StressNUR101 Fall 2009Lecture #13K. Burger, MSEd, MSN, RN, CNE

PPP by: Sharon Niggemeier RN MSNRevised 10/05,10/07 K. Burger

Stress Stress- condition when a person

responds to change to the normal balanced state

Stressor- anything an individual perceives as challenging, demanding or threatening (causes stress).

Coping responses- response due to threat or challenge (stressor)

Adaptation- change that occurs due to a response from stressor

Why do we study STRESS? Link between stress and health Diseases/conditions linked to stress

Autoimmune disorders: RA, Graves, Colitis PsoriasisCardiovascular disorders: HTN, CANRespiratory disorders: AsthmaGastrointestinal disorders: GERD

Stress directly affects nervous, endocrine, and immune systems

Stress indirectly affects health d/t poor health habits: smoking, drinking, eating too much, not sleeping enough.

Is all stress BAD for you? What about stress of knowing you have an exam

coming up? What about the stress of having to have a job,

raise a family, etc.? What about it’s protective mechanism?

(the stress of crossing a busy street)

DISTRESS (damaging stress)versus

EUSTRESS (motivating and/or protective stress)

Homeostasis Various physiological and

psychological mechanisms respond to changes in the internal and external environment to maintain a balanced state

To maintain health the body’s internal environment needs a balanced state. STRESS upsets this balance!

Physiological Homeostasis Regulating mechanisms of the body

react to change and keep the body in homeostasis

Primarily: Autonomic nervous system (sympathetic) & the endocrine system (epinephrine, cortisol, aldosterone)

Other: cardiovascular,respiratory, GI and renal systems

Physiological Indicators of Stress Pupils dilate Diaphoresis Increased HR/BP Pallor Increased

rate/depth respirations

Dry mouth

Decreased urinary output

Decreased peristalsis

Increased mental alertness

Increased muscle tension

•Intended for short term response to a PHYSICAL stressor

•It is inappropriate (and more harmful ) in response to NON-physical stress

Psychological Homeostasis Need to maintain mental well-being

It uses psychological adaptive behaviors ie: Coping mechanisms and defense mechanisms to return one to an emotionally balanced state

Psychological Indicators of Stress Anxiety

Mild - Panic

Coping Mechanisms(ie: anger, withdrawal, inappropriate laughing and/or crying)

Unconsciousdefense mechanisms

Defense Mechanisms text review

CompensationDenialDisplacementProjectionConversionDisassociation

Rationalization Reaction

formation Regression Repression Undoing

Adaptation to Stress

IF necessary resources are available to deal w/stressor THEN adaptation occurs & balance maintained.

IF resources are not available THEN adaptation doesn’t occur & stress results

Adaptation is individualized

Adaptation to StressFactors in the Process of Adaptation Perception of Event – realistic OR distorted Situational Support – adequate OR not Coping Mechanisms – adequate OR not

Leads to either: Positive resolutionOR Negative resolution

Adaptation: LAS

Local adaptation syndrome (LAS) - localized response of the body to

stress- involves only a specific body part

Short term adaptive response Examples = reflex pain response &

inflammatory response

Adaptation: GAS General adaptation syndrome (GAS) -

response to stress is characterized by a chain of physiological events

Theory developed by Hans Selye

Incorporates 3 stages: alarm reaction, resistance stage & exhaustion stage

GAS: First Stage

Alarm reaction- stressor (threat) activates the body’s various defense mechanisms

Autonomic nervous system responds ….Fight or flight response….. Lasts 1 minute –24hrs

Neuroendocrine activity (sympathetic ) increases

If stressor persists, body proceeds to nest stage - Resistance

GAS: Second Stage Resistance stage- body attempts

to cope with the stressor and brings down neuroendocrine responses – parasympathetic adaptations increase.

If stress can be managed – homeostasis results = Recovery

If stress is too great the third phase of GAS continues = Exhaustion

GAS: Third StageExhaustion stage- adaptation

mechanisms are exhausted. Body energy stores depleted and no

longer able to defend with sympathetic response.

At the end of this stage the body either rests & recovers or death will occur

Effects of Stress Stress can be a stimulus or a

barrier Effects basic human needs:

physiological, Safety/security, Love/belonging, Self-esteem & Self actualization

Effects patient & family Prolonged stress effects ability to

adapt Burnout/crisis

Sources of StressType of Stressors Sources:

developmental or situational

Type of stressors: physiological or psychosocial

Assessing Stress

Identify stress level by using:

Nursing history Physical assessment Standardized tests or rating scales

Focused AssessmentSUBJECTIVE

What is of most concern to you at this time?

What have you done in the past to cope with stress?

Do you smoke, use drugs, caffeine intake?

Do you follow a healthy diet ,exercise regime, see you physician regularly?

Change in eating and/or sleeping habits?

OBJECTIVE Observe for: Non-verbal cues

Eye-contactPostureGrooming/hygiene

Irritability / Tension Developmental level Sociocultural factors VS

Nursing DiagnosisEXAMPLE: Anxiety R/T loss of job AEB inability to

focus, unable to sleep, decreased appetite & states “ I’m so nervous worrying about finding a new job”

What are some others???

Planning Plan to maintain physiological &

psychological homeostasis Develops plan with patient, support

people & others as needed Outcome criteria may include

decreased anxiety, increased ability to cope or improved role performance

ImplementationNursing Interventions

Encourage health promotion strategies: exercise, sleep, proper nutrition, time management, minimizing anxiety, relaxation techniques

Encourage use of support systems May need to make referrals if stress is too

great- crisis intervention

What can nurses do for clients experiencing stressors of hospitalization?

Use calm reassuring approach Explain all procedures Listen attentively Encourage verbalization of feelings Assist client to gain and/or maintain

control of situations as much as possible

Evaluation Use desired outcomes as a guide Observe verbal & nonverbal cues Has goal been met?Example:The client is able to:

-verbalize cause & effect of stress-identify and use supports-practice healthy lifestyle -utilize effective relaxation techniques

Summary Stress affects homeostasis both

physiologically & psychologically Adaptation to stress includes LAS,

GAS, coping & defense mechanisms

Various factors affect stress Nursing process is used to aid

patients dealing with stress