The document discusses stress, defining it as a condition where a person responds to changes that exceed their adaptive abilities. Stress can be caused by internal or external stressors. Hans Selye proposed two models of stress adaptation: the general adaptation syndrome and local adaptation syndrome. The general adaptation syndrome describes the body's overall response to stress in three stages - alarm, resistance, and exhaustion. The local adaptation syndrome describes localized responses like wound healing. Stress can produce physiological, psychological, cognitive, and verbal-motor manifestations in the body.

1. STRESS

2. Personal definition What is Stress?

3. 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 – environmental / internal demands or both tax or exceed the adaptive resources of an individual, social system or tissue systems

4. Stress and Adaptation STRESSOR Any event or stimulus that causes an individual to experience stress They may neither positive or negative , but they have positive or negative effects Internal Stressor (illness, hormonal change, fear) External Stressor (loud noise, cold temperature) Developmental Stressor Situational Stressor

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

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

7. Stress and Adaptation SOURCES OF STRESS Internal External Developmental Situational

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

9. Effects of Stress on the Body Physical - affects physiologic homeostasis Emotional - affects feeling towards self Intellectual - influences perception and problem solving abilities Social – can alter relationships with others Spiritual - affects one’s beliefs and values

10. 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

11. GENERAL THEORETICAL FRAMEWORKS FOR UNDERSTANDING STRESS Stress can be defined differently by the three models STIMULUS RESPONSE TRANSACTION

12. Stress and Adaptation Models of Stress STIMULUS based models RESPONSE based models TRANSACTION based models

13. 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. Focus: disturbing events within the environment

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

15. 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 response of the body to any demand made on it

16. 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.

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

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

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

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

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

22. General Adaptation Syndrome I. ALARM REACTION Initial reaction of the body; “ fight OR flight” responses Mobilizing of the defense mechanisms of the body and mind to cope with stressors. SHOCK PHASE- the autonomic nervous system reacts; release of Epinephrine and Cortisol COUNTERSHOCK PHASE- reversal of the changes produced in the shock phase

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

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

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

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

29. Adrenal gland

30. Adrenal Gland

31. Adrenal Gland

32. Hormonal Changes Adrenal Cortex MINERALOCORTICOIDS Aldosterone Na+ retention WATER retention Protein anabolism GLUCOCORTICOIDS Cortisol (Anti-inflammatory) Protein catabolism Gluconeogenesis Adrenal Medulla 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

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

34. 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 sensory serve to the spinal cord, a connector neuron, motor nerve, effector’s muscles. Example: unconscious removal of hand from a hot surface, sneezing, etc. Inflammatory Response: Stimulated by trauma or infection, thus preventing it to spread; also promotes healing Pain, heat, redness, swelling

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

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

37. 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

38. 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

39. 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.

40. 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

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

42. 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.

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

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

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

46. Levels of Anxiety Mild- increased alertness, motivation and attentiveness Moderate- perception narrowed, selective inattention and physical discomfort

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

48. Anxiety

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

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

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

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

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

54. 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

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

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

57. 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

58. 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

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

60. VERBAL / MOTOR MANIFESTATIONS First hand responses to stress

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

62. 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, painful or sad events

63. Coping

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

65. Coping related terms Adaptive coping- helps person deal effectively with stress Maladaptive coping- results in unnecessary distress for the person and stressful events

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

67. 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

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

69. Applying the Nursing Process A D P I E

70. Assessment 1. Utilize the Nursing History Subjective data- such as the functional pattern, risk pattern and dysfunctional pattern. 2. Physical Examination – centered on the changes in the ANS and NES. Objective data- Physical assessment, Diagnostic tests and procedures 3. Laboratory Examination

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

72. Planning There are four important guidelines to be followed in choosing nursing goals. 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

73. 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

74. 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

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

76. 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.

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

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

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

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

81. 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.

82. 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

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

84. Stress Management for Nurses Plan daily relaxation program Establish a regular pattern of exercise Study assertive techniques. Learn to say “no” Learn to accept failures Accept what cannot be changed Develop collegial support Participate in professional organization Seek counseling