Ch12 stress & adaptation

JUDITH M. WILKINSON LESLIE S. TREASKAREN BARNETT MABLE H. SMITH

FUNDAMENTALS OFFUNDAMENTALS OFNURSINGNURSING

Chapter 12: Chapter 12: Stress & AdaptationStress & Adaptation

What Is Stress?

• Any disturbance in a person’s normal balanced state

• Unique response by each person to a stressor

• Can be harmful or motivating

Categories of Stress

Distress• Can threaten health (e.g., continual financial

worries)

Eustress• Good stress (e.g., passionate kiss)

Developmental• Associated with life stages (e.g., college

graduation)

Categories of Stress (cont’d)

Situational• Random, unpredictable (e.g., hurricane, accident)Physiological• Affect body: structure/function (e.g., diseases,

mobility problems)Psychological• Arise from life events (e.g., work pressure, family

arguments)

ClickerCheckThe hospitalized client states, “I need to know when I’m going to be discharged. I’m so upset and worried that I’m missing work.” The nurse knows

a.This is an example of “eustress” and no intervention is necessary.b.This is an example of psychological stress and the client should be placed on antidepressants.c.This is an example of developmental stress and the client should talk to someone his own age.d.This is an example of distress and could affect the client’s health status.

ClickerCheck (cont’d)

Correct answer: D

The client’s statement indicates that he is experiencing distress. Even though it could be termed psychological stress, it would be inappropriate to simply place the client on antidepressant therapy without gathering more data.

Dealing With Stress: Coping Strategies• There are three general approaches for

coping, depending on the situation– Alter the stressor: change jobs– Adapt to the stressor: change thoughts about

nursing clinicals– Avoid the stressor: end a relationship

Styles of Coping Strategies

Adaptive• Healthy choices• Directly reduce negative effects of stress• Examples: change in lifestyle, problem solving

Styles of Coping Strategies (cont’d)

Maladaptive• Unhealthy style, temporary fix• Possibly other harmful effects• Examples: substance abuse, overeating

Adaptation

• A possible/desired outcome of stress• Involves adjusting to the stress/stressor• Allows for

– Normal growth and development– Effective responses to life’s challenges

Adaptation (cont’d)

Ability to adapt depends on• Intensity of the stressor• Effectiveness of coping skills• Personal factors

Factors That Influence Adaptation

Personal perception of stressor• Is understanding of stressor realistic?• How successful have previous adaptation

attempts been?Overall health status• The number of illnesses present and the

chronicity of illnesses may affect the ability to adapt to new stressor(s)

Factors That Influence Adaptation (cont’d)

Support system (e.g., friends; family providing emotional, financial, physical help)

• Strong support = better adaptationPersonal factors• Age• Developmental level• Life experiences

Physical Responses to Stressors

General Adaptation Syndrome (GAS) • Selye’s theoretical model of physiological

responses to stress• Nonspecific bodily responses shared by all

people• Response to distress as well as eustress• Involves three stages

General Adaptation Syndrome: StagesAlarm Stage• Fight or flight• Involves involuntary body responses

– Endocrine system: CRH, ACTH, ADH– Sympathetic nervous system: epinephrine,

norepinephrine

General Adaptation Syndrome: Stages (cont’d)

Alarm Stage (cont’d)– Cardiovascular (CV) system: vasoconstriction,

elevated BP– Respiratory system: dilated bronchioles– Metabolic: increased availability of glucose– Urinary: sodium and water retention– Gastrointestinal (GI): decreased peristalsis– Musculoskeletal: increased blood flow to

muscles

Resistance Stage• Goal: maintenance of homeostasis• Involves use of coping mechanisms

• Psychological• Physical return of vital signs to normal

• Failure to adapt to or contain stress leads to third phase

Exhaustion • If adaptive mechanisms become

ineffective/nonexistent• Decrease in BP, elevated pulse, respiration• Usually ends in disease or death

Recovery• Third stage, if adaptation is successful

ClickerCheck

A client who is taking the drug atenolol (Tenormin) may not exhibit the expected rise in blood pressure and pulse during the alarm stage of the general adaptation syndrome.

a.Trueb.False

Correct answer: A

Atenolol is classified as a beta-blocking agent. By preventing epinephrine from binding to beta receptors, this drug would “mask” or lessen the cardiovascular response during the alarm stage.

Physical Response to Stressors

Local Adaptation Syndrome• Response to stress involving specific body

part, tissue, or organ• Short-term attempt to restore homeostasis• Localized• Types

– Reflex pain response– Inflammatory response

Psychological Responses to Stress

Include feelings, thoughts, and behaviors• Anxiety and fear• Ego defense mechanisms (e.g., denial,

rationalization, projection)• Anger• Depression

Consequences of Failed Adaptation

Stress-Induced Organic Responses• Continual stress• Repeated central nervous system (CNS)

stimulation• Elevation of certain hormones• Results in long-term changes in body systems

Consequences of Failed Adaptation (cont’d)

Somatoform Disorders• Hypochondriasis• Somatization• Somatoform pain disorder• MalingeringStress-Induced Psychological Responses• Crisis• Burnout• Post-traumatic stress disorder (PTSD)

Stress Reduction Interventions

Health Promotion Activities• Promote adequate nutrition.• Help the client establish a routine that

includes regular exercise.

• Teach the client the importance of getting 7 to 8 hr of sleep per day.

Stress Reduction Interventions (cont’d)

Health Promotion Activities (cont’d)• Encourage participation in leisure activities.• Help clients to manage time, balance

responsibilities, and prioritize tasks.• Advise clients to avoid maladaptive behaviors

such as excess alcohol, caffeine, sweets, smoking, and illicit drugs.

• Use of specific interventions to relieve anxiety

• Anger management• Stress management techniques

• Meditation, biofeedback, Reiki, humor, and so forth

• Change perception of self

• Change perception of stressor.• Identify and use support systems.• Use spiritual support.• Implement crisis intervention.• Use proper referrals.

ClickerCheck

The nurse should assess every client to determine if stress reduction interventions should be part of the plan of care. The rationale for this action is that

a.There are more persons experiencing mental illness now than in the past.b.Life is so much more stressful than it has ever been.c.The occurrence of stress in clients is unpredictable.d.Clients often develop maladaptive coping strategies.

Correct answer: C

The nurse recognizes that all clients respond differently to healthcare interventions. Therefore, it is important to assess every client’s level of stress to determine if interventions are required.

Think Like a NurseReview the scenario of Gloria and John (Meet Your Patients in Volume 1). How much does it really tell you about the clients’ situation?

•Which aspect of stress do you have the most information about: their stressors, their coping methods and adaptation, their responses to stress, or their support systems?•What facts do you have about the clients’ emotional and behavioral responses to their stressors?•What information do you have about how well they are coping with stress?•What data do you have about their support systems? What information do you need?

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