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stress adaptation process


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stress adaptation process

  1. 1. 9/15/2010 NURSING FUNDAMENTALS OBJECTIVES FOCUS IV • Explain the relationship between stress and stressors • Identify the physiological behaviors (responses) to stress and the endocrine actions responsible for the behavior • Describe the psychological responses to stress Stress Adaptation Process • Discuss the effects of prolonged exposure to stress • List some of the ways to reduce or manage stress STRESS STRESS DISORDERS CAUSED BY STRESS STRESS AND STRESSORS Stress? Stressor?(From Health and Wellness: A HolisticApproach, 9th ed. (p. 46), by G. Edlinand E. Golanty, 2007, Boston: Jones &Bartlett. Adapted with permission.) 1
  2. 2. 9/15/2010 RELATIONSHIP BETWEEN STRESS AND STRESSORS RESPONSES TO STRESS Factors influencing response to stress: PsychologicalCoping Strategies • • coping, control, emotions, beliefs • PhysiologicalCoping Responses • injuries, illness, infection, substances • Social • support, status, educationCoping Mechanisms • Environmental • pollution, hazards, extremes in temperatures SOURCES OF STRESS EFFECTS OF STRESS • Affects the Whole Person• Internal • Physically • Infection • Threatens homeostasis • Depression • Emotionally• External • Negative feelings toward self • Intellectually • A move, a death, pressure from peers • Perceptual and Problem-solving abilities• Developmental • Socially • Predictable • Relationships can be affected• Situational • Spiritually • Unpredictable - may be positive or negative • Challenges beliefs and values CONCEPTS REGARDING STRESS STIMULUS-BASED MODELS• Stimulus-based models • Stress defined as a stimulus, a life event, or set of circumstances that arouses physiologic/psychologic• Response-based models reaction• Transaction-based models • This stress may increase vulnerability to illness • Both positive and negative events considered stressful • Original work –– Holmes and Rahe - 1967 2
  3. 3. 9/15/2010 TRANSACTION BASED MODELS RESPONSE BASED MODELS • Based on work of Lazarus (1966) • Stress may be considered a response • Set of cognitive, affective, and adaptive (coping) responses • Selye (1956, 1976) defined as nonspecific • arise out of person-environment transactions response of body to any kind of demand • Person and environment are inseparable made upon it • each affects and affected by the other • Stress • any event in which environmental and/or internal demands tax adaptive resources of individual, social system, or tissue system GENERAL ADAPTATION SYNDROME GENERAL ADAPTATION SYNDROME (GAS) THEORY• Dr. Hans Selye - 1907-1982 • Differentiates cause of stress from the response of stress • Endocrinologist • Stressor • Director of Medicine and Surgery @ University of Montreal until 1976 • Produces stress • Disturbs body’’s equilibrium• Founded the Institute of Stress 1977 • Stress is state of the body• General Adaptation Syndrome Theory • Observed by changes produced in body • Based on experimentation with rats • Hormones released • Chain or pattern of physiologic events • Body changes in structure and chemical composition • GI tract, Adrenal glands, lymphatic structures LOCAL ADAPTATION SYNDROME PHYSIOLOGIC RESPONSE TO (LAS) STRESS • Generalized Adaptation Syndrome • Body can also react locally • Alarm Reaction • One organ or part of body • short term, acute, response • Inflammation • Resistance • intermediate hormonal response • Exhaustion • 3 stages of GAS and LAS • prolonged worry/fatigue/breakdown 3
  4. 4. 9/15/2010 SELYE’’S GENERAL ADAPTATION SYNDROME ALARM REACTION ALARM PHASE • Body defenses alerted • Shock phase • Counter shock phase (From Wellness: Concepts and Application, 6th ed. (p. 298), by D. J. Anspaugh, M. Hamrick, and F. D. Rosato, 2005, New York: McGraw-Hill. Reprinted with permission.) STAGE 2 STAGE 3Resistance! Exhaustion! Attempts to Adapt Resources gone!!! 4
  5. 5. 9/15/2010 SELYE DIAGRAM PHYSIOLOGIC INDICATORS Pupils dilate Urinary output decreases Sweat production increases Mouth may be dry Heart rate and cardiac Peristalsis of the intestines output increase decrease for serious Skin is pallid threats Sodium and water retained Mental alertness improves Rate and depth of Blood sugar increases respiration increase PSYCHOLOGIC RESPONSE TO STRESS • Anxiety • Fear • Anger • Depression • Unconscious ego defense mechanisms PHYSIOLOGIC RESPONSE TO STRESS COGNITIVE INDICATORS LAS Characteristics:• Problem solving Localized response does not involve body systems• Structuring The response is adaptive, stress is needed to stimulate• Self-control or self-discipline it The response is short term.• Suppression The response is restorative LAS is in business of• Fantasy assisting in homeostasis to the body region or part. 5
  6. 6. 9/15/2010 PSYCHONEUROIMMUNOLOGY PSYCHONEUROIMMUNOLOGY (PNI) • Concerned with the interrelationship• Dr. Robert Ader coined the concept in 1975 between the brain, behavior and the immune system.• Director of the Behavioral and Psychosocial Medicine • Neuro-psychological, neuro-anatomic at New York University of Rochester. and psychosocial studies have demonstrated their role in• Dr Ader believes there is a link between our state of mind, accentuating or diminishing our health and our ability to heal ourselves. immune/allergic responses• He carried out his primary experimentation on mice with saccharin. PSYCHONEUROIMMUNOLOGY PSYCHONEUROIMMUNOLOGY Negative States Physiologic Reaction Positive Bereavement Decreased lymphocyte proliferation Satisfying personal Increased lymphocyte function; increased NK activity; relationships and social increased immunity by mitogen tests; increased immune Pessimistic states Decreased lymphocyte reactivity; decreased T-cell effectiveness support response to hepatitis B vaccine Academic stress Decreased NK cell activity; decreased T-cells; decrease in certain Personal sharing and Increased lymphocyte response immune chemicals; increased susceptibility to herpes virus; disclosure of traumatic decreased immunoglobulin A; increased blood levels of Epstein- experiences Barr virus. Humor and laughter Increased Immunoglobulin A; increased lymphocyte count Depression Decreased T-cells; decreased number and function of and activity lymphocytes; decreased NK cells. Hypnosis and relaxation Increased T-cell effectiveness; increased NK cell activity; Loneliness Decreased NK (Natural Killer Cell) activity techniques decreased blood levels of stress hormones; decreased blood levels of herpes virus Chronic stress Decreased T-cells; decreased NK cells; decreased B-cells; increased blood levels of Epstein-Barr virus Physical exertion and Increased number of white blood cells; increase in aerobic exercise endorphins; increase in certain immune chemicals; increased Divorce/separation/ Decreased lymphocyte function; increased blood levels of NK cell number and activity; increased T-cells; decreased T- poor marital quality Epstein-Barr virus; decreased T-cell effectiveness. cell effectiveness; decreased lymphocyte function Expressed need for Decreased NK activity; decreased lymphocytes Group intervention and Increased NK cell number and activity; increased number of power and control support lymphocytes; decrease in T-helper cells PSYCHOLOGICAL RESPONSE TO STRESS STAGES OF ANXIETY ANXIETY • Mild Anxiety Mild • State of slight arousal Moderate • increases perception, learning, productive abilities Severe • seeking information and asking questions Panic Nursing approaches 6
  7. 7. 9/15/2010 MODERATE ANXIETY SEVERE ANXIETY • Increased state of arousal • Communication that is • Easily distracted • Feelings of tension, nervousness, concern difficult to understand • Severely impaired • Increased motor learning • Focuses on a particular aspect of a situation activity • Tachycardia • Slight increased RR and HR • Inability to relax • Hyperventilation • Mild gastric symptoms • Fearful facial • Headache expression • Inability to focus or • Dizziness concentrate • Nausea PROLONGED EXPOSURE TO STRESS PANIC Physiological effect• Communication not • Perception distorted or hypertension understandable exaggerated• Increased motor activity cardiovascular disorders • Inability to learn or function• Agitation migraine and tension headaches • Dyspnea, palpitations,• Unpredictable responses choking cancer• Trembling arthritis • Chest pain/pressure• Poor motor coordination respiratory disease• Overpowering, Frightening • Feeling of impending doom • Paresthesia, sweating ulcers• Person loses control• Can distort events colitis muscle tension problems ASSESSMENT PROLONGED EXPOSURE TO STRESS Physical data Psychosocial data Increased heart rate Anger, loss of temper Increased BP Helplessness• Psychological effect • Behavioral effects Palpitations Powerlessness • anxiety • conduct disorders Headaches Resistance to treatment regimen • panic attack Muscle tension and or testing • depression • eating disorders GI disturbances Overuse of drugs Withdrawn • adjustment disorders • alcoholism Sleep disturbance Unusual fatigue Nervousness • hypochondria Restlessness Irritability Complaints of anxiety Over excited 7
  8. 8. 9/15/2010 NURSING DIAGNOSIS Ineffective coping Ineffective denial Ineffective family coping Fear Isolation Physical dependency Loss of control Stress related to hospitalization Sleep pattern disturbance Physiological Evidence of Anxiety RELATED FACTORS …… Stressor itself Hospitalization Surgery Diagnosis Fiscal responsibilities GOAL SETTING ASSESSING STRESS AND COPING PATTERNSMeasurable short term and long term goal • Nursing History is set to measure a change in behavior. • Client-perceived stressors or stressful incidents • Manifestations of stress • Past and present coping strategies Behavior + change + timeframe • Developmental transitions 8
  9. 9. 9/15/2010 ASSESSING STRESS AND COPING ASSESSING STRESS AND COPING PATTERNS PATTERNS • Assessment interview • Physical Examination • Scale to rate specific stressors • Verbal • Duration of stressful situation • Motor • Cognitive • Usual strategy for handling stressful • Other physical manifestations of stress situations • Effectiveness of these strategies INTERVENTIONS FACTORS INVOLVED WITH HEALING• Interventions to increase coping skills • Education • Eliminate negative beliefs & • Enhance social supports emotions • Provide accurate information • fear, rage, anger, guilt • Protecting vulnerable self • Positive attitude • Forgiveness • Practicing adaptive thinking • Problem solving • Reducing stress • Gaining control through knowledge • creating positive future • Relaxation • Interventions to aid in effectively manage stressors goals • Exercise • Positive visual imagery • Stress management skills • Diet • + commands and instructions to the body RESOURCES REDUCING CLIENT STRESS • Audio Glossary • Other methods include: • American Institute of Stress • Understanding the role of stress in health and illness • Listen attentively • Georgia Reproductive Specialists • Provide atmosphere of warmth and trust • Stress management, definition, and coping with stress • Convey sense of caring and empathy • Mind Tool • Include client in plan of care • Stress management techniques • Health Education • Promote feeling of safety and security • Web book containing medical information on stress, depression, and anxiety • Minimize additional stressors • National Center for Post-Traumatic Stress • Help with recognition of stressors and coping mechanisms • Site to advance the clinical care and social welfare of Americas veterans through research, education, and training in the science, diagnosis, and treatment of PTSD and stress-related disorders 9
  10. 10. 9/15/2010 RESOURCES BIBLIOGRAPHY• International Society for Traumatic Stress Studies Berman, A., Snyder, S., Kozier, B, & Erb, G. (2008), Kozier & Erb’s • Home page for the International Society for Traumatic Stress Studies (ISTSS), the worlds Fundamentals of Nursing: Concepts, Process, and Practice. (8th ed). New premier trauma organization dedicated to trauma treatment, education, research, and Jersey. Prentice Hall Publishing. prevention. Harkreader H.& Hogan.M. (2004) The Fundamentals of Nursing Caring and• What You Need To Know About Clinical Judgment (2nd ed.) St. Louis MO:Saunders • Articles, chats, and tips for overcoming stress Ignatavicius D., Workman M, et al (1995) Medical Surgical Nursing: a Nursing• Center for Anxiety & Stress Treatment Process Approach (2nd ed.) Philadelphia PA : Saunders • Tips for relieving stress Reference: Kiecolt-Glaser, J.K., Garner, W., Speicher, C.E., Penn, G., and Vlaser, R.• Centers for Disease Control and Prevention, National Institute for "Psychosocial Modifiers of Immunocompetence in Medical Students." Psychosomatic Occupational Safety and Health Medicine 46 (1984 • Information on causes of stress at work and ways to prevent stress• Internet Mental Health • Diagnostic and treatment articles on stress 10