This document provides an outline and summary of a student assignment on stress and coping. It discusses various topics related to stress including the concept of stress, sources of stress, effects of stress, models of stress response, indicators of stress, anxiety vs fear, anger vs depression, ego defense mechanisms, and coping strategies. The assignment was submitted by two students, Nadia Khan and Abubakar, for their Fundamentals of Nursing course taught by Mahwish Younas at Multan Medical Dental & Nursing College in Multan, Pakistan.

2. ASSIGNMENT OF STRESS AND COPING
SUBJACT = FUNDMANTAL OF NURSING
TOPIC = STRESS & COPING
SUBIMMATED BY = NADIA KHAN & ABUBAKAR
ROLL NO = 10 , 2
SECTION = A
SUBMITTED TO = MA’AM MAHWISH YOUNAS
PROGROM = BSN (Generic)
MULTAN MEDICAL DENTAL &NURSING
COLLAGE MULTAN .
REFERENCE = (FON) Written by KOZIER & ERB’S

3. Objective/Topic out line:
1) Concept of stress .
2) Source of stress .
3) Effects of stress .
4) Modal of stress their are three modal of
stress .
(A) Stimulus-based models .
(B)Response-based models .
(C)Transaction-based models .
5) Indicators of stress their of three types .
(A)physiological (B) psychological indicators.

4. (A)physiological indicators.
(B) psychological indicators.
(c) Cognitive indicators.
6)Differentiate between Anxiety & Fear .
7) Differentiate between Anger & Depression .
8)What is Ego Defense Mechanisms .
9)What is coping .
10) Two types of coping strategy .
1) Problem focused Coping
2) Emotion focused Coping
Coping strategies may be involves :
1. Long term coping strategies
2. Short term coping strategies

5. Introduction : stress is universal phenomenon .
All people experience it . Parents refer to the
stress of raising children ,working people talk
of the stress of their job, at students at all
levels talk of the stress of school . stress can
result from both positive and negative
experience .
For example ; A bride preparing for her wedding
, A graduate preparing to start new job.

6. The concept of stress is important
because it provides a way of
understanding the person as a
being who respond in totality (
Mind , body , and spirit ) to a
variety of changes that take
place in daily life .
Concept of stress :
Stress is a condition In which
the person experience changes
in normal balanced state .
Stressor is any event or
stimulus that caused as
individual to experience stress
.

7. When a person face stressors , responses are
referred to as coping strategies ,coping
responses , or coping mechanisms .
Sources of stress :
There are many sources of stress such as
 Internal stressors.
 External stressors.
 Developmental stressors.
 Situational stressors.

8. Internal stressors : internal stressors
originate within person , e.g infection or
feelings of depression.
External stressors : External stressors
originate outside the individual , e.g a move
to another city , a death in the family or
pressure from peers .
Developmental stressors : Developmental
stressors occur at predictable times
throughout an individual’s life .
Situational stressors : Situational stressors are
unpredictable and may occur any time during
life. e.g

9.  Death of a family member .
 Marriage or divorce.
 Births of a child.
 New job.
 Illness.
The degree to which any of these events has
positive and negative effects depends to
some extent on an individual’s developmental
stage. For example
The death of a parent may be more stressful
for a 12 years old than for a 40 years old.

10. Internal stressors

13. Alcohol & job stress

15. Effect of stress
Stress can have Physical, Emotional
,Intellectual , Social and spiritual
consequences.
 Physically stress can threaten a person’s
physiological homeostasis .
 Emotionally stress can produce negative or no
constructive feelings about the self.
 Intellectually stress can influence a person’s
perceptual and problem solving abilities.
 Socially stress can alter a person’s relationship
with others.
 Spiritually stress can challenge one’s beliefs
and values.

17. Three main models of stress
1. Stimulus based
2. Response based
3. Transaction based

18.  Stress is define as a stimulus a life event, or a set
of circumstances that arouses physiologically
and/or psychologically reactions that may
increase the individual’s vulnerability to illness.
 Such as a divorce, pregnancy and retirement. In
this view both positive and negative event are
considered stressful.
 For example, a divorce may be highly traumatic to
one person and cause relatively little anxiety to
another. In addition many scales have not been
tested for age, socioeconomic status or cultural
sensitivity.

19. Stress may also be considered as a response .
This definition was developed and described
by selye (11956, 1976) as “the nonspecific
response of the body to any kind of demand
made upon it”
selye’s stress response is characterized by a
chain or pattern of physiological event called
the general adaptation syndrome(GAS) or
stress syndrome .

20. To differentiate the cause of stress from the
response to stress, selye (1976) used the
term stressor to denote any factor that
produce stress and disturbs the body’s
equilibrium.
Stress can be observed only by the changes it
produce in the body . The response of the
body , the stress syndrome or GAS , occurs
with the release of certain adaptive
hormones and subsequent changes in the
structure and chemical composition of the
body .

21. Effected point :
 Gastrointestinal tract .
 Adrenalin gland .
 Lymphatic structures .
 Deep ulcers appear in the lining of stomach
.
 Adrenal gland enlarge considerably .
Lymphatic structure such as the ( thymus
,spleen , and lymph node) .
In the addition to adaption globally , the
body can also react locally ; that is , one
organ or a part of the body reacts alone .
This is referred to as the Local adaptation
syndrome (LAS) . E.g Inflammation .

22. General adaptation syndrome(GAS) and Local
adaptation syndrome (LAS) have three stage .
1. Alarm reaction .
2. Resistance .
3. Exhaustion .
1 . Alarm reaction : the initial reaction of the
body is the alarm reaction , which alerts the
body’s defense.
Two types of alarm reaction :
1. Shock phase
2. Counter shock phase

24. 1. Shock phase ; the stress may be
perceived consciously or unconsciously by
the person. Stressor stimulate the
sympathetic nervous system, which in turn
stimulate the hypothalamus . The
hypothalamus releasing corticotrophin
releasing hormone , which stimulate anterior
pituitary gland to release
adrenocorticotrophic hormone . During the
time of stress the adrenaline medulla secrets
epinephrine and nor epinephrine in response
to sympathetic stimulation . Significant body
response to epinephrine include the
following .

25.  Increase myocardial contractility, which increase
the cardic output in blood flow to the active
muscle .
 Bronchial dilation which always increase the
oxygen intake.
 Increase the blood clotting .
 Increase the cellular metabolism .
The principal effect of nor epinephrine is decrease
blood to the kidneys in increasing secretion renin
. Renin is an enzyme that hydrolyze one of the
blood proteins to produce angiotensin .
Angiotensin tends to increase the blood pressure
by constricting arterioles . The person is then
ready for “ flight or fight”

26. 2 . Countershock phase : the second
part of the alarm reaction is called
countershock . during this time , the changes
produce in the body during the shock phase
are reverse . Thus , a person is best mobilize
they react during the shock phase of the
alarm reaction.
2. Stage of resistance :
The second stage in the GAS and LAS
syndromes the stage of resistance, in when
the bodies adaptation take place . In other
word ,the body attempts cope with the
stressor and to limit the stressor to the
smallest area of the body that can deal with it
.

28. 3. Stage of exhaustion : during the
third stage , the stage of exhaustion , the
adaptation that the body made during the
second stage cannot be maintain . this means
that the ways used to cope with the stressor
have been exhaustion . If adaptation has not
overcome the stressor , the stress may spread
to the entire body . It the end of this stage ,
the body may either rest and return to the
normal , or death may be ultimate
consiquence .

31. Transactional stress theory encompasses a set of
cognitive, effective , and adaptive coping
response that arise out of the person
environment transaction . The person and the
environment are inseparable; each effects and is
effected the other . Stress “ refers to any event in
which environmental demand , internal demand ,
or both tax are exceed the adaptive resources of
an individual , social system , or tissue system” .
the individual responds to perceived
environmental changes by adaptive or coping
responses.

32. Indicators of an individual’s stress may be
physiological , psychological , or cognitive .
 Physiology indicators : Responses to stress
vary depending on the individuals perception
of events . The physiological signs and
symptoms of stress result from activation of
the sympathetic and neuroendocrine system
of the body . Clinical manifestation lists
physiological indicators of the stress .

33.  Psychological indicator :
psychological manifestations of stress include
anxiety , fear , anger , depression, and
unconscious ego defense mechanisms . Some
of the coping patterns are helpful ; others are a
hindrance , depending on the situation and the
length of time they are used or experienced .
Anxiety and Fear
Anxiety : A state of mental uneasiness ,
apprehension , dread , or a feeling of
helplessness related to an Impending or
anticipated unidentified threat to self or
significant relationships .

34. Anxiety may be manifested on four
levels .
1) Mild anxiety
2) Moderate anxiety
3) Severe anxiety
4) Panic
1. Mild anxiety : produces a slight arousal
that enhances perception , learning ,and
productive abilities .
2.Moderate anxiety : increases the arousal to
a point where the person expresses feelings
of tension , nervousness , or concern .

35. 3. Severe anxiety : consumes most of the
persons energies and requires intervention .
Perception is further decreased . The person ,
unable to focus on what is really happening ,
focuses on only one specific detail of the
situation generating the anxiety .
4.Panic : panic is an overpowering , frightening
level of anxiety causing the person to lose
control .
Fear : Fear is an emotion or feeling of
apprehension aroused by impending or seeming
danger , pain or another perceived threat .

36.  Anxiety and fear differ in four ways:
 The source of anxiety may not be identifiable
; the source of fear is identifiable .
 Anxiety is related to the future that is to an
anticipated event . Fear is related to the past
,present and future .
 Anxiety is vague , whereas fear is definite .
 Anxiety is the result of psychological or
emotional conflict ; fear is the result of
specific of physical or psychological entity.

37. Differentiation between Anger &depression :
Anger :
Anger is an emotional state consisting of a
subjective feeling of animosity or strong
displeasure .
Anger differs from hostility , aggression , and
violence , but at can lead to destructiveness and
violence if the anger persists unabated .
Depression :
Depression is a common reaction to events
that seem overwhelming or negative .
Depression an extreme feeling of sadness ,despair
,dejection , lack of worth , or emptiness ,affects
millions of americans a year .

39. Signs and symptoms
Emotional symptoms :
 Feeling of tiredness .
 Sadness .
 Emptiness or numbness .
Behavioral signs :
 Irritability .
 Inability to concentrate .
 Crying .

40. Physical signs :
 Loss of appetite .
 Weight loss .
 Constipation .
 Headache and dizziness .

41. Ego Defense mechanisms :
Ego defense mechanisms are unconscious
psychological adaptive mechanisms or according
to Anna Freud (1967), mental mechanisms that
develop as the personality attempts to defend
itself , establish , compromises among
conflicting impulses , and calm inner tensions .
Defense mechanisms are the unconscious mind
working to protect the person from anxiety .
They can be considered precursors to conscious
cognitive coping mechanisms that will ultimately
solve the problem . Like some verbal and motor
responses , defense mechanisms release tension
.

42. Cognitive indicators :
cognitive indictors of stress are thinking
response that include
 problem solving .
 structuring .
 self-control or self-discipline.
 Suppression.
 fantasy .

43.  Cognitive problem :
cognitive problem involves thinking
through the threatening situation , using specific
step to arrive at a solution . The person assesses
the situation or problem , analyzes or defines it ,
chooses alternative , carries out the selected
alternative ,and evaluates weather the solution
was successful .
 Structuring :
structuring is the arrangement or
manipulation of a situation so that threatening
events do not occur .

44. For example, a nurse can structure or control an
interview with a client by asking only direct,
structuring can be productive in certain situations .
A person who schedules a dental examination
semiannually to prevent severe dental disease is
using productive structuring.
 Self control (discipline)
Self control (discipline) is assuming a manner and
facial expression that convey a sense of being in
control or in charge.
When self control prevents panic and harmful or
nonproductive action in a threatening situation ,
it is a helpful response that conveys strength.

45.  Suppression
Suppression is consciously and willfully putting
a thought or feeling out of mind . I wont deal
with that today . I will do it tomorrow . This
response relieves stress temporarily but does
not solve the problem . A ma who keeps
ignoring a toothache, pushing it out of his
mind because he fears the pain of having a
filling , will not obtain relief of his symptoms.

46.  Fantasy or daydreaming
Fantasy or daydreaming is linked to make believe
Unfulfilled wishes and desires are imagined ass
fulfilled ,or a threatening experience is reworked
or replayed so that it ends differently from reality
For example : a client who is waiting the results of
a breast biopsy result might say to herself ,Even
if the doctor says , you have cancer , as long as
he also says it can be treated . I can accept that .
Fantasies can be destructive and nonproductive if
a person uses them to excess and retreats from
reality.

48. Coping
Coping may be described as dealing with
change successfully or unsuccessfully . A
coping strategy (coping mechanism) is a natural
or learned way of responding to a changing
environment or specific problem or situation.
According to Folkman and Lazarus (1991)
coping is “the cognitive and behavioral effort to
manage specific external and/or internal
demands that are appraised as taxing or
exceeding the resources of the person.

49. Coping strategies
1) Problem focused Coping
2) Emotion focused Coping
1)Problem focused coping
Problem focused coping refers to efforts to
improve a situation by making changes or taking
some action.
2)Emotion focused Coping
Emotion focused coping includes thoughts and
action that relieve emotional distress. Emotion
focused coping does not improve the situation
but the person often feels better. Both types of
strategies usually occur together (Lazarus2006).

50. Coping strategies may be involves :
1. Long term coping strategies
2. Short term coping strategies
1) Long term coping strategies
Long term coping strategies can be constructive and
practical. For example: In certain situation
talking with others and trying to find out more
about the situation are long term strategies.
Others long term strategies include a change in
lifestyle pattern such as eating a healthy diet ,
exercising regularly ,balancing leisure time with
working , or using problem solving in decision
making instead of anger or other non constructive
responses.

51. 2) Short term coping strategies
Short term coping strategies can reduce stress
a tolerable limit temporarily but are
ineffective ways permanently deal with reality
. they may even have a destructive
detrimental effect on the person. Example of
short term strategies are using alcoholic
beverages or drugs daydreaming and
fantasizing ,relying on the belief that
everything will work out, and giving in to
others to avoid anger.

52. Coping can be
A. Adaptive coping :
B. Maladaptive coping :
A .Adaptive coping :
Adaptive coping helps the person to deal
effective with stressful events and minimizes
distress associated with them .
B .Maladaptive coping :
Maladaptive coping can result in
unnecessary distress for the person and others
associative with the person or stressful event .

53. In nursing literature , Effective and Ineffective
coping are often differentiated .
Effective coping : is results in
adaptation ;
Ineffective coping : is result in
maladaptation.
Although the coping behavior may not always
seem appropriate , the nurse needs to
remember that coping is always purposeful .
The effectiveness of an individual’s coping is
influenced by a number of factors , including :

54.  The number , duration , and intensity of the
stressor .
 Past experiences of the individual .
 Support systems available to the individual .
 Personal qualities of the person .
caregiver burden
If the duration of the stressor is extended
beyond the coping powers of the individual ,
that person becomes exhausted and may
develop increased susceptibility to health
problem .

55. Reaction to long –term stress is seen in family
members who undertake the care of a person in
home for a long period . This stress is called
caregiver burden and produces responses
such as chronic fatigue , sleeping difficulties
and high blood pressure . Prolonged stress
can also result in mental illness . A coping
strategies or defense mechanisms become
ineffective , the individual may have
interpersonal problem , work difficulties ,and a
significant decrease in the ability to meet basic
human need.

56. Assessmen
t
Diagnosis planning Implementi
ng
Rational Evalution
Subjective
data
Short term
goal
Independen
t
She
verbalized
that she
found lump
in her right
breast 1
week ago
.she and
her
husband
are
extremely
anxious
about the
surgery .
She feel
pain in her
right
Ineffective
coping r/t
personal
vulnerabili
ty
secondary
mastecto
my .
 Decrease
or
resolve
anxiety .
 Increase
ability to
manage
or cope
with
stressful
events or
circumst
ances .
 Improve
role
performa
nce .
Regular
exercise to
promote
both
physical
and
emotional
health .
Nutritional
is essential
for health
and in
increasing
the body’s
resistance
to stress.
Avoid
excessive of
To improve
muscle
tone &
relief of
tension .
To
minimize
the
negative
effects of
stress .
To reduce
the
infection
and pain .
After 1
week ,
nurse
collect data
needed to
determined
and client
goal and
out come
have been
achieved .

57. Objective
data
Long term
goal
Dependent
Temp
=98.6F
Pulse=
88R/M
Respiration
=
16/min
B.P =
142/82mm
hg.
 Physical
exercise .
 Optimal
nutrition .
 Adequate .
 Rest
&sleep .
 Time
management
.
Use antibiotic
and pain killer
as per doctor
order
Nurse
develops plans
in
collaboration
with the client
& significance
support
people , when
possible
according to
the client’s
state of health
collaborat
ion