Stress and Crisis - plays important role to deteriorate the physical and mental health of a person, so one should know how to manage it by knowing the condition, causes, sign and symptom and its intervention.

1. STRESS ADAPTATION
CRISIS & ITS INTERVENTION
Presented by;
Thangjam Sarjubala Devi
Msc (N) 1st year
Krupanidhi College of
Nursing

2. DEFINITION:
In a medical or biological context:
“ Stress is a physical, mental or emotional
factor that causes bodily or mental tension.
Stresses can be external or internal. Stress
can initiate the ‘fight or flight’ response, a
complex reaction of neurologic and
endocrinologic systems”.

3. “Stress is any situations in which a non-
specific demand requires an individual to
response or take action”
- Selye, 1976

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

5. Stressors:
“Any event or stimulus that causes an
individual to experience stress. The may be
neither positive or negative but they have
positive or negative effects”.

6. “Person perception or experience of a
major change may initiate the stress
response. The stimuli precipitating the
change are called stressors”
- Selye 1976

7. CAUSES:
Stressors are broadly classified into:
 Internal Stressors
 External Stressors

8. Internal Stressors:
 Posture
 Physical discomfort
 Pace
 Diet
 Addiction
 Exercise
 Attitudes

9.  Genes
 Spiritual contentment
 Sexual satisfaction
 Personal satisfaction
 Sensory behaviour

10. External Stressors:
 Air pollution
 Noise
 Lighting
 Overcrowd
 Lifestyle
 Job stress
 Event in life.

11.  Job insecurity
 High demand for performance
 Technology
 Workplace culture
 Personal & family problem
 Gender game

12. STAGES OF STRESS:
GENERAL ADAPTATION SYNDROME
(GAS)
1. Alarm stage
2. Resistance stage.
3. Exhaustion stage
LOCAL ADAPTATION SYNDROME
1. The reflex pain response
2. The inflammatory response

13. 1) Alarm Stage (min to hour)
“Fight or flight” response for immediate
action.
Characterised by:
 Overacting of sympathetic nervous system
release adrenaline & cortisol.
 Increase blood flow & blood glucose to
increase energy, increase oxygen for
adaptation.
 Increase mental alertness, cardiac output,
respiratory rate, pupils are dilated.
 Fear, Pressure & excitement.

14. 2. Resistance stage:
 Hormones levels, cardiac output, heart
rate & blood pressure returns to the
normal levels and starts adapting to the
stressor.
 Start repairing the damages that has
occured

15. 3. Exhaustion stage:
a. Initial phase:
 Due to lack of appropriate measures not
able to concentrate and work effectively.
b. Burnout phase:
 Loss all the energy and gets exhausted.
 Complete emotional & physical
breakdown.
 Required immediate attention as
depression and suicidal attempts are
common.

16. Local Adaptation Syndrome:
1. THE REFLEX PAIN RESPONSE.
 Spinal reflex
 Involuntary and nearly instantaneous
movement to protect the body from
damage or harm.

17. 2. THE INFLAMMATORY RESPONSE.
 Voluntary response to a stimulus
 Inflammatory response & repair local
tissue injury.
 Hypothalamic- pituitary- adrecortical
response

18. SYMPTOMS OF STRESS:
 Physical symptom
 Cognitive symptom
 Emotional symptom

19. 1. PHYSICAL SYMPTOM;
 Muscle tension
 High blood pressure
 Rapid breathing & pounding of heart
 Indigestion , ulcer
 backaches
 Difficulty in sleep, fatigue
 Increase smoking & drinking alcohol
 More prone to accidents

20. 2. COGNITIVE SYMPTOM;
 Forgetfulness
 Unwanted or repetitive thought
 Difficulty in concentration
 Fear of failure
 Self criticism

21. 3. EMOTIONAL SYMPTOM:
 Irritability
 Depression
 Anger
 Fear or anxiety
 Feeling overwhelmed
 Mood swings

22. SHORT TERM EFFECTS:
 Back & neck pain
 Cold, sweaty hands, dry mouth, tremors
 Goose bumps, frequent urination
 Diarrhoea, disturbing dreams
 Shabby appearance, headache, fainting
 frequent blushing, palpitation
 Feet taping, heart burn, change in
appetite
 Disorganized & anger

23. LONG TERM EFFECTS:
 Stammering
 mood swings
 Social isolation
 heart attack, stroke
 Asthma
 substance abuse
 Chronic headache
 frequent cold & cough

24. •Insomnia
•Depression
•Difficulty in concentration
•memory disturbance
•Irritable bowel syndrome
•Decrease sexual drive
•Increase minor mistakes
•Difficulty making decision

25. STRESS MANAGEMENT STRATEGIES:
1. PHARMACOLOGICAL MANAGEMENT;
 Benzodiazepines- used in acute stress
eg- alprazolam, diazepam, clonazepam.
 Beta adrenergic blocker- for controlling
tachycardia & palpitation
eg- antenolol, metoprolol, propanolol
 Antacid- to avoid stress ulcer. Eg renitidine
 Antihistamine- sedative eg pheniramine maleate
 Antidepressant- eg barbiturates

26. 2. NON-PHARMACOLOGICAL MANAGEMENT;
 Music therapy.
 Sound therapy.
 Yoga therapy
 Pet therapy
 Naturopathy
 Acupressure
 Acupuncture
 Creative visualization

27. CRISIS:
“Crisis is a state of disequilibrium resulting
from the interaction of an event with the
individual’s or family’s coping mechanism,
which are inadequate to meet the
demand of the situation combined with
the individual’s or family’s perception of
the meaning of the event”
- Taylor 1982

28. “Crisis is a disturbance caused by a stressful
event of a perceived threat. Here the
individual’s conventional way of coping
becomes ineffective in dealing with threat
causing anxiety”

29. STAGES OF CRISIS:
 Phase 1: Here the crisis-producing
event has occurred , resulting in anxiety.
This anxiety activates the person’s usual
methods of coping.
 Phase 2: Patient experience more
anxiety because previously effective
coping mechanisms are found
inadequate in the current education.

30.  Phase 3- patient tries out new coping
mechanisms or the threat is refined so
that old coping mechanisms can work. If
new coping mechanism is effective, the
resolution of the crisis take place. If not
patient progresses to 4th phase.
 Phase 4- here patient experiences
severe anxiety i.e panic, resulting in
psychological disorganization.

31. TYPES OF CRISIS:
 Maturational crisis
 Situational crisis
 Social crisis.

32. 1. Maturational crisis:
 Stage in a person’s life where adjustment
& adaptation to new responsibilities and
life patterns are necessary.
 Developmental events requiring role
changes.
 Influenced by role models, interpersonal
resource & the ease of others in accepting
the new role.
 Transitional periods for onset of this crisis
are adolescence, parenthood, marriage,
midlife & retirement.

33. 2. Situational crisis:
 Precipitated by an unanticipated stressful
event that creates disequilibrium by
threatening one’s sense of biological, social
& psychological integrity.
 Eg; loss of job
loss of loved one
unwanted pregnancy
divorce, school problems
change in geographic location
witnessing something very traumatic

34. 3. Social crisis:
 It is accidental, uncommon &
unanticipated and results in multiple
losses and radical environmental
changes.
 Social crisis include natural disaster like
floods, earthquakes, violence, nuclear
accidents, mass killings, contamination
of large areas by toxic wastes, wars etc.

35. SIGNS & SYMPTOMS:
 A heavy burden of free- floating anxiety.
 Depression, anger & guilt- victim will
attempt to get rid of anxiety using various
coping mechanisms, healthy or unhealthy.
 Incapable of even taking care of his daily
needs.
 May neglect his responsibilities.
 May become irrational & blame others for
what has happened to him.

36. FACTORS PREVENTING CRISIS:
 Realistic perception of the event.
 Adequate situational support.
 Adequate coping mechanisms.

37. CRISIS INTERVENTION:
“Crisis intervention is a technique used to
help an individual or family to
understand and cope with the intense
feelings that are typical of a crisis”

38. AIM:
“For the individual to return to pre-crisis
level of functioning”
OBJECTIVES:
 To provide a correct cognitive perception
of the situation.
 To assist the individual in managing the
intense and overwhelming feelings
associated with the crisis.

39. INTERVENTION:
A) Steps to provide a correct
cognitive perception;
 Assessment of the situation
 Defining the event
 Develop a plan of action

40. B) Steps to assist the victim in managing
the intense feelings;
 Helping the individual to be aware of the
feelings.
 Help the individual to attain mastery over
the feelings.

41. Role of nurse in crisis
intervention:
NURSING ASSESSMENT.
 Precipitating event or stressor
 Patient’s perception of the event or
stressor.
 Nature & strength of the patient’s
support system coping resource.
 Level of psychological stress
 Degree of impairment
 Previous strengths & coping
mechanism.

42. NURSING DIAGNOSIS:
 Ineffective individual coping- refers to
inability to ask help, problem solving or
meet role of expectation.
 Ineffective family coping- occurs when
family’s support systems are not
successful and economic or social well
being is threatened.

43.  Altered family processes- result when
family members are unable to adopt to
the traumatic experience constructively.
 Post- traumatic response- is a sustained
painful response to an overwhelming
traumatic event.

44. PLANNING:
Previously collected data is analyzed
and specific interventions are proposed.
Nurse will undertake the activities like:
 Dynamics underlying the present crisis are
formulated.
 Alternative solutions to the problem are
explored.
 Steps for achieving the solutions are
identified.
 Environmental support, coping
mechanisms need to developed &
strengthened are identified.

45. IMPLEMENTATION:
1. Environmental manipulation.
It includes interventions that directly
change the patients physical or interpersonal
situations which may remove stress or
provide situational supports.
2. General supports.
The nurse uses warmth, acceptance,
empathy & reassurance to provide general
supports to the patients.

46. 3. Generic approach:
 It is design to reach high risk individuals
and large groups as quickly as possible.
 Apply a specific method to all individuals
faced similar type of crisis.
 Debriefing is a method of generic
approach.
 In this, disaster victims are helped to
recall events and clarify traumatic
experience.

47.  It attempts to place the traumatic
experience, allows the individual to
relieve the event in a factual way,
encourages group support and provide
information on normal reaction to critical
events.
 The goals of debriefing is to prevent the
maladaptive response that may result if
the trauma is suppressed.

48. 4. Individual approach:
 It is a type of crisis intervention similar to
diagnosis & treatment of a specific
problem in a specific patient.
 It is particularly useful in combined
situational and maturational crisis, also
beneficial when symptom include
homicidal and suicidal risk.

49. EVALUATION:
 Nurse and patient review the changes that
have occurred.
 Nurse should give credit for successful
changes to patients so that they realize
their effectiveness and understand what
they learnt from crisis may help in coping
with future crisis.
 If goals have not met, return to assessment
and continue through the phases again.