Stress and adaptation

&
Crisis in illness
STRESS (DEFINITION)
Stress
 is any situation in which nonspecific demand
requires an individual to respond or take action.
(selye, 1976)
The word stress is defined by the oxford dictionary

as a "state of affect involving demand on physical or
mental energy
Stress is a state produced by a change in the

environment that is perceived as challenging,
threatening or demanding to the person dynamic
balance.
TYPES OF STRESSES:-

 Internal stressors(major life events)

 Physiological stressor

 Psychological stressor

 External (catastrophic)

 Physical stressor
TYPES OF STRESSES (CONT……..)

According to duration:

Acutetime limited
Chronic intermittent
Chronic enduring
RESPONSES TOWARD STRESS

PHYSILOGICALLY
EMOTIONALLY

INTELLECTUALLY

SOCIALLY
 PHYSIOLOGICAL RESPONSE TO
STRESS

AUTONOMIC NERVOUS SYSTEM

SYMPATHETIC NERVOUS SYSTEM PARASYMPATHETIC

SYSTEM
FLIGHT FIGHT RESPONSE

• #INCREASED PULSE * INCREASED

PERISTALSIS
#PERIPHERAL VASOCONSTRICTION *INCREASED G.I
SECRETION
#INCREASED RESPIRATION
#DECREASED PULSE
#DILATATION OF PUPILS FORMATION OF GLYOCOGEN
#INCREASED BLOOD SUGAR
MEDULLA OBLONGATA
 MEDULLA OBLUNGATA

ADRENAL MEDULLA

PRODUCE EPINEPHRIN &

NOREPINEPHRIN

CHANGES CIRCULATION & INCREASES

B.P, R.R, H.R

INCREASE SUPPLY TO MUSCLES

PITUTARY GLAND

SUPPLIES HARMONE

Regulate thyroid,
gland&
parathyroid
HELP IN ADAPTATION
TO STRESS
 MODELS OF STRESS
(OBJECTIVES)

o It assist nurses to identify the stressors.

o It help the nurse to predict individual

response.
o Nurse can use this model to assist

patient in strengthening healthy coping

& in adjusting unhealthy response.
MODELS OF STRESS:-

I. Stimulus based model (by Thomas Holmes &

Rah in 1967)
II. Response based model (by Hans selye i.e GAS)
RESPONSE BASED MODEL
 Stress may considered as response.
 Acc. to Selye stress response is characterized by
a chain or pattern of physiological events called
GAS.
 The gas is physiological response of the body
towards stress.
 It involves the autonomic nervous system

& the endocrine system

GENERAL ADAPTATION SYNDROME

STRESSOR....a demand placed on the body that

requires adjustment and brings about the stress
reaction.
3 STAGES

ALARM
RESISTANCE
EXHAUSTION
GENERAL ADAPTATION SYNDROME
Alarm
“Fight or Flight” reaction: body mobilizes
resources to combat threat; activates the
sympathetic nervous system.
Resistance

Enhanced ability to fight stressor via moderate

physiological arousal; ability to withstand
additional stressors (e.g., infection) is reduced.

Exhaustion
Depletion of resources brings on diseases and disorders (e.g., chronically high heart rate and blood
pressure increase chances of heart attack and stroke).
FIGHT OR FLIGHT RESPONSE
FIGHT OR FLIGHT RESPONSE
 increased mental activity
 Dilated pupils
 Bronchiolar dilatation

 Increased respiratory rate

 Increased heart rate

 Increased glucose

 Increased cardiac output, B.P

 Increased blood flow to the

skeletal muscles
LOCAL ADAPTATION SYNDROME
CHARACTERSTICS:

the response is localized. it does

not involve entire body
the response is adaptive
the response is short term
the response is restorative
REFLEX PAIN RESPONSE

this response is a localized response of the CNS

to pain. it is an adaptive response and protects
tissues from further damage . the response
involves a sensory, motor response.

Example:- reflex removal of hand from a hot

surface
INDICATORS OF STRESS
 MENTAL STATE
 Inability to concentrate
 Poor judgment
 Agitation
 Irritability
 Loneliness
INDICATORS CONTD….
 Constant worrying
 Negativity
 Restlessness
 Quick temper
 Sense of being overwhelmed
 Unhappiness
 Anxiousness
 Inability to relax
STRESS
PHYSICAL & BEHAVIORAL INDICATORS

 Headache
 Muscle tension
 Nausea
 Insomnia
 Acne breakout
 Diarrhea
 Loss of sex derive
 Frequently being sick
 Dizziness
 Weight gain
INDICATORS CONTD….
Change
 in appetite
Neglect


Drug
 use
Nail biting


Tooth grinding


Excessive exercise


Overreaction


Sleeping to much or little



Starting fight

PSYCHOLOGICAL RESPONSE
 It is also referred to coping mechanism

 Themost imp nursing intervention is to enhance the

coping mechanism of the disease person

 Mc closkey & bulecheck(1999) identifies “ coping

enhancement” as a nursing intervention and defined it
as “assisting a patient to adapt to perceive stressors,
changes or threats that interfere with meeting demands
and rules
ACC TO NURSING RESEARCH (JALOWIEC 1993)

Trying to be optimistic about the

outcome
Using social support

Using spiritual resources

Trying to accept the situation

Trying to maintain control over the

feelings
PSYCHOLOGICAL RESPONSE CONTD ……….

 Psychological
response

Constructive Destructive
PSYCHOLOGICAL RESPONSE CONTD ……

COPING
STRATEGIES

Problem
focused Emotion focused Long term Short term
DEVELOPMENTAL RESPONSE

• Prolonged stress can affect the

developmental tasks.
• It can also lead to maturational crisis.
• If the parent prevent young child
from developing a sense of autonomy
the child may experience stress.
INTELLECTUAL RESPONSE

 Stress effect the short term

memory.
 A person ability to acquire new
knowledge or skills may also
be impaired.
 The client is unable to learn
new skills or disease process.
PROMOTING HEALTHY LIFESTYLE

 Regular exercise
 Adequate rest
 Nutrition diet
 Positive lifestyle
 Stop smoking, alcohol
 Time management
 Meditation
TEACHING RELAXATION TECHNIQUE
 Quiet environment

 Comfortable position

 Passive attitude

 Progressive relaxation
TYPES OF RELAXATION THERAPY

 Breathing exercises
 Progressive relaxation
 Imagery
 Yoga
 Meditation
 Therapeutic touch
 Music therapy
 Laughter therapy
CHANGES RESULTING FROM RELAXATION

 Lowered B.P
 Dec cardiac dysrhythmia
 Dec oxygen consumption
 Dec muscle tension

 Lowered metabolic rate

 Improved concentration

 Improved ability to
 cope with stress
CRISIS IN ILLNESS

It is the disturbance caused by

stressful event or perceived
stress to self.
According to lagerquistvent:- a
sudden event in one’s life
that disturbs homeostasis,
during which, usual coping
CHARACTERISTICS OF CRISIS:-

According to Caplan & sadock, 1998

 It occur in all individual but not equated by psychopathology
 Its personal by nature, what may be considered a crisis situation
by one may not be so for others.
 Crisis is acute not chronic
 It contains the potential for psychological growth & deterioration.
PHASES OF CRISIS
PHASE 1:Exposure to stressor
PHASE 2: confusion & disorientation
PHASE 3: Think on different
perspectives
PHASE 4: tension mount beyond limit
TYPES OF CRISIS:-

Baldwin 1968 has identified six classes of emotional

crisis, which progress by degree of severity
Class 1: Dispositional crisis
Class 2: Crisis of anticipated life transition
Class 3: Crisis resulting from traumatic stress
Class 4: Maturational & developmental crisis
Class 5: Crisis reflecting psychopathology
Class 6:Psychiatric emergency
SUMMARY:-

Today we have discussed about:-

 Definition of stress

 Sources of stress
 Adaptation model

 Stress management
 Definition of crisis

 Phases & types of crisis

REFERENCES
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publication .1067-71
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3) Perry & potter. Textbook fundamental of nursing.5th edition. Elsevier publication. 645-55
4) Siddhartha & Brunner. Textbook of Medical surgical nursing.10th edition. Lipincott
publication.80-96
5) Don land & Smeltzer. Psychiatric essential of clinical practice.2-3
6) Townsend c. Mary. Psychiatric mental health nursing. Jaypee publication. 5th edition.195-200
7) Nightingale nursing times ,Vol I,issue-8, Nov 2005; 27
8) Prism nursing practice, journal of clinical Nsg
`education,vol-II,no-2 Oct 07; 155:60
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THANKS