FUNDAMENTALS

OF NURSING

Stress and
Adaptation
1
 Physiologic Homeostasis
Local Adaptation System (LAS) — involves only one
specific body part
Reflex pain response
Inflammatory response
General Adaptation Syndrome — biochemical
model of stress (Hans Selye)
Alarm reaction
Resistance
Exhaustion
2
 Alarm Reaction
Person perceives stressor, defense
mechanisms activated
Fight-or-flight response
Hormone levels rise, body prepares to react
Shock and counter-shock phases

3
 Resistance
Body attempts to adapt to stressor.
Vital signs, hormone levels, and energy
production return to normal.
Body regains homeostasis or adaptive
mechanisms fail.

4
 Exhaustion
Results when adaptive mechanisms are
exhausted
Body either rests and mobilizes it’s defenses
to return to normal or dies

5
 Psychological Homeostasis
Love and belong needs
Safety and security needs
Self-esteem needs

6
Emotional Responses to Stress
Depression
Anger
Anxiety (most common)
Mild
Moderate
Severe
Panic

7
 Coping Mechanisms
Crying, laughing, sleeping, cursing
Physical activity, exercise
Smoking, drinking
Lack of eye contact, withdrawal
Limiting relationships to those with similar
values and interests

8
Task-Oriented Reactions to Stress
Attack behavior
Withdrawal behavior
Compromise behavior

9
 Defense Mechanisms
Compensation
Denial
Displacement
Introjection
Projection
Rationalization

10
Defense Mechanisms (continued)
Reaction formation
Regression
Repression
Sublimation
Undoing

11
Adaptation to Acute and Chronic
Illness
General tasks — e.g., maintaining self-
esteem and personal relationships
Illness related tasks — e.g., handling pain
and disability

12
 Effects of Long-Term Stress
Affects physical status
Increases risk for disease or injury
Compromises recovery and return to normal
function
Is associated with specific diseases

13
 Family Stressors
Changes in family structure and roles
Anger and feelings of helplessness and guilt
Loss of control over normal routines
Concern for future financial stability

14
 Factors Affecting Stress and
Adaptation
Sources of stress
Types of stressors experienced
Personal factors

15
 Categories of Stress
Developmental stress
Occurs when person progresses through stages
of growth and development
Situational stress
Does not occur in predictable patterns

16
 Types of Stressors
Physiological
Chemical agents, physical agents, infectious
agents, nutritional imbalances, hypoxia, genetic
or immune disorders
Psychosocial
Includes real and perceived threats

17
 Stressful Activities in Nursing
Profession
Assuming responsibilities for which not
prepared
Working with unqualified personnel
Working in environment in which supervisors
are not supportive
Caring for patient in cardiac arrest or dying
person
Experiencing conflict with peers
18
 Teaching Healthy ADLs
Exercise
Rest and sleep
Nutrition
Use of support systems
Use of stress management techniques

19
Stress Management Techniques
Relaxation
Meditation
Anticipatory guidance
Guided imagery
Biofeedback
Crisis intervention

20
 Crisis Intervention
Identify the problem
List alternatives
Choose from alternatives
Implement the plan
Evaluate the outcome

21
 Evaluating the Plan of Care
Patient verbalizes causes and effects of stress and
anxiety.
Patient identifies and uses sources of support.
Patient uses problem solving to find solution to
stressors.
Patient practices healthy lifestyle habits and
anxiety-reducing techniques.
Patient verbalizes decrease in anxiety and increase
in comfort.

22