1. All YOU EVER WANTED TO KNOW ABOUT STRESS
Psychiatric Mental Health Nursing
Eve Karpinski, APHN-BC, RN-BC
Lecture 1

2. Your psychiatric book does not have a chapter on Stress Adaptation.
Review notes below.
Visit youtube.
LEARNING OBJECTIVES
After reading this chapter, the student will be able to:
3. Explain the relationship between stress and “diseases of adaptation.”
2. Identify physiological responses to stress.
1. Define adaptation and maladaptation.
5. Explain the concept of stress as a transaction between the individual and the
4. Describe the concept of stress as an environmental event.
KEY TERMS CORE CONCEPTS
6. Discuss adaptive coping strategies in the management of stress.
environment.
“fight or flight syndrome” adaptation
predisposing factors
precipitating event stressor
general adaptation syndrome maladaptation
I. Introduction
CHAPTER OUTLINE/LECTURE NOTES
homeostasis to the internal environmental system. This includes responses
B. Adaptation as a healthy response to stress has been defined as restoration of
A. The word stress lacks a definitive definition.
directed at stabilizing internal biological processes and psychological preservation
integrity of the individual is disrupted.
C. Maladaptive responses are perceived as negative or unhealthy and occur when the
of self-identity and self-esteem.
A. This definition of stress is a result of research by Hans Selye. He defined stress
II. Stress as a Biological Response
syndrome.”
syndrome of physical symptoms has come to be known as the “fight or flight
as a “non-specific response by the body to any stressor placed upon it.” This
B. Selye called this general reaction of the body to stress the general adaptation
“fight or flight” syndrome are initiated.
1. Alarm reaction stage. During this stage, the physiological responses of the
syndrome (GAS). He described the reaction in three distinct stages:
first stage as a defense in the attempt to adapt to the stressor. If adaptation
2. Stage of resistance. The individual uses the physiological responses of the
3. Stage of exhaustion. Occurs when there is a prolonged exposure to the
disappear.
occurs, the third stage is prevented or delayed. Physiological symptoms may
stressor to which the body has become adjusted. The adaptive energy is
and, without intervention for reversal, exhaustion and even death can ensue.
adaptation described in the first two stages. Disease of adaptation may occur,
depleted, and the individual can no longer draw from the resources for
1. The initial stress response
C. The “Fight or Flight Syndrome”
b. The adrenal medulla releases epinephrine and norepinephrine into the
turn stimulates the adrenal medulla.
a. The hypothalamus stimulates the sympathetic nervous system, which in
bloodstream.
d. In the respiratory system, the bronchioles and pulmonary blood vessels are
lacrimal glands.
c. Changes in the eye include pupil dilation and increased secretion from the
e. Changes in the cardiovascular system result in increases in force of
dilated and the respiration rate is increased.
secretions. Sphincters are contracted.
f. The gastrointestinal (GI) system undergoes decreases in motility and
contraction, cardiac output, heart rate, and blood pressure.
g. Effects on the liver result in increased glycogenolysis and gluconeogenesis
the sphincter relaxes.
h. Ureter motility increases. In the bladder, the muscle itself contracts, while
and decreased glycogen synthesis.
j. The fat cells undergo lipolysis.
i. There is increased secretion from the sweat glands.
b. The pituitary gland releases adrenocorticotropic hormone (ACTH), which
a. The hypothalamus stimulates the pituitary gland.
2. The sustained stress response
(1) The adrenal cortex releases glucocorticoids, resulting in increased
stimulates the adrenal cortex.
(2) The adrenal cortex also releases mineralocorticoids, resulting in
response.
gluconeogenesis, immunosuppression, and an anti-inflammatory
c. The pituitary gland releases vasopressin (antidiuretic hormone [ADH]),
increased retention of sodium and water.
effect on protein, carbohydrate, and lipid metabolism, resulting in
d. The pituitary gland releases growth hormone, which produces a direct
which results in increases in blood pressure and fluid retention.
increased levels of serum glucose and free fatty acids.
f. The pituitary gland releases gonadotropins, the initial response of which is
the thyroid gland, resulting in an increase in the basal metabolic rate.
e. The pituitary gland releases thyrotropic hormone (TTH), which stimulates
secretion is suppressed, resulting in decreased libido or impotence.
an increase in secretion of sex hormones. Later, with sustained stress,
physiological and psychological responses in an individual. The event is one that
A. This concept defines stress as a “thing” or “event” that triggers the adaptive
III. Stress as an Environmental Event
creates change in the life pattern of the individual, requires significant adjustment
B. Easily measured by the Miller and Rahe Recent Life Changes Questionnaire.
positive or negative.
in lifestyle, and taxes available personal resources. The change can be either
illness or actually precipitates it, but there does appear to be a clear causal link.
C. It is not known for certain whether stress overload merely predisposes a person to
and available support systems at the time of the life change.
the individual’s personal perception of the event or his or her coping strategies
D. A weakness in the Miller and Rahe tool is that it does not take into consideration
IV. Stress as a Transaction Between the Individual and the Environment
her resources and endangering his or her well-being.
the environment that is appraised by the individual as taxing or exceeding his or
A. This definition of stress emphasizes the relationship between the individual and
and perceived by the individual in a specific manner.
B. Precipitating event. A stimulus arising from the internal or external environment
1. Primary appraisal. The individual makes a judgment about the situation in
undergoes a primary appraisal and a secondary appraisal of the situation.
C. Individual’s perception of the event. When an event occurs, an individual
one of the following ways:
b. Benign-positive. This type of event is perceived as producing pleasure for
significance for the person.
a. Irrelevant. When an event is judged irrelevant, the outcome holds no
c. Stress appraisal. These types of event include harm/loss, threat, and
the individual.
individual.
(1) Harm/loss. Refers to damage or loss already experienced by the
challenge.
(2) Threatening. These types of events are perceived as anticipated harms
potential for gain or growth, rather than on risks associated with the
(3) Challenges. With these types of events, the individual focuses on
or losses.
2. Secondary appraisal. This type of appraisal is an assessment of skills,
event.
and the secondary appraisal of available coping strategies determines the
3. The interaction between the primary appraisal of the event that has occurred
resources, and knowledge that the person possesses to deal with the situation.
individual’s quality of adaptation response to stress.
and existing conditions.
responds to a stressful event. They include genetic influences, past experiences,
D. Predisposing Factors. Elements that influence how an individual perceives and
through heredity (e.g., family history of physical and psychological
1. Genetic influences. Circumstances of an individual’s life that are acquired
an individual’s adaptation response (e.g., previous exposure to the stressor,
2. Past experiences. Occurrences that result in learned patterns that can influence
conditions).
learned coping responses, and degree of adaptation to previous stressors).
adaptive demands (e.g., current health status, motivation, developmental
individual’s physical, psychological, and social resources for dealing with
3. Existing conditions. Vulnerabilities that influence the adequacy of the
resources, age, existing coping strategies, and a support system of caring
maturity, severity and duration of the stressor, financial and educational
A. Stress management is the utilization of coping strategies in the response to
V. Stress Management
others).
B. Adaptive coping strategies protect the individual from harm and restore physical
stressful situations.
goes unresolved or intensifies.
C. Coping strategies are considered maladaptive when the conflict being experienced
and psychological homeostasis.
interpersonal communication with a caring other, problem solving, pets, music,
D. Some adaptive coping strategies include awareness, relaxation, meditation,
and many others.

3. Youtube sites to review
Stress and Memory
How the Body Works : Center of Emotion and Memory
How the Body Works : Physical Responses to Emotion
Stress and Stressors
Stress Management 1 - Stress Exhaustion

4. Question 1 How stress are you now? 1. Not at all. 2. Mildly
3. Moderately
4. Severely
What are you feeling related to your stress level?
Decribe the systems you are experiencing?

5. Stress The word stress lacks a definitive definition.
Adaptation is defined as restoration of homeostasis to the internal environmental system.
Adaptation includes responses directed at stabilizing internal biological processes and psychological preservation of self-identity and self-esteem.

6. Stress as a Transaction Between the Individual and the Environment
Individual’s perception of the event: The way you interpreted the event is how you respond to the event.
Primary appraisal – a judgment about the situation in one of the following ways:
Secondary appraisal –
Precipitating event –

7. The physiological of stress
. “Fight or Flight” Response
When the body encounters a stressor, it prepares itself for “fight or flight.” Identify the adaptation responses that occur in the initial stress
response in each of the physical components listed.
Physical component Adaptation Response
Adrenal medulla
Eye
Respiratory system
Cardiovascular system
Gastrointestinal system
Liver
Urinary system
Sweat glands
Fat cells

8. Releases norepinephrine and epinephrine.
Pupils dilate.
Secretion is increased from lacrimal glands.
Bronchioles dilate.
Respiration rate is increased.
Increased force of cardiac contraction
Increased cardiac output
Increased heart rate
Increased blood pressure
Decreased gastric and intestinal motility
Decreased secretions
Sphincters contract
Increased glycogenolysis and gluconeogenesis
Decreased glycogen synthesis
Increased ureter motility
Bladder muscle contracts
Bladder sphincter relaxes
Increased secretion
Lipolysis

9. Stress Mastery
Stress Mastery is the utilization of coping strategies in the response to stressful situations.
Adaptive coping strategies protect the individual from harm and restore physical and psychological homeostasis.
Coping strategies are considered maladaptive when the conflict being experienced goes unresolved or intensifies.

10. Effects of chronic Stress
Increase Gluconeogenisis
Decrease Immune
Decrease inflammatory response
Retention of sodium and water
Decrease in libido, frigidity and impotence
Increase in blood pressure
Discuss the wt of the bottle.

11. The parasympathetic nervous system
Relaxation
Body repair and restoration
Lower heart rate
Lower blood pressure
Lower glucose and insulin
Blood directed to digestion
Decrease in oxygen consumption CO2 elimination.

12. Unhealthy Coping Strategies
Smoking
Drugs
Alcohol
Over eating/poor eating habits.
What other unhealthy coping strategies can you think of?

13. Healthy Coping Strategies
Awareness
Relaxation
Meditation
communication with caring other
Problem-solving
Pets
Exercise
Your own thoughts
Laughter
Aromatherapy
Massage
Journaling
Music
Hydro-therapy

14. What are your coping strategies?
Are they healthy strategies?

15. From the following case study, identify the predisposing factors (genetic influences, past experiences, and existing conditions) that influence Robert’s adaptation response. What is the precipitating stressor in this situation?
Robert, age 56, was admitted to the emergency room of a large hospital at 2:00 a.m. after vomiting a large
amount of blood. In doing the admitting assessment, the nurse learned the following about Robert:
His father and brother are both recovering alcoholics.
B. Robert had his first drink at age 12 and has been continually increasing the amount and requency of drinking since that time
C. His mother died of lung cancer when Robert was 23. She was a heavy smoker. Robert smokes three packs of cigarettes a day.
D. He has been hospitalized only once before, about 3 months ago, and diagnosed with an ulcer.
The doctor told him at that time he must stop drinking and smoking in order for the ulcer to heal.
E. Robert is married and has three children. He has a long history of moving from one job to
another, staying only until his drinking interferes with his work performance and attendance. He was fired from his job yesterday and spent the evening and nighttime hours drinking two fifths of bourbon. He was engaged in this activity at the time the hematemesis began.
F. Because of the erratic job history, Robert and his wife experience severe financial difficulties.
His wife shows much concern for Robert’s condition and stays by his side during the emergency admission. She states to the nurse, “I want so much for our marriage to work, but he is drinking more and more all the time and still doesn’t see his drinking as a problem. Every time he gets fired, he blames his boss.”