challenge.
 Fever/Infection status 
 Normal response to a situation; “key for survival”  Chronic Illness  Death of close family
 Inadequate sleep member or friend
 Has a powerful effect on mind thus it has significant
 Inadequate nutrition  Diagnosis of terminal
effect of individual’s well-being
illness
 Important signals which tells us when its time to be  Divorce 
conscious, time to take a break, and evaluate our  Environmental
priorities emergencies 
 Also includes good and bad stress  Failing an examination 
 Finances
*Chronic Stress – major factor in causing and worsening  National Events
health chronic condition. And high level of stress are common  Loss of job 
to those patient and even in caregiver.  Marriage
 Moral distress
 How they deal with their stress is very critical in their
 Moving 
well-being
 Parenting 
Note: Nurses play a vital role which is the one who recognized  Politics
and manage their stressful events.  Physical disability 
 Relationship problems
Stressor - is a stimulus that causes stress. Any situations,  Social unrest 
events, or factors that produces or causes stress are  Spiritual distress
considered as stressors  Violence

Note: Every individual has different response to stress 3. Internal Stressors – comes from within the
person. (memory, sensation, or an emotion)
Sources of Stress:
4. External Stressors - comes from the environment and
1. Physiologic Stressors – This are stressors that put us on events taking place around us. (out of our control)
strain or it gives tension in our body. Have physical
causes. It originates as physiologically triggered usually Example:
associated with an injury or illness
Internal External
ex: pain, infection, starvation, illness or lack of sleep  Feelings (fear)  Loss of job 
 Unrealistic expectations  Loss of a loved one 
2. Psychologic Stressors – social and emotional factors,
 Negative self-talks  Overcrowding
events, situation. Normally encounter in everyday basis.
 Lifestyle choices  Confined Spaces 
And generates unpleasant arousal on a person.
(excessive caffeine &  Pollution
ex: academic pressure,  occupational pressure, financial alcohol or constant lack  Relationship/Financial
pressure, major life events (good or bad)  or of sleep) problems
bereavement.   Pain  Major life changes 
 Pressure from work
/family
 Daily hassles 

Other Example:  Is Stress Good or Bad? 

 In some, stress are threat in our health. But any • Pulse rate increases
events or situation which is out in ordinary can be a stressor. Physiologic  • Blood pressure
It also includes events which is normally happy and enjoyable. increases
Our body cannot distinguish whether this stress are bad or When the stress is • Breathing is rapid,
good. prolonged it can shallow
lead in harmful • Blood thickens
Stress response is a way our body reacts both
disease. Long • Dizziness, sweaty
physically and emotionally.
exposure to palms
Stress can also be helpful. Mild or little stress can caticolanids from • Headache
motivate and inspire us to do better. the excessive • Pupils dilate
symphathetic • Nausea, change in
nervous activity appetite
Types of Stress in terms of outcomes: 
(increase risk for • Constipation or
1. Eustress - describes a type of stress resulting in positive CVD) diarrhea
outcomes. (motivates) • Increased urination
Stress also affect • Twitching, trembling
2. Distress - describes a type of stress resulting in negative • Increased level of
the control of
outcomes. blood glucose and
metabolism
cortisol
Other Types of Stress:  • Irritability
Psychologic • Feelings easily hurt 
1. Acute Stress – sudden & occurs for a short period
• Sadness, depression
of time. Results from body reaction to a new or
Also susceptible in • Feelings of pleasure
challenging situation
infection    and accomplishment
 Symptoms doesn’t last long. Sweating, headache,    reduced 
stomach pain, rapid heartbeat, and irritability.
• Impaired memory
2. Episodic Acute Stress - occurs on a frequent basis.     and judgment 
• Confusion, unable to
 Repeated type of events, frequent high stress    concentrate 
situation Cognitive • Poor decision making
 People worry constantly are prone in experiencing • Altered perceptions,
this type of stress    delayed response
 Symptoms are similar with acute but often and • Distressing dreams
accumulates. • Sleep disturbances

3. Chronic Stress - occurs for a long period of time.  • Pacing, rapid speech 

• Insomnia 
 Feels like never ending. Difficulty seeing any ways
• Withdrawal
to cope and manage the situation. Often
• Easily startled 
associated with loss of hope
• Alienation, social
 Can result in mental fatigue or burnout. Gastro Behavioral
   isolation 
and cardiovascular diseases
• Becoming quiet 
 Caused abuse, poverty, poor work environment
• Changing eating habits
Note: Both acute and chronic can cause immunosuppression • Drinking alcohol
(decreasing or intentionally declining of immune system)    excessively
which increases the risk in worsening or progression of the
immune related disease.

What are the Signs & Symptoms of Stress?

 Note: It is important to use holistic approach in handling a
stressful client

Four Key Personal Characteristics that Buffer the Effects of

Stress:

 Resilience – resourceful, flexible and good problem-

solving skills. They are not likely to perceived the
situation as stress

 Hardiness - commitment, control & openness to

change. Ability to endure difficult conditions. It
provides courage and motivation needed

 Attitude - positive attitude. Used the situation

Example:
differently to those with negative attitude.
Common Disorders with a Stress Component: Influences how they manage stress.

• Depression  Optimism - is a mental attitude characterized by

• Dyspepsia hope and confidence in success and a positive
future. Cope more effectively. Always look in a
• Eating disorders
brighter side. Tend to recover quickly.
• Erectile dysfunction
• Fatigue
• Fibromyalgia
Mind-Body-Spirit Connection:
• Headaches
• Hypertension
• Insomnia
• Irritable bowel syndrome
• Low back pain
• Menstrual irregularities
• Peptic ulcer disease
• Sexual dysfunction 

Factors Affecting Person's Response to Stress:

Example:

Internal External
• Age • Cultural and ethnic
• Health status  influences 
• Personality characteristics  • Socioeconomic status 
• Previous experience with • Social support 
stressors  • Religious or spiritual
• Genetic background  influences 
• Resilience  • Timing of stressors 
• Hardiness  • Number of stressors
• Attitude  already experiencing
• Optimistic outlook 
• Nutritional status 
• Sleep status
Coping  Perceived Stress Scale: Is used to measure person’s
perception of stress, Assessing the number of stressors,
 is a person’s efforts to manage stressors.
duration of stressors, prior similar stressors. Assessing the
 positive & negative coping. personal meaning attached to the stressful situation (provide
useful insight in management). Also the response.

2 Broad Categories of Coping:

1. Emotion-focused coping – managing the emotions. (what

they feel during stressful events)

2. Problem-focused coping – attempts to resolve the

problems causing the stress.

Problem-Focused Emotion-Focused
Stressor
Coping Coping
Failing an Obtaining a tutor Going for a run 
examination 
Being diagnosed Attending Getting a massage
with diabetes  education classes
about diabetes
Personal Tips for Handling Stress:
Receiving Scheduling follow- Expressing
questionable up testing for feelings of anxiety  Do not try to be superhuman. 
mammogram ultrasound to friends and
results  nurse  Learn to “let go” of things that are outside of your
control. 

 Learn acceptance of yourself. 

Relaxation Strategies:
 Exercise regularly. 
 Biofeedback
 Share your feelings. 
 Imagery
 Keep a sense of humor; laugh often. 
 Massage 
 Learn relaxation breathing. 
 Meditation / Praying
 Use imagery. 
 Muscle relaxation
 Meditate or pray. 
 Music 
 Get adequate sleep. 
 Qigong
 Live a healthy lifestyle (includes healthy nutrition)
 Relaxing breathing
 Try to look at change as a positive challenge, not as a
 Tai Chi threat. 

 Yoga  Solve the little problems, since this can help you gain
a feeling of control. 
*Regular used of this relaxation strategies is an effective
treatment for a wide range of stress related disorders.  Work to resolve conflicts with other people. 
Increased sense of control
 If needed, get professional counseling. 
*first step in managing stress is to become aware for its
presence
How to Implement Stress Management in Practice:

1. Learn relaxation breathing. It is the easiest method

of relaxation to use. 
2. Practice teaching relaxation breathing with peers,
then patients.
3. Pick coping strategies, and relaxation strategies
that are appropriate for your clinical area.
4. Practice using the strategy yourself. It becomes
easier with time. 
5. Take advantage of opportunities to teach coping and
relaxation strategies to patients.
6. If you have setbacks, think about what went wrong.
Do NOT quit!
7. Attend seminars and workshops on stress
management to learn more. 

COPING STRATEGIES: