53 a focus 7 stress adaptation process

1. 9/15/2010
1
NURSING FUNDAMENTALS
FOCUS IV
Stress Adaptation Process
•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
•Discuss the effects of prolonged exposure to stress
•List some of the ways to reduce or manage stress
OBJECTIVES
STRESS STRESS
DISORDERS CAUSED BY STRESS
(From Health and Wellness: A Holistic
Approach, 9th ed. (p. 46), by G. Edlin
and E. Golanty, 2007, Boston: Jones &
Bartlett. Adapted with permission.)
Stress?
Stressor?
STRESS AND STRESSORS

2. 9/15/2010
2
Coping Strategies
Coping Responses
Coping Mechanisms
RESPONSES TO STRESS
Factors influencing response to stress:
•Psychological
•coping, control, emotions, beliefs
•Physiological
•injuries, illness, infection, substances
•Social
•support, status, education
•Environmental
•pollution, hazards, extremes in temperatures
RELATIONSHIP BETWEEN STRESS
AND STRESSORS
•Internal
•Infection
•Depression
•External
•A move, a death, pressure from peers
•Developmental
•Predictable
•Situational
•Unpredictable - may be positive or negative
SOURCES OF STRESS
•Affects the Whole Person
•Physically
•Threatens homeostasis
•Emotionally
•Negative feelings toward self
•Intellectually
•Perceptual and Problem-solving abilities
•Socially
•Relationships can be affected
•Spiritually
•Challenges beliefs and values
EFFECTS OF STRESS
•Stimulus-based models
•Response-based models
•Transaction-based models
CONCEPTS REGARDING
STRESS
•Stress defined as a stimulus, a life event, or set of
circumstances that arouses physiologic/psychologic
reaction
•This stress may increase vulnerability to illness
•Both positive and negative events considered stressful
•Original work K Holmes and Rahe - 1967
STIMULUS-BASED MODELS

3. 9/15/2010
3
•Stress may be considered a response
•Selye (1956, 1976) defined as nonspecific
response of body to any kind of demand
made upon it
RESPONSE BASED MODELS
•Based on work of Lazarus (1966)
•Set of cognitive, affective, and adaptive (coping)
responses
•arise out of person-environment transactions
•Person and environment are inseparable
•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
TRANSACTION BASED MODELS
•Dr. Hans Selye - 1907-1982
•Endocrinologist
•Director of Medicine and Surgery @
University of Montreal until 1976
•Founded the Institute of Stress 1977
•General Adaptation Syndrome Theory
•Based on experimentation with rats
•Chain or pattern of physiologic events
GENERAL ADAPTATION SYNDROME
THEORY
•Differentiates cause of stress from the response
of stress
•Stressor
•Produces stress
•Disturbs bodyVs equilibrium
•Stress is state of the body
•Observed by changes produced in body
•Hormones released
•Body changes in structure and chemical composition
•GI tract, Adrenal glands, lymphatic structures
GENERAL ADAPTATION SYNDROME (GAS )
•Body can also react locally
•One organ or part of body
•Inflammation
•3 stages of GAS and LAS
LOCAL ADAPTATION SYNDROME
(LAS)
•Generalized Adaptation Syndrome
•Alarm Reaction
•short term, acute, response
•Resistance
•intermediate hormonal response
•Exhaustion
•prolonged worry/fatigue/breakdown
PHYSIOLOGIC RESPONSE TO
STRESS

4. 9/15/2010
4
SELYE;S GENERAL ADAPTATION
SYNDROME
•Body defenses alerted
•Shock phase
•Counter shock phase
ALARM REACTION ALARM 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.)
Resistance!
Attempts to Adapt
STAGE 2
Exhaustion!
Resources gone!!!
STAGE 3

5. 9/15/2010
5
SELYE DIAGRAM
Pupils dilate
Sweat production increases
Heart rate and cardiac
output increase
Skin is pallid
Sodium and water retained
Rate and depth of
respiration increase
Urinary output decreases
Mouth may be dry
Peristalsis of the intestines
decrease for serious
threats
Mental alertness improves
Blood sugar increases
PHYSIOLOGIC INDICATORS
•Anxiety
•Fear
•Anger
•Depression
•Unconscious ego defense
mechanisms
PSYCHOLOGIC RESPONSE TO STRESS
•Problem solving
•Structuring
•Self-control or self-discipline
•Suppression
•Fantasy
COGNITIVE INDICATORS
LAS Characteristics:
Localized response does not involve body systems
The response is adaptive, stress is needed to stimulate
it
The response is short term.
The response is restorative LAS is in business of
assisting in homeostasis to the body region or part.
PHYSIOLOGIC RESPONSE TO STRESS

6. 9/15/2010
6
•Dr. Robert Ader coined the concept in 1975
•Director of the Behavioral and Psychosocial Medicine
at New York University of Rochester.
•Dr Ader believes there is a link between our state of mind,
our health and our ability to heal ourselves.
•He carried out his primary experimentation on mice with saccharin.
PSYCHONEUROIMMUNOLOGY
(PNI)
•Concerned with the interrelationship
between the brain, behavior and
the immune system.
•Neuro-psychological, neuro-anatomic
and psychosocial studies have
demonstrated their role in
accentuating or diminishing
immune/allergic responses
PSYCHONEUROIMMUNOLOGY
Negative States Physiologic Reaction
Bereavement Decreased lymphocyte proliferation
Pessimistic states Decreased lymphocyte reactivity; decreased T-cell effectiveness
Academic stress Decreased NK cell activity; decreased T-cells; decrease in certain
immune chemicals; increased susceptibility to herpes virus;
decreased immunoglobulin A; increased blood levels of Epstein-
Barr virus.
Depression Decreased T-cells; decreased number and function of
lymphocytes; decreased NK cells.
Loneliness Decreased NK (Natural Killer Cell) activity
Chronic stress Decreased T-cells; decreased NK cells; decreased B-cells;
increased blood levels of Epstein-Barr virus
Divorce/separation/
poor marital quality
Decreased lymphocyte function; increased blood levels of
Epstein-Barr virus; decreased T-cell effectiveness.
Expressed need for
power and control
Decreased NK activity; decreased lymphocytes
PSYCHONEUROIMMUNOLOGY PSYCHONEUROIMMUNOLOGY
Positive
Satisfying personal
relationships and social
support
Increased lymphocyte function; increased NK activity;
increased immunity by mitogen tests; increased immune
response to hepatitis B vaccine
Personal sharing and
disclosure of traumatic
experiences
Increased lymphocyte response
Humor and laughter Increased Immunoglobulin A; increased lymphocyte count
and activity
Hypnosis and relaxation
techniques
Increased T-cell effectiveness; increased NK cell activity;
decreased blood levels of stress hormones; decreased blood
levels of herpes virus
Physical exertion and
aerobic exercise
Increased number of white blood cells; increase in
endorphins; increase in certain immune chemicals; increased
NK cell number and activity; increased T-cells; decreased T-
cell effectiveness; decreased lymphocyte function
Group intervention and
support
Increased NK cell number and activity; increased number of
lymphocytes; decrease in T-helper cells
ANXIETY
Mild
Moderate
Severe
Panic
Nursing approaches
http://www1.us.elsevierhealth.com/Evolve/Ackley/NDH6e/Constructor/index.cfm?plan=4
PSYCHOLOGICAL RESPONSE TO STRESS
•Mild Anxiety
•State of slight arousal
•increases perception, learning, productive abilities
•seeking information and asking questions
STAGES OF ANXIETY

7. 9/15/2010
7
•Increased state of arousal
•Feelings of tension, nervousness, concern
•Focuses on a particular aspect of a situation
•Slight increased RR and HR
•Mild gastric symptoms
MODERATE ANXIETY
•Communication that is
difficult to understand
•Increased motor
activity
•Inability to relax
•Fearful facial
expression
•Inability to focus or
concentrate
•Easily distracted
•Severely impaired
learning
•Tachycardia
•Hyperventilation
•Headache
•Dizziness
•Nausea
SEVERE ANXIETY
•Communication not
understandable
•Increased motor activity
•Agitation
•Unpredictable responses
•Trembling
•Poor motor coordination
•Overpowering, Frightening
•Person loses control
•Can distort events
•Perception distorted or
exaggerated
•Inability to learn or function
•Dyspnea, palpitations,
choking
•Chest pain/pressure
•Feeling of impending doom
•Paresthesia, sweating
PANIC
Physiological effect
hypertension
cardiovascular disorders
migraine and tension headaches
cancer
arthritis
respiratory disease
ulcers
colitis
muscle tension problems
PROLONGED EXPOSURE TO STRESS
•Psychological effect
•anxiety
•panic attack
•depression
•adjustment disorders
•Behavioral effects
•conduct disorders
•eating disorders
•alcoholism
•hypochondria
PROLONGED EXPOSURE TO STRESS
Physical data
Increased heart rate
Increased BP
Palpitations
Headaches
Muscle tension
GI disturbances
Sleep disturbance
Unusual fatigue
Restlessness
Psychosocial data
Anger, loss of temper
Helplessness
Powerlessness
Resistance to treatment regimen
and or testing
Overuse of drugs
Withdrawn
Nervousness
Irritability
Complaints of anxiety
Over excited
ASSESSMENT

8. 9/15/2010
8
Ineffective coping
http://www1.us.elsevierhealth.com/Evolve/Ackley/NDH6e/Constructor/index.cfm?plan=14
Ineffective denial
Ineffective family coping
Fear
http://www1.us.elsevierhealth.com/Evolve/Ackley/NDH6e/Constructor/index.cfm?plan=19
Isolation
Physical dependency
Loss of control
Stress related to hospitalization
Sleep pattern disturbance
http://www1.us.elsevierhealth.com/Evolve/Ackley/NDH6e/Constructor/index.cfm?plan=4
NURSING DIAGNOSIS
Physiological Evidence of Anxiety
Stressor itself
Hospitalization
Surgery
Diagnosis
Fiscal responsibilities
RELATED FACTORS ^
Measurable short term and long term goal
is set to measure a change in behavior.
Behavior + change + timeframe
GOAL SETTING
•Nursing History
•Client-perceived stressors or stressful incidents
•Manifestations of stress
•Past and present coping strategies
•Developmental transitions
ASSESSING STRESS AND COPING
PATTERNS

9. 9/15/2010
9
•Assessment interview
•Scale to rate specific stressors
•Duration of stressful situation
•Usual strategy for handling stressful
situations
•Effectiveness of these strategies
ASSESSING STRESS AND COPING
PATTERNS
•Physical Examination
•Verbal
•Motor
•Cognitive
•Other physical manifestations of stress
ASSESSING STRESS AND COPING
PATTERNS
•Interventions to increase coping skills
•Enhance social supports
•Protecting vulnerable self
•Practicing adaptive thinking
•Gaining control through knowledge
•Interventions to aid in effectively manage stressors
•Stress management skills
INTERVENTIONS
•Education
•Provide accurate
information
•Positive attitude
•Reducing stress
•Relaxation
•Exercise
•Diet
•Eliminate negative beliefs &
emotions
•fear, rage, anger, guilt
•Forgiveness
•Problem solving
•creating positive future
goals
•Positive visual imagery
•+ commands and
instructions to the body
FACTORS INVOLVED WITH HEALING
•Other methods include:
•Listen attentively
•Provide atmosphere of warmth and trust
•Convey sense of caring and empathy
•Include client in plan of care
•Promote feeling of safety and security
•Minimize additional stressors
•Help with recognition of stressors and coping mechanisms
REDUCING CLIENT STRESS
•Audio Glossary
•American Institute of Stress
•Understanding the role of stress in health and illness
•Georgia Reproductive Specialists
•Stress management, definition, and coping with stress
•Mind Tool
•Stress management techniques
•Health Education
•Web book containing medical information on stress, depression, and anxiety
•National Center for Post-Traumatic Stress
•Site to advance the clinical care and social welfare of America's veterans through
research, education, and training in the science, diagnosis, and treatment of PTSD
and stress-related disorders
RESOURCES

10. 9/15/2010
10
•International Society for Traumatic Stress Studies
•Home page for the International Society for Traumatic Stress Studies (ISTSS), the world's
premier trauma organization dedicated to trauma treatment, education, research, and
prevention.
•What You Need To Know About
•Articles, chats, and tips for overcoming stress
•Center for Anxiety & Stress Treatment
•Tips for relieving stress
•Centers for Disease Control and Prevention, National Institute for
Occupational Safety and Health
•Information on causes of stress at work and ways to prevent stress
•Internet Mental Health
•Diagnostic and treatment articles on stress
RESOURCES BIBLIOGRAPHY
Berman, A., Snyder, S., Kozier, B, & Erb, G. (2008), Kozier & Erb’s
Fundamentals of Nursing: Concepts, Process, and Practice.(8
th
ed). New
Jersey. Prentice Hall Publishing.
Harkreader H.& Hogan.M. (2004)The Fundamentals of Nursing Caring and
Clinical Judgment (2
nd
ed.) St. Louis MO:Saunders
Ignatavicius D., Workman M, et al (1995) Medical Surgical Nursing: a Nursing
Process Approach(2
nd
ed.)
Philadelphia PA : Saunders
Reference: Kiecolt-Glaser, J.K., Garner, W., Speicher, C.E., Penn, G., and Vlaser, R.
"Psychosocial Modifiers of Immunocompetence in Medical Students." Psychosomatic
Medicine 46 (1984