Stress and adaptation

1. STRESS AND ADAPTATION
Presented by,
Ms Flavia. Dass
M.Sc Nsg 1st year
KIMS, Hubli
Presented to,
Mr S.M. Badiger
Professor
KIMS, Hubli
ADVANCE NURSING PRACTICE
Presentation on

2. INTRODUCTION
Stress is a part of life. Everyone feels
stress at one time or another. The
experience of stress & the way one
response to it are unique to each
individual. The process of responding to
stress is constant & dynamic & essential
to the person’s physical, emotional &
social well being.

3. TERMINOLOGIES
• STRESS
It is a condition in which the human
responds to changing in its normal balanced
state. Stress results from a change in the
environment, that is presided as a challenge a
threat or a danger and can have both negative
& positive effects.
- Pender & Parsons 2006

4. • STRESSORS
stressors are themselves neither
positive or negative but they can have
positive or negative effects as the
persons responds to the changes.

5. • ADAPTATION
when person is in a threatening
situation immediate response occur,
those response are often involuntary
called coping response. The change that
takes place as a result of the response to
a stressor is adaptation

6. CONCEPT OF STRESS & STRESSORS
Stress is any situation in which a non –
specific demands requires an individual to
response or take action
Selye 1976
It involves physiological & psychological
responses.

7. Stress can lead to negative or counter
productive feelings or threaten emotional well
being. It can threaten the way a person
normally perceives reality, solve problems,
thinks in general; & a person’s relationship &
sense of belonging.
in addition, stress can threaten a person’s
general outlook on life, attitude towards loved
one & health status.

8. TYPES OF STRESS
STRESS
EUSTRESS DISTRESS

9. • EUSTRESS
The optimal amount of stress, which helps
to promote health & growth
e.g. Praise from a superior for hard working
• DISTRESS
Stress due to an excess of adaptive
demands placed upon us. The demands are
so great that they lead to bodily & mental
damage
e.g. unexpected death of a loved one

10. TYPES OF DISTRESS
• ACUTE STRESS
It’s our body’s immediate reaction
to a new challenge event or demand & it
triggers your fight or flight response
e.g. Pressures of a near miss automobile
accident or arguments with family..

11. • EPISODIC ACUTE STRESS
when acute stress happens frequently, it’s
called episodic acute stress
• CHRONIC STRESS
If acute stress isn’t resolved & begins to
increase lasts for long period of time, it becomes
chronic stress. This stress is constant & doesn’t go
away.

12. TYPES OF STRESSORS
STRESSORS
PSYCHOLOGICAL
STRESSORS
PHYSIOLOGICAL
STRESSORS

13. • PSYCHOLOGICAL STRESSORS
a) Accidents can cause stress for the victim, the
person who caused the accident & the families
of both
b) Stressful experiences of family members &
friends
c) Fear of aggression or mutilation from others
such as murder, rape, terrorist & attacks
d) Events that we see on TV such as war,
earthquake, violence
e) Developmental & life events
f) Rapid changes in our world, including
economic & political structures & technology

14. • PHYSIOLOGICAL STRESSORS
a) Chemical agents
b) Physical agents
Illness, injuries, hormonal fluctuation,
inadequate sleep or nutrition
c) Infection agents
d) Nutrition imbalance
e) Genetic or immune disorders

15. SCOURCES OF STRESS
They are many sources of stress, these are
broadly classified as
 Internal stressors: They originate with in a
person
like- Inability to accept uncertainty
negative self talk
unrealistic expectations
perfectionism
lack of assertiveness

16.  EXTERNAL STRESSORS
It originates outside the individual
like- →Major life changes
→work
→Relationship difficulties
→financial problems
→being too busy
→children & family

17. PHYSIOLOGY OF ADAPTATION
Physiological adaptation to stress is the body’s
ability to maintain a state of relative balance.
This ability is a dynamic form of equilibrium in
the body’s internal environment
The internal environment constantly changes, &
the body’s adaptive mechanism continually
function to adjust to these changes & thus to
maintain equilibrium or homeostasis

18. The body makes adjustments
in heart rate, respiratory rate, blood
pressure, temperature, fluid &
electrolyte balance, hormone secretion &
level of consciousness all directed at
maintaining adaptation.

19. MECHANISM OF PHYSIOLOGY OF
ADAPTATION
Physiological mechanisms of adaptation
functions through negative feedback, a
process by which the controlling
mechanism senses an abnormal state,
such as lowered body & makes adaptive
response, such as initiating shivering to
generate body heat

20. MECHANISMS USED IN ADAPTING
STRESSORS
• MEDULLA OBLONGATA
The medulla oblongata control vital
functions necessary to survival. These include
heart rate, blood pressure & respiratory.
Impulses traveling to & from the medulla
oblongata can increase or decrease these vital
functions.

21. • RETICULAR FORMATION
The reticular formation is a small cluster of
neurons in the brainstem & spinal cord.
It also controls vital functions & continuously
monitors the physiological status of the body
through connections with sensory & motor
tract

22. • PITUITARY GLAND
The pituitary gland produces hormones necessary
for adaptation to stress. In addition, the pituitary
gland regulates the secretion of thyroid gonadal
& parathyroid hormones. Hormones secretion
like other homeostatic mechanisms is normally
regulated, by a feedback mechanism that
continuously monitors hormone level in blood.
When hormone level drops, the pituitary gland
receives a message to increase hormone
secretion. When hormone level rise, the pituitary
gland decreases hormone production

23. MODELS OF STRESS
• RESPONSE BASED MODELS OF STRESS
Selye stress response is characterized by a
chain or pattern of a physiologic events called
General adaptation syndrome

24. GENERAL ADAPTATION SYNDROME (Dr. Hans
Selye)
• A homeostatic mechanism is aimed at counter
acting the everyday stress of living. If they are
successful, the internal environment
maintains normal physiological limits of
temperature, chemistry & pressure
• If stress is extreme or long lasting, the normal
mechanism may not be sufficient. In this case
the stress triggers a wide-ranging set of bodily
changes called GAS

25. A. Alarm reaction or fight or flight response
It is the body’s initial reaction to a stressor.
It is a set of reactions include

26. Stressor hypothalamus
Sympathetic
nervous system
Adrenal
medulla
Catecholamine
( epinephrine, nor
epinephrine
produces)
Alarm reaction
Fight or Flight
response

27. A stress response is characterized by alarm reaction
include
o Increased heart rate
o Increased blood supply to organs active in stress
response
o Increased production of RBC leading to increase in
ability of blood to clot
o Increased rate of breathing
o The liver converts glycogen to glucose & release into
the bloodstream which provides energy to fight
o Decrease production of saliva & digestive enzymes

28. B . Resistance Reaction
It is the 2nd stage in stress response
Stressor
Hypothalamus
CRH, GHRH, TRH
Anterior pituitary
Fight or Flight response

29. C . Exhaustion stage
In this, the cells start to die & the organs
weakens. Long term resistance reaction put a
heavy demand on the body

30. GENERAL ADAPTATION SYNDROME

31. • STIMULUS BASED MODEL
The stimulus – based model focuses on the
following assumptions
1. Life change events are normal & they
require the same type & duration of
adjustment
2. People are passive recipients of stress &
their perception of the events are irrelevant
3. All the people have a common threshold of
stimulus & illness results at any point after
the threshold

32. As the stimulus based model does not allow for
individual differences in perception &
response to stressors. Nurses may experience
difficulty when attempting to use this model
in stress management because of the lack of
flexibility for individual adaptation

33. • Transaction Based Model
The transaction based model views the person
& environment in a dynamic, reciprocal
interactive relationship
This model was developed by Lazarus &
Folkman, views the stressor as an individual
perceptual response rooted in psychological &
cognitive processes

34. Stress originates from the relationship between
the person & the environment
This model focuses on stress related processes
such as cognitive appraisal & coping

35. • Adaptation Model
Factors determine whether a situation is
stressful (Mechanic, 1962)
• The ability to cope with stress
• The practice & norms of the person’s peer
group
• Resources that can be used to deal with the
stressor

36. The adaptation model is based on the
understanding that people experience anxiety
& increased stress when they are unprepared
to cope with stressful situation
Using this model & appropriate interventions,
nurses can help the client & families to
promote health in all human dimensions

37. FACTORS INFLUCING RESPONSE TO
STRESSORS
The response to any stressor depends on
physiological accounting, personality &
behavioral characteristics , as well as the nature
of the stressor
The nature of the stressor involves the following
factors
• Intensity . Duration
• Scope . Number & nature
of stressors

38. ADAPTATION TO STRESSORS
Adaptation is the process by which the
physiological of psychosocial dimensions
change in response to stress
An adaptative response occurs when a
stimulus from the internal or external
environment causes a departure from the
balances state of organism
Adaptation is an attempt to maintain the
optimal functioning

39. Adaptation involves
• Reflexes
• Automatic body mechanisms for protection
• Coping mechanisms
• Leading to adjustment or mastery of a situation
A stressor that stimulates adaptation may be
• Short term such as fever
• Long term such as paralysis of limb

40. DIMENSIONS OF ADAPTATION
 Physical dimension
 Adaptative resources : Local adaptation
syndrome
e.g. Fever
 Unsuccessful outcome can result in
death
 Successful outcome results in resolution

41.  Developmental dimension
 Adaptive resource : successful coping in the
past developmental task/ stages or successful
adaptation to past stressors
e.g. Retirement
 Unsuccessful outcome can result in
depression
 Successful outcome results in alteration of
role functions to other meaningful activities

42. Emotional dimension
 Adaptive response are : psychological defense
mechanisms, individual personality changes
e.g. Rape
 Unsuccessful outcome can result in irrational
fear of me
 Successful outcome can result in integration
of traumatic memory

43. Intellectual dimension
 Adaptive responses are: Formal education,
ability to solve problem, communication skills ,
positive coping strategies
e.g. diagnosis of cancer
 Unsuccessful outcome can result iin denial of
cancer & fore goes for treatment
 Successful outcome can result in using of an
active problem solving approach to make
decisions about care

44. Social dimension
 Adaptive response are : social network provides
support, others may direct person to needed
resources
e.g. Alcoholism in a family member
 Unsuccessful outcome can result in withdrawal
from family & other social contacts
 Successful outcome can result in active
participation of all the family members in
alcoholic anonymous support group

45. Spiritual development
Adaptive response are : Prayer group, support from
priests, rabbi & minister
e.g. Family member feels that he has abandoned by
god
Unsuccessful outcome can result in withdrawal from
church activities not mingling with church people
Successful outcome can result in seeking friends from
the church, becoming volunteers for in church activities

46. RESPONSE TO STRESS
Characteristics of the Stress Response
• Stress response is natural, protective & adaptive
• There are normal response to stressors; stressors
encountered in everyday circumstances increase
catecholamine excretion, which causes an
increase in heart rate & blood pressure
• Physical & emotional stressors trigger similar
responses. Magnitude & patterns may differ

47. • There are limits in ability to compensate
• Magnitude & duration of stressors may be so
great that homeostatic mechanism for
adjustment fail. Leading to death
• Repeated exposure to stimuli results in adaptive
changes; that is, tissue level of the enzyme
trysine hydrolase increase which increase
capacity for the body to produce nor epinephrine
& epinephrine
• There are individual differences in response to
same stressors

48. PHYSIOLOGICAL RESPONSE
• The classic research by Selye (1946,1976) has
identified 2 physiological responses to stress:
• The local adaptation syndrome (LAS)
• The General adaptation syndrome (GAS)

49. • THE LOCAL ADAPTATION SYNDROME
The LAS is are response of a body tissue, organ
or part to the stress of trauma, illness or other
physiological change
The body produces many localized responses to
stress which include blood clotting ,wound
healing ,accommodation of the eye to light &
response to pressure

50. All the forms of LAS share the following
characteristics
• The response is localized; it does not involve
entire body system
• The response is adaptive , meaning that a
stressor is necessary to stimulate it
• The response is short term. It does not persist in
definitely
• The response is restorative, meaning that the LAS
assist in restoring homeostasis to the body region
or part
Two localized responses, the reflex pain response &
the inflammatory response

51. • THE GENERAL ADAPTATION SYNDROME (GAS)
The GAS is a defense response of the whole
body to stress. It involve several body system
primarily the autonomic nervous system &
endocrine system.
The GAS consists of the Alarm reaction, The
resistance stage & exhaustion stage

53. PSYCHOLOGICAL RESPONSE
• Exposure to a stressor results in psychological
& physiological adaptive response
• As people are exposed to stressors, their
ability to meet their basic needs is threatened
• This threat, whether actual or perceived;
produce frustration anxiety & tension
psychological adaptive behaviors assist the
person’s ability to cope with stressors
• Psychological adaptive behaviors can be
constructive or destructive

54. • Constructive behaviors help accept the challenge
to resolve conflict, even anxiety can be
constructive
• Destructive behaviors affect reality ,orientation
problem, solving abilities, personality & in severe
circumstances, the ability to function. Anxiety can
also referred to be destructive
• Psychological adaptive behaviors are also
referred to as coping mechanism

55. TASK ORIENTATION BEHAVIORs
• The task oriented behaviors involves using
cognitive abilities to reduce stress, solve
problems, resolve conflicts & gratify needs
• Task oriented behavior enables a person to
cope realistically with demands of a stressor
• The 3 general types of task – oriented
behavior are Attack behavior, Withdrawal
behavior & Compromise

56. EGO DEFENSE MECHANISMS
• Ego defense mechanism, first described by
Sigmud Freud,are unconscious behaviors that
offer psychological protection from stressful
events
• They are used by everyone & help protect
against feelings of worthlessness & anxiety
• Occasionally a defense mechanism can
become distorted & is no longer to assist the
person in adapting to a stressor

57. PLANNING
In most situations, stress management plans are
long term & are conducted in the clients home or
on an outpatient basis.
The general goals for clients who require stress
management include the following:
1. Reduction in frequency of stress – inducing
situation
2. Decreased physiological response to stress
3. Improved behavioral & emotional response to
stress

58. COPING WITH STRESS
Bio feedback
Using thought process to control a
physiological response
• A person is taught a series of exercise designed to
help them learn how to gain control over the
physiological response that is being monitored
• Bio feedback can be beneficial in helping people
mange stress related problems such as high BP,
chronic pain & migraines

60. Meditation or relaxation
A deeply relaxed state; reduces
psychological & physiological tension
 When in a relaxed or meditative state, people
typically report.
o Feeling calm
o A low level or absence of anxiety
o Response associated with low level of overall
physiological arousal such as lower heart rate,
slower breathing rate & loss of muscle tension

61. Physical exercise
Engaging in physical activity
• A physical exercise is physical activity that is
usually planned & performed to improve or
maintain one’s physical condition
• Aerobic exercise is the best for physical &
mental health, although anaerobic exercise is
better than no exercise at all

62. Social support
Is helper assistance from other
people when needed
• Appraisal support – Person is helped to
realistically appraise the stressor
• Tangible support – Person is given tangible
support e.g. food , financial support etc
• Informed support- Person is given information
• Emotional support – Person is given warmth,
care & nurturing

63. NURSING DIAGNOSIS FOR STRESS
 Anxiety related to :
• Change in health status
• Maturational or situational crisis
 Altered growth & development related to:
• Separation from significant others
• Situational crisis (unplanned pregnancy)
 Caregiver role strain related to:
• Adjustment to medical diagnosis
• Adjustment to decrease level of physical
function

64. Fatigue related to:
• Overwhelming psychological demands
• Excessive role demands
Hopelessness related to:
• Long term stress
• Lost belief in values
Ineffective family coping: compromised or
disabling or ineffective individual coping
related to:
• Inadequate coping methods
• Prolonged stress

65. Risk for injury related to :
• Impaired problem- solving abilities
Sleep pattern disturbance related to:
• Maturation or situational

66. IMPLEMENTATION
• The nurse is responsible for implementing
thoughtful interventions that are caused out
in several nursing domains

67. HEALTH PROMOTION
• Before specific stress management techniques
are taught to the client, the nurse must establish
a helping role
• Presenting or just being there for the client
fosters sense of support that facilities personal
growth
• When helping the client reduces stress the nurse
reduces stressful situations, decreases the
physiological response to stress & improve the
behavioral & emotional responses to stress
• Creating a trusting caring environment serves as a
foundation for any change

68. REDUCING STRESSFUL SITUATION
There are several methods that assist in stress
reduction
Structure
Illness, crises or change in living
arrangements disturb a client’s routine,
thereby disturbing the pattern of living &
resulting in greater energy expenditure
A plan that assist a client to renew a familiar
life structure or develop a new routine
consistent with a changed life situation can
reduce stress

69. Time management
Persons who use time efficiently generally
experience less stress because they feel more in
control of their lives.
A nurse acting in the teaching – coaching domain
may assist client to prioritize tasks if they are
feeling over whelmed or immobilizes
Environmental modification
Although all stress cannot be avoided, those
life changes that are under the client’s control
can be deliberately postponed so more energy is
available for coping with unavoidable stressors

70. STRESS MANAGEMENT
• Regular exercise
Almost any form of exercise
or movement can increase your
fitness level while decrease your
stress. The most important thing
is to pick an activity you enjoy. Exercising
regularly can have a positive effect on your mood
by relieving the tension, anxiety, anger & mild
depression that often go hand in hand with
stress.

71. • Humor
Adopting a humorous view towards life
situations can take the edge off everyday stressor.
Being able to laugh stress away is the smartest
way to ward off its effects
• Provides good cardiac condition
• Reduce stress hormones ( epinephrine, cortisol,
dopamine & growth hormone)
• Boast immune function
• Produces a general sense of well being

72. • Nutrition & Diet
Good nutrition is an important stress
management tool. When our bodies are
poorly fed, stress takes an even greater toll on
our health
Eating fruits & vegetables, complex
carbohydrates ( whole grain bread, brown
rice), nuts ( almonds , walnuts), dairy ( yogurt
& cheese)

73. • Relaxation techniques
To effectively combat stress, you need to
activate your body’s natural relaxation
response.
You can do this by practicing
 Deep breathing exercise
Mindfulness meditation – meditation helps
you to switch your focus on the present rather
than dwelling on the past or worrying about
the future

74.  Yoga – yoga reduces stress & anxiety.
Yoga helps in increasing flexibility,
stamina & strength. It should be done
morning to start the day with more energy & feeling
refreshed
 Aromatherapy – it is a holistic healing treatment that
uses aromatic essential oils medicinally to improve the
health of the body, mind & spirit. It enhances both
physical & emotional health
 Spirituality – spirituality & religious people find various
ways to express these qualities by praying, attending
religious services, interacting with people who share
the same beliefs, visiting nature

75. • Have a good cry
A good cry during period of stress can
be healthy way to bring relief to your anxiety
• Connect with others
A good way to combat sadness,
boredom & loneliness is to set out activities
involving others

76. • Crisis intervention
Is a short term management technique
designed to reduce potential permanent damage
to an individual affected by a crisis
• Enhancement of self esteem
Is a type of motivation hat
works to make people feel good
about themselves. It involves a
preference for positive over
negative views.

77. PROMOTING STRESS MANAGEMENT
FOR NURSES
• Most nurses experience stress in their work
environment
• Job stress frequently results in a condition called
burnout, characterized by decreased concern for
the people with whom one is working
• During burnout the client experiences physical &
emotional exhaustion

78. • Nurse should identify specific stressors at
work & strive to eliminate them
• It is also helpful to gain social support from
other nurses in order to maintain a caring
attitude to wards clients