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  1. 1. Concepts Related to Stress and Adaptation
  2. 2. Stress Provides stimulus for change and growth – Some positive, necessary – Too much • Poor judgment, physical illness, inability to cope • Affects all dimensions of person’s life – Changes in internal and external environments • Essential to adapt for survival – “Fight or Flight”
  3. 3. Define the Concept of Stress Hans Selye -General Adaptation Syndrome – Describes physiological events during stress response • STRESSORS – internal or external stimuli that cause stress – Physiological, psychological, social, environmental, developmental, spiritual or cultural – Internal or external • STRESS – any situation where nonspecific demand requires an individual to respond or take action • Perception may initiate the stress response
  4. 4. Physiological Adaptation Body’s ability to maintain homeostasis – Controlled by nervous and endocrine systems • Unconscious responses – automatic • Negative feedback system – Adjust heart and respiratory rates, blood pressure, temperature, fluid and electrolyte balances, hormone secretions, level of consciousness • Medulla oblongata • Reticular formation • Pituitary gland
  5. 5. Medulla Oblongata Controls vital functions necessary to survival – Heart rate, blood pressure, respiration
  6. 6. Reticular Formation Small cluster of neurons in brain stem and spinal cord Controls vital functions, continuously monitoring physiological status of body through connections with sensory and motor tracts
  7. 7. Pituitary Gland Pituitary gland, attached to hypothalamus – Produces hormones necessary for adaptation to stress • Secretions of thyroid, gonadal and parathyroid hormones – Hormone levels fall, secretions increase – Hormone levels rise, secretions decrease
  8. 8. Limitations of Homeostatic Control Healthy-meet day to day needs – Only short term control over body’s equilibrium • Cannot adapt to long-term changes in hormones or vital functions – Illness, injury or prolonged stress decreases adaptive capacity • Results in inadequate homeostatic control or breakdown of feedback system – Leads to further illness or death – Severe stress • Hormones insufficient in quantity to provide physiological energy needed for coping – Condition deteriorates, functioning declines
  9. 9. Models of Stress Related to Nursing Practice Selye’s GAS model – Stress- nonspecific response of body to any demand made on it • Physiological response of the whole body – No individual responses – Useful determining physiological responses
  10. 10. Adaptation Model People experience anxiety and increased stress when unprepared to cope with stressful situations 4 factors determine if situation is stressful – Person’s experience with similar stressors, support systems and overall perception of the stressor – Practices and norms of peer group • Can they talk about it? – Impact of social environment in assisting individual to adapt to stressor – Resources available
  11. 11. Stimulus-based Model Focuses on disturbing or disruptive events in the environment – Change is normal – Perceptions are irrelevant – All have common threshold
  12. 12. Transaction-based Model Views person and environment in dynamic, reciprocal, interactive relationship – Stress originates from relationship between the person and the environment
  13. 13. Factors Influencing Response to Stressors Physiological functioning Personality Behavioral characteristics Nature of stressor – Perception of intensity or magnitude – Scope – Duration – Other stressors – Predictability – Resources available – Support group
  14. 14. Adaptation Processes physiological or psychosocial dimensions change in response to stress – An attempt to maintain optimal functioning – Requires active response from whole person
  15. 15. Dimensions of Adaptation Physical – Local adaptation and general adaptation syndrome Developmental – Success in past, more likely to succeed now Emotional – Physiological defense mechanisms, personality strengths Intellectual – Education, problem solving, communication skills, realistic perception Social – Social network Spiritual
  16. 16. Local Physiological Adaptation Response of body tissue, organ or part to the stress of trauma, illness or other physiological change – Blood clotting, wound healing, accommodation to light, response to pressure • Localized • Adaptive, needs stressor to stimulate it • Short term • Restorative
  17. 17. Localized Adaptation Syndrome Reflex pain response – CNS responds • Protects from further tissue damage – Sensory receptor, sensory nerve to spinal cord, connector neuron in spinal cord, motor nerve from spinal cord, effector muscle • Pull hand from hot surface
  18. 18. Localized Adaptation Syndrome Inflammatory Response – Stimulated by trauma or infection • Localizes infection, prevents spread, promotes healing – Local pain, swelling, heat, redness, change in functioning • First phase – changes in cells and circulatory system – Vasoconstriction, histamine release, increased blood flow, increasing WBC’s, capillary permeability increased • Second phase – release or exudate • Third phase – repair of tissue by regeneration or scar formation
  19. 19. 3 Phases of General Adaptation Syndrome Physiological response of whole body to stress – Involves many body systems • Primarily autonomic nervous system and endocrine system
  20. 20. Alarm Reaction Mobilizes defense mechanisms of body and mind to cope with stressor – Hormone levels rise to increase blood volume – Increase blood glucose levels to make energy available – Epinephrine and norepinephrine increase • “fight or flight” – Increased heart rate, blood flow to muscles, oxygen intake, greater mental alertness – Pupils dilate for greater visual field • May last a minute to many hours – Extreme or long term • May threaten life – If stressor still present after initial alarm reaction, progresses to next phase
  21. 21. Resistance Phase Body stabilizes – Hormone levels, heart rate, blood pressures and cardiac output return to normal – Attempting to adapt • If stress can be resolved, body repairs damage • If stressor remains present and adaptation fails, enters third phase
  22. 22. Exhaustion Phase When body can no longer resist stress and energy is depleted – Physiological response is intensified • Energy is compromised • Adaptation diminishes – Body cannot defend itself • Physiological regulation diminishes – If stress continues, death may result
  23. 23. Behavioral Responses to Stress Psychological adaptive behaviors (Coping Mechanisms) – Constructive • Help accept challenge to resolve conflict – Destructive • Do not help cope with stressor – Affect reality orientation, problem-solving abilities, personality and in severe cases, ability to function – Task oriented • Use problem solving skills to cope with threat – Ego-defense mechanisms • Regulate emotional distress, protecting from anxiety and stress
  24. 24. Task-oriented Behaviors Use cognitive abilities to reduce stress, solve problems, resolve conflicts – Enable one to cope realistically with demands of stressor • Attack behavior – act to remove or overcome a stressor or satisfy a need • Withdrawal behavior – removing the self physically or emotionally from the stressor • Compromise behavior – changing the usual method of operating, substituting goals, or omitting the satisfaction of needs to meet other needs or to avoid stress
  25. 25. Ego-defense Mechanisms used as Stress Responses Unconscious behaviors that offer psychological protection from a stressful event – Help protect against feelings of worthlessness and anxiety • Can become distorted, becomes destructive – Compensation • Make up for deficiency by exaggerating strength – Conversion • Transfer conflict into nonorganic symptom – Denial • Refuse to consciously acknowledge – Displacement • Transfer emotions to less anxiety-producing substitute – Identification • Pattern behavior after another
  26. 26. Effects of Prolonged Stress  Developmentally – Unable to complete devekopmental task • Repeated stress can lead to maturational crisis  Intellectually – Short term memory impaired – Ability to learn impaired  Emotionally – Relate to prior experiences  Family – Respect client’s ideals of family • Poor communication and maladaptive behaviors may affect outcome  Lifestyle – Smoking, drinking, obesity, homosexuality • Set aside personal judgments  Sociocultural – Individualized beliefs  Spiritual – Individualized
  27. 27. Spiritual Religion and spirituality are not the same Religion – System of organized beliefs and worship Spirituality – Unique capacity for love, joy, caring, compassion and for finding meaning in life’s difficult experiences During stress, one relies on their faith, but may abandon their practices out of disillusionment and anger
  28. 28. Assessment of Stress  Physiological – objective – Elevated B/P – Increased neck, shoulder and back tension – Elevated pulse and respirations – Sweaty palms – Cold hands and feet – Slumped posture – Fatigue – Tension headache – Upset stomach – High pitched voice – Nausea, vomiting and diarrhea – Appetite change, weight change – Urinary frequency – Abnormal labs • Elevated adrenocorticotropic hormone, cortisol, catecholamine levels, hyperglycemis – Restless • Difficulty falling asleep or frequent awakening – Dilated pupils
  29. 29. Physical Disorders related to Stress Cardiovascular and gastrointestinal diseases Some cancers Immunological disorders Migraine headaches Infertility Burnout Exacerbates Parkinson’s and Tourette’s syndrome
  30. 30. Levels of Stress  Mild – Few minutes to few hours • Usually don’t affect health unless several at once  Moderate – Several hours to days  Severe – several weeks to several years • More frequent and longer, the higher the health risk • As stress increases, stress behaviors increase, decreasing energy and adaptive responses  Assess perception to decide level for patient – several weeks to several years • More frequent and longer, the higher the health risk • As stress increases, stress behaviors increase, decreasing energy and adaptive responses
  31. 31. Assessment of Stress (cont)  Psychological – Assess for destructive behaviors  Developmental – Assess where they are developmentally • Any delays, are they new?  Emotional – Observe behavior  Intellectual – Assess learning, cognitive appraisal, attention span  Family – What do they consider effective emotional support • Do they have it?  Lifestyle – Smoking, obesity, drug abuse, chronic sleep deprivation – Regular exercise, adequate rest, nutritious diet  Sociocultural – Be aware of cultural differences  Spiritual – Examine how beliefs and values have changed  What does client expect?
  32. 32. Nursing Diagnoses Related to Stress  Need defining characteristics – Identify etiology  Activity intolerance  Anxiety  Caregiver role strain  Coping, ineffective family or individual: compromised or disabling  Fatigue  Fear  Growth and development, altered  Hopelessness  Injury, risk for  Self-esteem disturbance
  33. 33. Stress Management Techniques Goals – Reduce frequency of stress-inducing situations – Decrease physiological response to stress – Improve behavioral and emotional responses to stress
  34. 34. Stress Management Techniques Health promotion – Regular exercise – Good nutrition – Adequate rest – Effective time management • More in control of life – Prioritize tasks – Interactions with positive support systems – Humor
  35. 35. Acute Care Crisis Intervention – Therapeutic technique to help resolve immediate stress problem • Addresses immediate, urgent need for stress reduction – Crises • When one encounters problems or stress situations they are unable to cope with in usual fashion • SITUATIONAL – External • Symptoms transient, episode brief • new baby, role change, acute illness, family change • DEVELOPMENTAL – Internal • Unable to complete developmental tasks of stage • can occur at any point •
  36. 36. Crisis Intervention Resolution of conflict depends on realistic perception, use of adequate coping mechanisms – Health promotion
  37. 37. Restorative Care Assist in life style changes that are healthy and stress reducing – SMOKING CESSATION – HUMOR • Use appropriately – Laughing alleviates stress, releases endorphins – SPIRITUALITY • Prayer, meditation or reading religious material – SELF ESTEEM • Stress positive characteristics – RELAXATION TECHNIQUES • Guided imagery, progressive relaxation, meditation, biofeedback – STRESS MANAGEMENT
  38. 38. Stress in Workplace Stress is working women’s number one problem – Stressors: workload, institutional policies, conflict with co-workers, dealing with death, conflict with physicians, inadequate preparation to deal with emotional needs of clients and families • Level of stress depends on personality, health status, previous experiences with stress, coping mechanisms – Job stress = Burnout • Depletes energy to deal with it • Sense of helplessness and negativism • No positive rewards • Anger or apathy – Identify stressors and strive to eliminate them