1. 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

2. 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

3. Why do we study STRESS?  Link between stress and health  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.

4. 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)

5. 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!

6. 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

7. 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

8. 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

9. Psychological Indicators of Stress  Anxiety Mild - Panic  Coping Mechanisms (ie: anger, withdrawal, inappropriate laughing and/or crying)  Unconscious defense mechanisms

10. Defense Mechanisms text review  Compensation  Denial  Displacement  Projection  Conversion  Disassociation  Rationalization  Reaction formation  Regression  Repression  Undoing

11. 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

12. Adaptation to Stress 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

13. 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

14. 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

15. 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

16. 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

17. GAS: Third Stage  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

18. 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

19. Sources of Stress Type of Stressors  Sources: developmental or situational  Type of stressors: physiological or psychosocial

20. Assessing Stress  Identify stress level by using:  Nursing history  Physical assessment  Standardized tests or rating scales

21. Focused Assessment 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

22. Nursing Diagnosis 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???

23. 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

24. Implementation Nursing 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

25. 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

26. 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

27. 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