STRESS

Sandra S. Arimbay
RM,RN,MAN,NC II,EMR-B
Clinical Instructor
Bicol College College of Nursing
 Stress
-Is a non-specific response of the body to
an demand made upon.
-A broad class of experiences in which a
demanding situation taxes a person’s
resources or coping capabilities causing a
negative effect.
Statements of Stress
1. Stress is not a nervous energy
2. Man, whenever he encounter stress,
he tends to adapt it.
3. Stress is not always something to be
avoided.
4. Stress does not always lead to distress.

5. A single stress does not cause a disease.

6. Stress may lead to another stress.
7. A stress, whenever prolonged or intense
may lead to exhaustion.
8. Stress is always a part of the fabric of
daily life.
 Response to stress
A. Fight-flight (aggression-withdrawal response )
1.Hearbeat increases to pump more blood to tissues
faster and remove waste product quicker.
2.BP rises
3.Epinephrine released into blood
4.Liver releases stored sugar into the blood to meet the
increased energy needs of survival
1. 5.Pupils dilate to let in more light; all senses are
heightened.
2. 6.Muscles tense for movement.
3. 7.Backflow to the digestive organs is greatly constricted
4. 8.Blood flow to the brain and major muscles increase.
5. 9.Blood flow to extremities is constricted and the hands
and feet become cold.
6. 10.Body perspires to cool itself.
B. Stages of General Adaptation Syndrome
1. Stage of Alarm
-the person becomes aware of the
presence of threat or danger
-adaptive mechanisms are mobilized
(fight or flight reaction)
-if the stress is intense enough, even
at the stage of alarm, death may
ensue.
 2.Stage of Resistance
-characterized by adaptation
-levels of resistance are increased
-the person moves back to homeotasis
3.Stage of Exhaustion
-results from prolonged exposure to
stress and adaptive mechanisms
can no longer persist
-unless other adaptive mechanism
will be mobilized, death may ensue.
C. Local Adaptation Syndrome -Man
may respond to stress through a
Particular body part or body organ.
Characteristics of Adaptive Response
1.Attempts to maintain homeotasis
2.Whole body/total organism response
3.Have limits.
4.Require time.
5.Vary from person to person.
6.Inadequate or excessive.
7.Egocentric, tiring.
 Modes of Adaptation
 Physiologic/ Biologic Adaptive Mode
 Psychologic Adaptive Mode
 Sociocultural Adaptive Mode
 Technologic Adaptive Mode
Stressors - a stimulus perceived by the
individual or the organism as
challenging, threatening or damaging

Classified into:
1. Maturational
-are those experiences that are expected as a
part of normal processes of growth and
development for most of the individuals in a given
society
-these can be anticipated
2. Situational
-are less predictable and specific actions are
taken only when the threat is eminent or the event
has occurred.
 Homeostasis
- A state of dynamic equilibrium;
stability, balance; constancy; uniformity
- It is now more commonly referred to as
“homodynamic”, it is characterized by
constant change.
- It is regulated by negative feedback
mechanism.
 Concepts of Homeostasis

Stressors

Hypothalamus

SNS
Adrenal Medulla

Brain, Eyes, Mouth, Heart, Lungs, Blood

vessels, Skin, Liver, Muscles, G.I. Tract,
Spleen, Pancreas, Urinary Bladder
 Neurohypophyseal Response

Stressors
Stressors
Oliguria
Conservation
Conservation of
of
Circulating
Circulating
Volume
Volume
Hypothalamus
Hypothalamus

Retention of
water in the
renal tubules

Prevention of
ADH Hypovolemic
Shock
Kidneys
Adreno-Cortical Response
Stressor:
Hypoglycemia

Hypothalamus

Anterior Pituitary

ACTH

Adrenal Cortex

Glucocorticoid
Mineralocorticoid
Adrogen/ Estrogen
Local Physiologic Response to Stress

Purposes of Inflammation
1. To localize tissue injury
2. To protect tissue from injury
3. To prepare tissue for repair
 Inflammatory Response

Physical. Mechanical,
Inflammants Chemical,
Microbial, Electrical

Tissue Injury

Increased Capillary
Permeability

Vascular
Response
Fluid/
Cellular
Exudation
Hypermia

Edema Exudates
(tumor)

Pain
(dolor) Impaired
 Inflammatory Response

1. Vascular Response
2. Cellular Response
3. Healing Process
-first intention
-second intention
-third intention
 The Systemic Manifestations of
Inflammation
1.Fever
2.leukocytosis
3.Elevated ESR
4.Lymphadenopathy
5.Anorexia
6.headache
7.body weakness/ fatigue
8.body malaise
 Systemic Manifestations of Inflammation
Endogenous pyrogens

Hypothalamus

Resetting of the body temperature set-point at a higher level

Increasing heat production/

decreasing heat-loss

Increased production of interferon

Increased phagocytic activity

 Nursing Interventions for Clients
with Inflammation
1.Promote rest to enhance recovery.
2.Reduce swelling.
-position
-heat & cold application
3.Relieve pain
4.Increase excretion of microorganism by adequate
hydration.
5.Provide them adequate nutrition.
6.Pharmacotherapy
7.Surgery
-incision and drainage
-debridement
 Cognitive-Behavioral
Assumptions Goals/Approaches Dialogue

-an individual has value Substitution of rational Patient: My wife makes

simply because he exists beliefs for irrational me so angry
ones
-Irrational beliefs produce Elimination of self- Immediate response:
irrational emotions and defeating behaviors What did your wife do
behaviors that you chose to get
angry about?
-change involves Challenging of irrational Cognitive-behavioral
changing belief in order to beliefs response: What is self-
change feelings and defeating about the
behaviors statement you just
made?
-irrational belief produce Increased responsibility
irrational emotions for feeling, behaviors
and change

Change is a process of Role playing and out

rational thinking new testing behaviors
Behavioral responses to Stress
-Anxiety
-Aggressiveness
-Depression
-Withdrawal
-Suspiciousness
-Somatic behavior
 Anxiety
-A state of uneasiness or discomfort
experienced to varying degrees.

-Is frequently coupled with doubts , fears and

obsessions.

-A feeling of terror or dread; the most

uncomfortable feeling a person can
experience
 Stages
I- Mild Anxiety

-has broad perceptual field

-has heightened ability to take in sensory
stimuli
-more alert to what is going on and make
better sense of what is happening
with others and the environment
II-Moderate Anxiety
-remains alert but perceptual field
narrows
-shout out the events on periphery
while focusing on central concerns
-uses selective inattention to cope
-can still focus on what they have
previously shut out
III-Severe Anxiety
-sensory reception is greatly reduced
-focus on small or catered details of an
experience
-have difficulty in problem solving and ability
to organize is reduced
-selective inattention is increased and less
amenable to voluntary control
-unable to focus on events in the environment
-new stimuli may be overwhelming and may
cause anxiety level to rise even higher
-increase in pulse, BP, RR and epinephrine
secretion, vasoconstriction and temperature
IV-Panic
-completely disrupted personal field
-disintegration of the personality
experienced as intense terror
-details maybe enlarged, scattered or
distorted
-logical thinking and effective decision-
making maybe impossible
-behavior appear purposeless and
communication unintelligible
Nursing interventions for clients with Anxiety
1. Reduce stimuli
-e.g. calm, quiet . Non-stimulating
environment
2.calm approach
3.provide structure/ explanations for
treatments, procedures
4.explain situation
5.help to use coping mechanisms to bring the
anxiety level down to a controlled level
6.promote, explore feelings
7.avoid asking client to make choices.
Defense/Coping Mechanisms
* are mental mechanisms to lessen
uncomfortable feelings of anxiety and to
prevent pain regardless of cost.

*are primarily unconscious and often

inflexible patterns that protect a person
through intrapsychic distortions that are
self-deceptions.
 Aggressiveness
-a way to feel less helpless and more
powerful
-acting in a hostile manner or launching
attack
-angry due to loss of health status and
question what is happening to them
-irritable, uncooperative, project anger to
others
 Nursing Interventions
-provide opportunities to express feelings
and reason for the feelings
-accept expressions of hostility without
retaliation or making the person feel
guilty demands
-anticipate demands
-maintain eye contact with patient
-approach in calm, direct manner
-set limits
 Depressions
-sadness / unhappiness

Signs and symptoms

1.decreased interactions with others.
2.lack of interest in activities and environment
3.Voices concern about illness
4.Expresses wish for dying
5.dependent behavior
6.decreased activity
7.complaints of fatigue and sleep pattern
8.Crying spells, change of appetite
 Nursing Interventions
-approach in a serious mood
-convey by action and communicate
-help to express feeling of concern
-listen to the person
 Withdrawal
-Feelings of low-self worth and low self-
esteem
Nursing Interventions:
1.Spend time with the client to increase
self-worth and self-esteem
2.Gentle encouragement to talk, express
feelings, and relate to others
 Suspicious
Signs and Symptoms
1. powerlessness
2.lack of control
3.difficulty with trust
4.suspiciousness
 Nursing Interventions
1. Encourage to talk about concerns.
2. Provide trust, keep promises made.
3. Provide explanations to help the client.
4. Avoid whispering or talking softly within
person’s hearing
 Somatic behavior
Signs and symptoms
-express anxiety through physical
symptoms
-seeks attention
Nursing Intervention:
-accept all symptoms and report to
physician
-spend time with the person
 Repression
- the basis of all defense mechanisms
and the dynamic behind much of
“forgetting”
-unconscious exclusions of distressing
emotions, thoughts or experience from
awareness
 Suppression
-an intentional act that helps to keep
thought, feeling, wishes or actions that
cause anxiety out of conscious
awareness.
-it is the conscious forms of reppression

e.g. “ I’d rather not talk it “

 Dissociation
-temporary alteration of consciousness or
identity

-resembles repression but has a different origin

-the self is formed through the process of

disapproval and approval from significant
others

-people who dissociate do not “notice” what

they are doing
 Identification
-the wish to be like another person and to
assume the characteristics of that
person’s personality.
-it is unconscious, unlike imitations,
which is the conscious copying of another
person’s qualities
 Introjections
-the process of accepting another’s values
and opinions as one own if they
contradict ought to identification,
although more primitive and intractable
 Projection
- an unconscious means of dealing with
personal difficulties or unacceptable
wishes by attributing them to others.
-blaming others for our shortcoming or
seeing them as harboring our own
unacceptable feelings or thoughts.
 Denial
-painful or anxiety-producing aspects of
awareness are blocked out of
consciousness
 Fantasy
-is a form of non-rational mental activity
that enables the individual to escape
temporarily the demands of the everyday
world
 Rationalization
-attribution of “good” or plausible for
questionable behavior to justify it or to
deal with disappointment
-
 Compensation
-used when a person attempts to overcome
some inability or inferiority
-feelings of satisfaction are achieved through
successful actions or developments which
are make up for the lack of satisfaction in
the area of the person’s inabilities or
inadequacies.

e.g. “ an unattractive person may dress like a

fashion model to make up for the
unattractiveness”
 Reaction
formation/overcompensation
-keeping an undesirable impulse out of
awareness by emphasizing the opposite
 Displacement
-discharging of pent-up s, feeling generally
hostility, on an object les dangerous than
the object that aroused the feelings

e.g. “turning our anger toward another

person inward on the self”
 Sublimation
-release into a different situations of the
unused energy or impulses which cannot be
realized or socially approved in one situation

e.g. “strong sexual urges might be sublimated

into creative arts such as writing, sculpture,
or design: hostile impulse into sports or
business activities”
 Conversion
-individual converts an emotional problem
into physical symptom or outlet which
provides a release for the tension and
anxiety associated with the conflict

e.g. “the person who lacks self-confidence

to assume executive responsibilities may
develop the symptoms of an illness which
could prevent his acceptance of an
promotion”
 Condensation
-results from a delusional system fortified
over a long period of time
-it is the experiences into one
experiences or manifestations
 Isolation
-when the person consciously protects
himself by a avoiding painful situations or
separates disturbing ideas from their
affects
 Symbolism
-a mechanism whereby a person attaches
significance to shapes of objects, colors,
materials, slogans, words

e.g. repetitive hand washing may symbolize

guilt feelings
 Undoing
- An unconscious, symbolic attempt by the
patient to eradicate or eliminate the
existence of a previous painful
experience.
- Feelings of guilt and anxiety are relieved
for the moment as the patient
symbolically reversely enacts or undoes
the steps of the painful experience.
 Regression
- a process whereby an individual escapes
the frustration and anxiety of conflict by
returning to methods of adjustment at
proved successful at an earlier stage of
life
 Intellectualization
-process of separating an the emotion
aroused by an event from ideas or opinions
about the event because the emotion itself
is too painful to acknowledge
-the painful emotion is avoided by means of
a rational explanation that divests the
event of any personal significance
-failures are made less significant by telling
oneself that the situation could have been
worse
Thank you!