Personal definition

What is Stress?

Stress and Adaptation 

STRESS  A condition in which the person responds to changes in the normal balanced state  Selye: non specific response of the body to any kind of demand made upon it 

Any event ² environmental / internal demands or both tax or exceed the adaptive resources of an individual, social system or tissue systems

Stress and Adaptation 


Any event or stimulus that causes an individual to experience stress 

They may neither positive or negative, but they negative, have positive or negative effects 

Stressor (illness, hormonal change,

fear)  External Stressor (loud noise, cold temperature)  Developmental Stressor  Situational Stressor

.Stress and Adaptation  COPINGCOPING- a problem solving process that the person uses to manage the stresses or events with which he/she is presented.

It is a change that results from response to stress. .Stress and Adaptation  ADAPTATIONADAPTATION- the process by which human system modifies itself to conform to the environment.

Stress and Adaptation SOURCES OF STRESS 1. Developmental 4. Situational . Internal 2. External 3.

 It is not a nervous energy.Stress Characteristics It is a universal phenomenon.  It provides stimulus for growth and change.  It affects all dimension of life.  .  It is an individual experience.

affects physiologic homeostasis EmotionalEmotional.influences perception and problem solving abilities Social ² can alter relationships with others SpiritualSpiritual.Effects of Stress on the Body      PhysicalPhysical.affects one·s beliefs and values .affects feeling towards self IntellectualIntellectual.

Effects of Stress on the Body      Metabolic Disorders  Hyper/hypothyroidism  Diabetes Cancer Accident proneness Skin disorders  Eczema  Pruritus  Urticaria  Psoriasis Respiratory disorders  Asthma  Hay fever  Tuberculosis     CVD  Coronary artery disease  Essential hypertension  CHF GIT disorders  Constipation  Diarrhea  Duodenal ulcer  Anorexia nervosa  Obesity  Ulcerative colitis Menstrual irregularities Musculoskeletal disorders  RA  LBP  Migraine Headache  Muscle tension .


. Models of Stress STIMULUS based models RESPONSE based models TRANSACTION based models 2. 3.Stress and Adaptation 1.

Focus: disturbing events within the environment .Stress as a Stimulus   Holmes and Rahe 1967: They studied the relationship between specific life changes such as divorce or death. and the subsequent onset of illness.

affective. The person responds to perceived environmental changes by coping mechanisms. as well as in their interpretations & reactions  .Stress as a Transaction  The transactional stress theory includes cognitive. Transactional theory of stress emphasizes that people & groups differ in their sensitivity & vulnerability to certain types of events. and adaptive responses from person and environment interaction.

Stress As a Response    Disruptions caused by harmful stimulus or stressors Specifies particular response or pattern of responses that may indicate a stressor Selye (1976): developed models of stress. that defines stress as a non-specific nonresponse of the body to any demand made on it .

Stress As a Response    Focus: reactions of the BODY Selye used the term ´stressor· as the stimulus or agents that evokes a stress response in the person . . A stressor may be anything that places a demand on the person for change or adaptation.

Stress As a Response Hans Selye (1976) ´ non-specific response of nonthe body to any kind of demand made upon it He called it ´non-specificµ because the body ´nongoes through a number of biochemical changes and re-adjustments without regard reto the nature of the stress producing agents.  Any type of stressor may produce the same responses in the human body  .

determines physiological response to stress Disadvantage: does not consider individual differences in response pattern  .Stress As a Response  Advantage : response to stress is purely physiologic.

Local Adaptation Syndrome . General Adaptation Syndrome 2.Stress as a response SELYE proposed two Stress adaptation responses 1.

and Endocrine System Occurs with the release of adaptive hormones and subsequent changes in the WHOLE body .General Adaptation Syndrome    Physiologic responses of the whole body to stressors Involves the Autonomic Nervous System.

General Adaptation Syndrome Three stages adaptation to stress for both GAS/LAS: Stressor Alarm reaction Shock phase Epinephrine Cortisone Countershock Phase Normal state Stages of resistance Stages of exhaustion Rest Death .

´ fight OR flightµ responses  Mobilizing of the defense mechanisms of the body and mind to cope with stressors.the autonomic nervous system PHASEreacts. release of Epinephrine and Cortisol  COUNTERSHOCK PHASE.General Adaptation Syndrome I. ALARM REACTION  Initial reaction of the body.reversal of the PHASEchanges produced in the shock phase .  SHOCK PHASE.

Long-term terminal illness. and Longcontinuous blood loss) . heart rate. thus resolving and repairing body damage. blood pressure and cardiac output return to normal 2 things may occur:  Either the person successfully adapts to the stressors and returns to normal. mental illness. or  The stressor remains present. STAGE OF RESISTANCE:  The BODY stabilizes. and adaptation fails (ex. hormonal levels return to normal.General Adaptation Syndrome II.

. STAGE OF EXHAUSTION:  Occurs when the body can no longer resist stress and body energy is depleted.General Adaptation Syndrome III.  Body may not be able to defend self that may end to death.  The body·s energy level is compromised and adaptation diminishes.

Stress and Adaptation A-R-E ALARM: sympathetic system is mobilized! RESISTANCE: adaptation takes place EXHAUSTION: adaptation cannot be EXHAUSTION: maintained .

GAS Hypothalamus Anterior Pituitary Gland Adrenal Gland Adrenal Cortex Adrenal medulla .



Adrenal gland .

Adrenal Gland .

Adrenal Gland .

Hormonal Changes Adrenal Cortex  Adrenal Medulla  MINERALOCORTICOIDS  Aldosterone  Na+ retention  WATER retention  Protein anabolism GLUCOCORTICOIDS  Cortisol  (Anti-inflammatory) (Anti Protein catabolism  Gluconeogenesis  NOREPINEPHRINE  Peripheral vasoconstriction  Decreased blood to kidney  Increased renin (angiotensin) EPINEPHRINE  Tachycardia  Increased myocardial activity  Increased Bronchial dilatation  Increased Blood clotting  Increased Metabolism  Increased Fat Metabolism  .

response to pressure Adaptive: a stressor is necessary to stimulate it ShortShort. vision. blood clotting. Wound healing.Local Adaptation Syndrome     Localized responses to stress Ex.term Restorative: assist in homeostasis .

a sensory serve to the spinal cord. Inflammatory Response:  Stimulated by trauma or infection. thus preventing it to spread. also promotes healing  Pain. etc. heat. effector·s muscles. redness. Example: unconscious removal of hand from a hot surface. sneezing. swelling . motor nerve.Local Adaptation Syndrome Reflex Pain response:  Localized response of the CNS to pain  Adaptive response and protects tissue from further damage  Involves a sensory receptor. a connector neuron.

Sex Nature of Stressors Physiological functioning Personality Behavioral Characteristics Level of personal control Availability of support system  Feelings of competence  Cognitive appraisal.FACTORS INFLUENCING RESPONSE TO STRESS       Age. Economic Status  .

The MANIFESTATIONS OF STRESS INDICATORS OF STRESS  Physiologic  Psychological  Cognitive  Verbal-Motor Verbal- .

Physiological Indicators 

Dilated pupils Diaphoresis Tachycardia, tachypnea, HYPERTENSION, increased blood flow to the muscles Increased blood clotting Bronchodilation Skin pallor Water retention, Sodium retention Oliguria Dry mouth, decrease peristalsis Hyperglycemia

Remember these Physiologic Manifestations of Stress 

Pupils dilate to increase visual perception when serious threats to the body arise Sweat production (diaphoresis) increases to control elevated body heat due to increased metabolism 

Remember these Physiologic Manifestations of Stress 

Heart rate or pulse rate increases to transport nutrients & byproducts of metabolism more effectively Skin becomes pale (Pallor) because of constriction of peripheral blood vessels to shunt blood to the vital organs. 

Remember these Physiologic Manifestations of Stress 

BP increases due to vasoconstriction of vessels in blood reservoir (skin, kidneys, lungs), due to secretion of renin, Angiotensin I and II Increased rate/depth of respiration with dilation of bronchioles, promoting hyperventilation and increased oxygen uptake 

urine output may decrease.Remember these Physiologic Manifestations of Stress  Mouth may become dry. The peristalsis of the intestines decreases leading to constipation For serious threats. there is improved mental alertness  .

Remember these Physiologic Manifestations of Stress  Increased muscle tension to prepare for rapid motor activity/defense Increased blood sugar (glucocorticoids & gluconeogenesis) to supply energy source to the body.  .

Psychological indicators  This includes anxiety. fear. anger. depression and unconscious ego defense mechanisms .

or unconscious levels  Occurs . or helplessness. subconscious.Anxiety A state of mental uneasiness. apprehension. related to anticipated unidentified stress in the Conscious.

Levels of Anxiety 4 Levels of Anxiety:  Mild  Moderate  Severe  Panic .

increased alertness. selective inattention and physical discomfort . motivation and attentiveness  ModerateModerate.Levels of Anxiety  MildMild.perception narrowed.

very narrow focus on specific details. PanicPanic.overwhelmed.behaviors become automatic. loss of strong displeasure  . with possible bodily harm to self and others.Levels of Anxiety  SevereSevere. senses are drastically reduced. details are not seen. unable to function or to communicate. impaired learning ability.

Anxiety .

choking. chest Hyperventil pain ation . .ANXIETY CATEGORY MILD Increased arousal Increased questioning MODERATE SEVERE PANIC Inability to focus Difficult to understand Easily distracted Perception and attention Communication Narrowed focus Voice tremors Focus on particular object Slight Increase Distorted perception Trembling unpredictable response VS changes NONE Tachycardia Palpitation.

. The Object of fear may or may not be based on reality.Fear   It is a mild to severe feeling of apprehension about some perceived threat.

Anxiety versus fear ANXIETY FEAR State of mental Emotion of apprehension uneasiness Source may not be Source is identifiable identifiable Related to the future Related to the present Vague Result of psychological or emotional conflict Definite Result of discrete physical or psychological entity. definite and concrete events .

Anger   Subjective feeling of strong displeasure It is an emotional state consisting of subjective feeling of animosity or strong displeasure .

Depression Emotional Symptoms:    Behavioral signs:    Tiredness emptiness numbness loss of appetite weight loss constipation headache dizziness Physical signs          irritability inability to concentrate difficulty making decision loss of sexual desire crying sleep disturbance social withdrawal .

Unconscious Ego defense mechanism   These are PSYCHOLOGIC adaptive mechanisms Mental mechanisms that develop as the personality attempts to DEFEND itself. establishes compromises among conflicting impulses and allays inner tensions .

Unconscious Ego defense mechanism   The unconscious mind working to protect the person from anxiety Releases tension .

self control. prayer. suppression and fantasy Thinking responses of the individual toward stress  . structuring.COGNITIVE MANIFESTATIONS  Thinking responses that include problem solving.

COGNITIVE MANIFESTATIONS  PROBLEM SOLVING: Use of specific steps to arrive at a solution STRUCTURING: manipulation of a situation so that threatening events do not occur  .

COGNITIVE MANIFESTATIONS  SELF CONTROL / DISCIPLINE: assuming a sense of being in control or in charge of whatever situation SUPPRESSION: willfully putting a thought / feeling out of one·s mind  .

description of the problem. suggestion of solution. then reaching out for help or support to the supreme being  .COGNITIVE MANIFESTATIONS  FANTASY / DAYDREAMING: ´ make believeµ or imagination of unfulfilled wishes as fulfilled PRAYER: identification.

VERBAL / MOTOR MANIFESTATIONS  First hand responses to stress .

VERBAL / MOTOR MANIFESTATIONS  CRYING: feelings of pain. joy. and stress producing events LAUGHING: anxiety reducing response that leads to constructive problem solving   . sadness are released VERBAL ABUSE: release mechanism toward non living objects.

painful or sad events   .VERBAL / MOTOR MANIFESTATIONS  SCREAMING: response to fear or intense frustration and anger HITTING AND KICKING: spontaneous response to physical threats or frustrations HOLDING AND TOUCHING: responses to joyful.


COPING A problem solving process or strategy that the person uses to manage the out-of-ordinary events out-ofor situations with which he/she is presented.  Successfully dealing with problems .

Coping related terms   Adaptive coping.results in copingunnecessary distress for the person and stressful events .helps person copingdeal effectively with stress Maladaptive coping.

Physiologic mode (biologic adaptation)  Occurs in response to increased or altered demands placed on the body & results in compensatory physical changes. Socio-cultural Mode Socio .MODES OF ADAPTATION 1. (Ex. conversions. & beliefs of various groups (leaving in new country) 2. Psychological Mode  3. Involves a change in attitude & behavior toward emotionally stressful situations. Stopping smoking) Changing persons behavior in accordance with the norms.

CHARACTERISTICS OF ADAPTIVE RESPONSES       All attempts to maintain homeostasis Whole body or total organism response Have limits (Physiologic. Psychologic/Social) Requires time Varies from person to person Maybe inadequate or excessive (infection/allergy .

MANIFESTATIONS OF ALTERED COPING  Addictive behaviors  Physical illness  Anxiety and depression  Violent behaviors .

Applying the Nursing Process      A D P I E .

Physical dataassessment. Objective data. Utilize the Nursing History  Subjective data. Diagnostic tests and procedures 3. Physical Examination ² centered on the changes in the ANS and NES. 2.Assessment 1. Laboratory Examination .such as the functional pattern. datarisk pattern and dysfunctional pattern.

Ineffective Denial 5. Impaired adjustment 3. Post-trauma Syn Post6.Diagnoses Utilize those accepted by NANDA 1. Caregiver role strain 8. Anxiety 7. Ineffective coping 4. Disabled Family coping 12. Defensive coping 11. Decisional conflict 10. Relocation Stress Syn . Fear 2. Compromised family coping 9.

The nurse must choose goals geared :  To eliminate as many stressors as possible  To teach about the effects of stress to the body  To teach how to cope with stress  To teach on how to adjust to stress .Planning There are four important guidelines to be followed in choosing nursing goals.

Planning Examples of Patient outcome criteria are: After 3 hours/ 4days: 1. The patient will identify sources of stress in his/her life 2. The patient will identify usual personal coping strategies for stressful situations 3. The patient will define the effect of stress and coping strategies on activities of daily living .

Implementation There are essentially three ways to manage Stress:  Eliminate the causes/sources of stress  Produce a relaxation response in the body  Suggest a change in lifestyle. if possible .

creative imagery. time management. YOGA  Communication. Problem Solving Techniques . Breathing exercises. physical activity & recreation  Meditation. organizing time  Biofeedback  Therapeutic touch  Relaxation response . expression of feeling.Implementation Stress reduction techniques:  Proper nutrition  Regular exercise. talking it out.

Implementation Minimize anxiety  Support the client and the family  Orient the client to the hospital  Give the client in a hospital some way of maintaining identity. .  Provide information when the client has insufficient information.

friction. pressure. vibration and percussion. petrissage (kneading or large.Implementation Massage  These include effleurage (stroking). quick pinches of the skin.  Purposes -enhances or induces relaxation before sleep  -stimulates skin circulation   Duration: 5-20 minutes 5- . subcutaneous tissue and muscle).

Implementation Progressive Relaxation  Jacobson (1930). the originator of the Progressive relaxation technique .

furry cat . Example: Visual -A valley scene with its many greens Auditory -Ocean waves breaking rhythmically Olfactory -Freshly baked bread Gustatory -A Juicy hamburger TactileTactile-proprioceptive -Stroking a soft.Implementation Guided Imagery  Imagery is "the formation of a mental representation of an object that is usually only perceived through the senses" (Sodergren 1985). 1985).

muscle tension.Implementation  Biofeedback is a technique that brings under conscious control bodily processes normally thought to be beyond voluntary command. heartbeat. blood flow. & skin temperature ² can be voluntarily controlled feedback provided through:  a. peristalsis. temperature meters (that indicate temp. EMG (electromyogram) that shows electric potential created by contraction the muscles . changes)  b.

Implementation Therapeutic Touch  ´a healing meditation. . because the primary act of the nurse (healer) is to "center" the self and to maintain that center (mental concentration and focusing) throughout the process.

Implementation CRISIS INTERVENTION A technique of helping the person go through the crisis  To mobilize his resources  To help him deal with the here and now  A five step problem solving technique designed to promote a more adaptive outcome including improved abilities to cope with future crises .

. It is important to observe BOTH verbal and nonnon-verbal cues when evaluating the usefulness of the plan.Evaluation   The evaluation of the plan of care is based on the mutually established expected outcomes.

Stress Management for Nurses Plan daily relaxation program  Establish a regular pattern of exercise  Study assertive techniques. Learn to say ´noµ  Learn to accept failures  Accept what cannot be changed  Develop collegial support  Participate in professional organization  Seek counseling  .

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