Ch12 stress & adaptation

1. JUDITH M. WILKINSON LESLIE S. TREAS KAREN BARNETT MABLE H. SMITH FUNDAMENTALS OFFUNDAMENTALS OF NURSINGNURSING Copyright © 2016 F.A. Davis Company Chapter 12:Chapter 12: Stress & AdaptationStress & Adaptation

3. Copyright © 2016 F.A. Davis Company 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)

4. Copyright © 2016 F.A. Davis Company 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)

5. Copyright © 2016 F.A. Davis Company ClickerCheck The 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.

6. Copyright © 2016 F.A. Davis Company 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.

7. Copyright © 2016 F.A. Davis Company 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

10. Copyright © 2016 F.A. Davis Company 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

12. Copyright © 2016 F.A. Davis Company 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)

13. Copyright © 2016 F.A. Davis Company Factors That Influence Adaptation (cont’d) Support system (e.g., friends; family providing emotional, financial, physical help) • Strong support = better adaptation Personal factors • Age • Developmental level • Life experiences

14. Copyright © 2016 F.A. Davis Company 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

15. Copyright © 2016 F.A. Davis Company General Adaptation Syndrome: Stages Alarm Stage • Fight or flight • Involves involuntary body responses – Endocrine system: CRH,ACTH,ADH – Sympathetic nervous system: epinephrine, norepinephrine

16. Copyright © 2016 F.A. Davis Company 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

17. Copyright © 2016 F.A. Davis Company General Adaptation Syndrome: Stages (cont’d) 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

18. Copyright © 2016 F.A. Davis Company General Adaptation Syndrome: Stages (cont’d) 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

19. Copyright © 2016 F.A. Davis Company 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.True b.False

20. Copyright © 2016 F.A. Davis Company ClickerCheck (cont’d) 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.

21. Copyright © 2016 F.A. Davis Company 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

22. Copyright © 2016 F.A. Davis Company Psychological Responses to Stress Include feelings, thoughts, and behaviors • Anxiety and fear • Ego defense mechanisms (e.g., denial, rationalization, projection) • Anger • Depression

23. Copyright © 2016 F.A. Davis Company 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

24. Copyright © 2016 F.A. Davis Company Consequences of Failed Adaptation (cont’d) Somatoform Disorders • Hypochondriasis • Somatization • Somatoform pain disorder • Malingering Stress-Induced Psychological Responses • Crisis • Burnout • Post-traumatic stress disorder (PTSD)

25. Copyright © 2016 F.A. Davis Company 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.

26. Copyright © 2016 F.A. Davis Company 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.

27. Copyright © 2016 F.A. Davis Company Stress Reduction Interventions (cont’d) • Use of specific interventions to relieve anxiety • Anger management • Stress management techniques • Meditation, biofeedback, Reiki, humor, and so forth • Change perception of self

28. Copyright © 2016 F.A. Davis Company Stress Reduction Interventions (cont’d) • Change perception of stressor. • Identify and use support systems. • Use spiritual support. • Implement crisis intervention. • Use proper referrals.

29. Copyright © 2016 F.A. Davis Company 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.

30. Copyright © 2016 F.A. Davis Company ClickerCheck (cont’d) 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.

31. Copyright © 2016 F.A. Davis Company Think Like a Nurse Review the scenario of Gloria and John (MeetYour Patients inVolume 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?

Ch12 stress & adaptation

Ch12 stress & adaptation

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Ch12 stress & adaptation