Coping and Stress Tolerance

Key Terms
• Stress: Regarded as a normal part of life and
can have both positive and negative effect on
a person’s functional capacity.
• Eustress: positive stress that can be associated
with adaptation and is necessary for growth
and development.
• Distress: Negative stress that is potentially
harmful and may exhaust adaptive capacity.
 Cont…

• Stressor: alarming stimuli that arouse the body from

the resting state into a state of readiness to combat
or deal with the stressor.
 Types of Stressor:
• Physiologic Stressor: Physical stimuli that initiate the
stress response. It may be detected during the
physical examination as well as during the interview.
Examples: disease process, fatigue, aging, sleep
deprivation.
 Cont…
• Psychological Stressors: stimuli originating from the
person’s thought process in relation to personal safety and
security, personal control over events, and social
integration.
• Environmental Stressors: a person’s unfamiliar
surrounding or setting.
• Examples: Changes in daily routine, lack of privacy, sensory
deprivation or overload.
• Sociocultural Stressors: Encompass stressful events related
to family relations, career, financial concerns and religion.
• Stress Response: An adaptive mechanism that
restores a person’s balance and equilibrium.
• Coping: is a process used to manage events that are
perceived and interpreted as stressful.
• OR what one does about a problem in order to bring
about relief, and equilibrium.
• Adaptation: is the process of development of
resistance to changes in environment.
• Coping Strategies: Specific techniques used to deal
with a stressor and its consequences to relieve the
intensity of the stressors..
 Effective Coping
• Effective coping is manifested by high levels of
adaptation to stress or the development of stress
tolerance. It may have the following results as:
• Distress is maintained within manageable limits.
• Hope and encouragement are generated.
• A sense of personal worth is maintained.
• Relationship with significant others are maintained or
destroyed.
• Prospects for favorable situations and physical recovery
are enhanced.
 Stressor Intensity
• An intense stressor may be perceived as
insurmountable/overwhelming and may
precipitate crisis.
• Past experiences with stressors----the stressors
may be viewed as less threatening.
• Personality---certain people are more stress
resistant especially those who view change as a
challenge and believe that they can influence
events
• Crisis occurs when the person feels
overwhelmed by stressors and unable to
resolve the problem.
• It is an acute, self-limiting state that usually
resolved within a period of 4 to 6 weeks.
 Stages of Stress
• Alarm Reaction (AR)—body alerts in response to stress.
• Stage of Resistance (SR)—adaptation and competition with
stressors to limit them.
• attempts are made to maintain usual structures, often by
applying coping strategies to reduce tension and to
recognize one’s thoughts. Being challenged at this stage
may result in anger because it interferes with coping
attempts.
• Stage of Exhaustion (SE)—If the adaptation does not
overcome the stressors the adaptation will fail and the
effects may spread to the entire body.
 A) ALARM STAGE
As you begin to experience a stressful event or
perceive something to be stressful,
psychological changes occur in your body. This
experience or perception disrupts your body’s
normal balance and immediately your body
begins to respond to the stressor(s) as
effectively as possible.

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 EXAMPLES

 Cardiac - increased heart rate

 Respiratory - increased respiration
 Skin - decreased temperature
 Hormonal - increased stimulation of adrenal
genes which produce an adrenal rush.

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 B) RESISTANCE STAGE
During this stage your body tries to cope or
adapt to the stressors by beginning a process
of repairing any damage the stressor has
caused. Your friends, family or co-workers
may notice changes in you before you do so. It
is important to examine their feedback to
make sure you do not reach overload.

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 EXAMPLES

 Behavior indicators include: lack of

enthusiasm for family, school, work or life in
general, withdrawal, change in eating habits,
insomnia, hypersomnia, anger, fatigue.

 Cognitive Indicators include: poor problem

solving, confusion, nightmares.

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 RESISTANCE STAGE (CON…)
MORE EXAMPLES

Emotional indicators include:

 tearfulness
 fear
 anxiety
 guilt
 agitation
 depression
 overwhelmed.
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 C) EXHAUSTION STAGE
During this stage the stressor is not being
managed effectively and the body and mind
are not able to repair the damage.

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 EXAMPLES

Digestive disorders, withdrawal, headaches,

tension, insomnia, loss of temper.

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 Nursing Assessment
• A Physiological Response: Stressors activate
the sympathetic nervous system and the
hypothalamic-pituitary-adrenal axis, resulting
in physiological alterations that may be
observed during physical assessment.
 Assessment Cont…

• Cardiovascular System: When the SNS is activated during

stress, norepinephrine is released, producing the
following:
• Increased heart rate
• Cutaneous vasoconstriction
• Increased myocardial consumption
• Increased systolic blood pressure
• Cardiac dysrhythmias, PVC
• Chest pain sensations/ischemic pain and palpitations
• Headache
 Assessment Cont…

• Respiratory System: Norepinephrine secretion

during stress can lead to bronchodilation.
• Increased respiratory rate.
• Gastrointestinal System: SNS stimulation
inhibits GIT motility.
Stress is often associated with nausea, vomiting,
increases peristaltic activity, and excessive
secretion of HCl.
 Assessment cont…
• Musculoskeletal System:
• Increased muscular tone in response to stress.
• The person may appear tense
• May be tremors in hands.
• Integumentary System:
• Diaphoresis
• Skin lesions
 Assessment cont…
• Behavioral Response:
• Impaired thinking process
• Difficulty learning new skills
• Inability to interact with friends
• Cognitive Responses:
• Inability to concentrate and make decision
• Affective Responses:
• Anxiety, depression, fear and frustration
• Ambivalence and conflict.
 Coping Mechanism/Strategy

• Coping mechanism is an innate or acquired way of

responding to a changing environment or situation.
• Effective coping results in adaptation.
• Ineffective coping results in maladaptation.
• All coping strategies may not always be
appropriate.
• Coping strategies vary among individuals.
• Coping mechanism may be short term or long term
 Stress Management
• A nurse can relieve and manage a client’s stress
through:
• Therapeutic touch
• Massage—effleurage (stroking) and
petrissage(kneading)
• Relaxation exercise
• Guided imagery
 Nursing Diagnosis
• Ineffective coping mechanism
• Fear (related to perceived effects of…..)
• Hopelessness (r/t separation from significant others)
• Altered self-concept (r\t change in role)
• Rape trauma syndrome
• Spiritual distress
• Potential for violence: self directed or directed at others
• Powerlessness (r/t long term abusive relationship)
• Anxiety r/t perceived threat to health status
• Ineffective individual coping r/t problem-solving skills
deficit