S TRESS NUR101 Fall 2010 Lecture #13 K. Burger, MSEd, MSN, RN, CNE PPP by: Sharon Niggemeier RN MSN Revised 10/05,10/07,10/10 K. Burger

S TRESS Stress- condition when a person responds to a change in their 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

W HY DO WE STUDY STRESS? There are Links between stress and health Some diseases/conditions linked to stress: Autoimmune disorders: RA, Graves, Colitis, Psoriasis Cardiovascular disorders: HTN, CAN Respiratory disorders: Asthma Gastrointestinal 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.

I S ALL STRESS BAD FOR YOU ? NO….consider the following: Stress of knowing you have an exam coming up? Stress of having to have a job, raise a family, etc.? What about it’s protective mechanism? (the stress of crossing a busy street) NOTE the difference between: DISTRESS (damaging stress) EUSTRESS (motivating and/or protective stress)

H OMEOSTASIS 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!

P HYSIOLOGICAL H OMEOSTASIS 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

P HYSIOLOGICAL I NDICATORS OF S TRESS 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 (more harmful ) in response to NON-physical stress

F IGHT OR F LIGHT R ESPONSE

P SYCHOLOGICAL H OMEOSTASIS 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

P SYCHOLOGICAL I NDICATORS OF S TRESS Anxiety Mild - Panic Coping Mechanisms (ie: anger, withdrawal, inappropriate laughing and/or crying) Unconscious defense mechanisms

D EFENSE M ECHANISMS TEXT REVIEW Compensation Denial Displacement Projection Conversion Rationalization Reaction formation Regression Repression Undoing

A DAPTATION TO S TRESS 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

A DAPTATION TO S TRESS Factors 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 resolution OR  Negative resolution

A DAPTATION : 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

A DAPTATION : 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: F IRST S TAGE 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 next stage - Resistance

GAS: S ECOND S TAGE 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: T HIRD S TAGE Exhaustion 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

E FFECTS OF S TRESS Stress can be a stimulus or a barrier Affects basic human needs: Physiological, Safety/security, Love/belonging, Self- esteem & Self actualization Affects patient & family Prolonged stress affects ability to adapt Burnout/crisis

S OURCES OF S TRESS T YPE OF S TRESSORS Sources: Developmental – teen yrs, midlife crisis Situational – new job, illness Types of stressors: physiological or psychosocial

A SSESSING S TRESS Identify stress level by using: Nursing history Physical assessment Standardized tests or rating scales

F OCUSED A SSESSMENT SUBJECTIVE 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-contact Posture Grooming/hygiene Irritability / Tension Developmental level Sociocultural factors VS

N URSING D IAGNOSIS EXAMPLE: 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??? Ineffective coping Decisional conflict Disturbed thought processes Disturbed sleep pattern Relocation stress syndrome

P LANNING 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

I MPLEMENTATION N URSING I NTERVENTIONS 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

W HAT 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

E VALUATION 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

S UMMARY 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

D R. B EVERLY M ALONE ’ S S TRESS D EFINITION – NLN CEO Inevitable: Aging, Illness, Death Imposed: Outside stress from other people. Someone gives you this stress and YOU receive it { agree to accept it } Chosen: We make for ourselves. We often forget we actually chose it. Stress of nursing school – it was your idea to enroll – yes??