Stress NUR101 Fall 2009 Lecture #13 K. Burger, MSEd, MSN, RN, CNE PPP by: Sharon Niggemeier RN MSN Revised 10/05,10/07 K. Burger
Dec 28, 2015
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