Stress

Importance of studying stressImportance of studying stress

It provides a way of It provides a way of understanding the person as a understanding the person as a holistic beingholistic being

NursesNurses must also learn to cope must also learn to cope with stress in their work and with stress in their work and life as they are subjected to life as they are subjected to the demands of their career. the demands of their career.

Stress and AdaptationStress and Adaptation STRESSORSTRESSOR

• Any event or stimulus that causes an Any event or stimulus that causes an individual to experience stressindividual to experience stress

They may They may neither positive or neither positive or negativenegative, but they have positive , but they have positive or negative effects or negative effects

Internal Stressor (illness, hormonal Internal Stressor (illness, hormonal change, fear)change, fear)

External Stressor (loud noise, cold External Stressor (loud noise, cold temperature)temperature)

Developmental StressorDevelopmental Stressor Situational StressorSituational Stressor

Stress and AdaptationStress and Adaptation

COPINGCOPING- a problem - a problem solving process that the solving process that the person uses to manage person uses to manage the stresses or events the stresses or events with which he/she is with which he/she is presented.presented.


ADAPTATIONADAPTATION- the process - the process by which human system by which human system modifies itself to conform modifies itself to conform to the environment. It is a to the environment. It is a change that results from change that results from response to stress.response to stress.


SOURCES OF STRESSSOURCES OF STRESS

1.1. InternalInternal

2.2. ExternalExternal

3.3. DevelopmentalDevelopmental

4.4. SituationalSituational

Stress CharacteristicsStress Characteristics It is a universal It is a universal

phenomenon.phenomenon. It is an individual It is an individual

experience. experience. It provides stimulus for It provides stimulus for

growth and change.growth and change. It affects all dimension of It affects all dimension of

life. life. It is not a nervous energy. It is not a nervous energy.

Effects of Stress on the BodyEffects of Stress on the Body PhysicalPhysical- affects physiologic - affects physiologic

homeostasishomeostasis EmotionalEmotional- affects feeling towards - affects feeling towards

self self IntellectualIntellectual- influences - influences

perception and problem solving perception and problem solving abilitiesabilities

SocialSocial – can alter relationships – can alter relationships with otherswith others

SpiritualSpiritual- affects one’s beliefs and - affects one’s beliefs and valuesvalues

Effects of Stress on the Effects of Stress on the BodyBody

Metabolic Metabolic DisordersDisorders

• Hyper/Hyper/hypothyroidismhypothyroidism

• DiabetesDiabetes CancerCancer Accident Accident

pronenessproneness Skin disordersSkin disorders

• EczemaEczema• PruritusPruritus• UrticariaUrticaria• PsoriasisPsoriasis

Respiratory Respiratory disordersdisorders

• AsthmaAsthma• Hay feverHay fever• TuberculosisTuberculosis

CVDCVD• Coronary artery Coronary artery

diseasedisease• Essential Essential

hypertensionhypertension• CHFCHF

GIT disordersGIT disorders• ConstipationConstipation• DiarrheaDiarrhea• Duodenal ulcerDuodenal ulcer• Anorexia nervosaAnorexia nervosa• ObesityObesity• Ulcerative colitisUlcerative colitis

Menstrual irregularitiesMenstrual irregularities Musculoskeletal Musculoskeletal

disordersdisorders• RARA• LBPLBP• Migraine HeadacheMigraine Headache• Muscle tensionMuscle tension

GENERAL THEORETICAL FRAMEWORKS GENERAL THEORETICAL FRAMEWORKS FOR UNDERSTANDING STRESSFOR UNDERSTANDING STRESS

Stress can be defined differently Stress can be defined differently by the three modelsby the three models

STIMULUSSTIMULUS RESPONSERESPONSE TRANSACTIONTRANSACTION

Stress as a StimulusStress as a Stimulus

When viewed as a stimulus, When viewed as a stimulus, stress is defined as an stress is defined as an event event or set of events causing a or set of events causing a disrupted responsedisrupted response (Lyon (Lyon and Werner, 1987) and Werner, 1987)

Life events or circumstances Life events or circumstances causing a disrupted causing a disrupted responseresponse on an individual on an individual

Stress as a TransactionStress as a Transaction

Views the person and Views the person and environment in a dynamic, environment in a dynamic, reciprocal and interactive reciprocal and interactive relationships (Lazarus, 1966 )relationships (Lazarus, 1966 )

Mental and physiologic Mental and physiologic (adaptive and affective) (adaptive and affective) responses to stressresponses to stress

Stress as a TransactionStress as a Transaction The transactional stress theory includes The transactional stress theory includes

cognitive, affective, and adaptive cognitive, affective, and adaptive responses from person and environment responses from person and environment interaction. The person responds to interaction. The person responds to perceived environmental changes by perceived environmental changes by coping mechanisms.coping mechanisms.

Transactional theory of stress emphasizes Transactional theory of stress emphasizes that people & groups differ in their that people & groups differ in their sensitivity & vulnerability to certain types sensitivity & vulnerability to certain types of events, as well as in their of events, as well as in their interpretations & reactionsinterpretations & reactions

Stress as a TransactionStress as a Transaction Includes mental & psychologic components Includes mental & psychologic components

or responses as part of his concept of or responses as part of his concept of stressstress

takes into account cognitive processes takes into account cognitive processes that intervene between the encounter & that intervene between the encounter & the reactionthe reaction

encompasses a set of cognitive, affective encompasses a set of cognitive, affective & adaptive (coping) responses that arise & adaptive (coping) responses that arise out of person-environment transactions.out of person-environment transactions.

Cognitive appraisalCognitive appraisal: evaluative process : evaluative process determines why & to what extent a determines why & to what extent a particular/series transaction between the particular/series transaction between the person & the environment is stressfulperson & the environment is stressful

Stress As a ResponseStress As a Response

Disruptions caused by harmful Disruptions caused by harmful stimulus or stressorsstimulus or stressors

Specifies particular response or Specifies particular response or pattern of responses that may pattern of responses that may indicate a stressorindicate a stressor

Selye (1976): developed models of Selye (1976): developed models of stress, that defines stress as a non-stress, that defines stress as a non-specific response of the body to any specific response of the body to any demand made on itdemand made on it


Focus:Focus: reactions of the BODY reactions of the BODY Selye used the term “stressor’ Selye used the term “stressor’

as as the stimulus or agents that the stimulus or agents that evokes a stress response in the evokes a stress response in the person . person .

A stressor may be anything that A stressor may be anything that places a demand on the person for places a demand on the person for change or adaptation.change or adaptation.

Stress As a ResponseStress As a Response Hans Selye (1976) “ non-specific Hans Selye (1976) “ non-specific

response of the body to any kind of response of the body to any kind of demand made upon itdemand made upon it

He called it “non-specific” because the He called it “non-specific” because the body goes through a number of body goes through a number of biochemical changes and re-biochemical changes and re-adjustments without regard to the adjustments without regard to the nature of the stress producing nature of the stress producing agents.agents.

Any type of stressor may produce the Any type of stressor may produce the same responses in the human bodysame responses in the human body


Advantage : response to Advantage : response to stress is purely physiologic; stress is purely physiologic; determines physiological determines physiological response to stressresponse to stress

Disadvantage: does not Disadvantage: does not consider individual differences consider individual differences in response patternin response pattern

Stress as a responseStress as a response

SELYE proposed two Stress SELYE proposed two Stress adaptation responsesadaptation responses

1.1. General Adaptation General Adaptation SyndromeSyndrome

2.2. Local Adaptation Local Adaptation SyndromeSyndrome

General Adaptation SyndromeGeneral Adaptation Syndrome

Physiologic responses of the Physiologic responses of the whole whole body to stressorsbody to stressors

Involves the Involves the Autonomic Nervous Autonomic Nervous System, and Endocrine SystemSystem, and Endocrine System

Occurs with the release of adaptive Occurs with the release of adaptive hormones and subsequent changes hormones and subsequent changes in the WHOLE bodyin the WHOLE body

General Adaptation General Adaptation SyndromeSyndrome

Stressor

Alarm reaction

Shock phase

Epinephrine Cortisone

Stages of resistance

Stages of exhaustion

Three stages adaptation to stress for both GAS/LAS:

Counter-shock Phase

Rest Death

Normal state


I. ALARM REACTIONI. ALARM REACTION Initial reaction of the body; “ fight OR Initial reaction of the body; “ fight OR

flight” responsesflight” responses Mobilizing of the defense mechanisms Mobilizing of the defense mechanisms

of the body and mind to cope with of the body and mind to cope with stressors.stressors.

SHOCK PHASE- the autonomic nervous SHOCK PHASE- the autonomic nervous system reacts; release of Epinephrine system reacts; release of Epinephrine and Cortisoland Cortisol

COUNTERSHOCK PHASE- reversal of COUNTERSHOCK PHASE- reversal of the changes produced in the shock the changes produced in the shock phasephase


II. STAGE OF RESISTANCE:II. STAGE OF RESISTANCE: The BODY stabilizes, hormonal levels The BODY stabilizes, hormonal levels

return to normal, heart rate, blood return to normal, heart rate, blood pressure and cardiac output return to pressure and cardiac output return to normalnormal

2 things may occur:2 things may occur: Either the person successfully adapts to Either the person successfully adapts to

the stressors and returns to normal, thus the stressors and returns to normal, thus resolving and repairing body damage; orresolving and repairing body damage; or

The stressor remains present, and The stressor remains present, and adaptation fails (ex. Long-term terminal adaptation fails (ex. Long-term terminal illness, mental illness, and continuous illness, mental illness, and continuous blood loss)blood loss)


III. STAGE OF EXHAUSTION:III. STAGE OF EXHAUSTION: Occurs when the body can no Occurs when the body can no

longer resist stress and body longer resist stress and body energy is depleted. energy is depleted.

The body’s energy level is The body’s energy level is compromised and adaptation compromised and adaptation diminishes. diminishes.

Body may not be able to defend Body may not be able to defend self that may end to death.self that may end to death.


Stage 1 Stage 1 ALARM REACTIONALARM REACTIONEnlargement of adrenal cortexEnlargement of adrenal cortexEnlargement of lymphatic systemEnlargement of lymphatic system

Increase in hormone levelsIncrease in hormone levels

Stage 2Stage 2 RESISTANCE PHASERESISTANCE PHASE Shrinkage of adrenal gland to normal sizeShrinkage of adrenal gland to normal size

Lymph nodes closer to normal sizeLymph nodes closer to normal sizeHormone levels sustainedHormone levels sustained

Stage 3Stage 3 EXHAUSTION PHASEEXHAUSTION PHASERest or deathRest or deathIncrease in hormone levelsIncrease in hormone levelsDepletion of adaptive hormonesDepletion of adaptive hormones


A-R-EA-R-EALARM:ALARM: sympathetic system is sympathetic system is

mobilized!mobilized!

RESISTANCE: RESISTANCE: adaptation takes adaptation takes placeplace

EXHAUSTIONEXHAUSTION: adaptation cannot : adaptation cannot be maintained be maintained

GASGAS

HypothalamusHypothalamus

Anterior Pituitary GlandAnterior Pituitary Gland

Adrenal GlandAdrenal Gland

Adrenal CortexAdrenal Cortex Adrenal medullaAdrenal medulla

Adrenal glandAdrenal gland



Hormonal ChangesHormonal Changes Adrenal Adrenal

CortexCortex MINERALOCORTICOIDSMINERALOCORTICOIDS

• AldosteroneAldosterone• Na+ retentionNa+ retention• WATER retentionWATER retention• Protein anabolismProtein anabolism

GLUCOCORTICOIDSGLUCOCORTICOIDS• CortisolCortisol• (Anti-(Anti-

inflammatory)inflammatory)• Protein catabolismProtein catabolism• GluconeogenesisGluconeogenesis

Adrenal MedullaAdrenal Medulla NOREPINEPHRINENOREPINEPHRINE

• Peripheral Peripheral vasoconstrictionvasoconstriction

• Decreased blood to Decreased blood to kidneykidney

• Increased renin Increased renin (angiotensin)(angiotensin)

EPINEPHRINEEPINEPHRINE• TachycardiaTachycardia• Increased myocardial Increased myocardial

activityactivity• Increased Bronchial Increased Bronchial

dilatationdilatation• Increased Blood clottingIncreased Blood clotting• Increased MetabolismIncreased Metabolism• Increased Fat MetabolismIncreased Fat Metabolism

Local Adaptation SyndromeLocal Adaptation Syndrome

Localized responses to stressLocalized responses to stress

Ex. Wound healing, blood Ex. Wound healing, blood clotting, vision, response to clotting, vision, response to pressurepressure

Adaptive:Adaptive: a stressor is necessary to a stressor is necessary to stimulate itstimulate it

Short- termShort- term Restorative:Restorative: assist in homeostasis assist in homeostasis

Local Adaptation SyndromeLocal Adaptation Syndrome

Reflex Pain response:Reflex Pain response: Localized response of the CNS to painLocalized response of the CNS to pain Adaptive response and protects tissue Adaptive response and protects tissue

from further damage from further damage Involves a sensory receptor, a sensory Involves a sensory receptor, a sensory

serve to the spinal cord, a connector serve to the spinal cord, a connector neuron, motor nerve, effector’s muscles. neuron, motor nerve, effector’s muscles. Example: unconscious removal of hand Example: unconscious removal of hand from a hot surface, sneezing, etc. from a hot surface, sneezing, etc.

Inflammatory Response:Inflammatory Response: Stimulated by trauma or infection, thus Stimulated by trauma or infection, thus

preventing it to spread; also promotes preventing it to spread; also promotes healinghealing

Pain, heat, redness, swellingPain, heat, redness, swelling

FACTORS INFLUENCING RESPONSE TO FACTORS INFLUENCING RESPONSE TO STRESSSTRESS

Age, SexAge, Sex Nature of StressorsNature of Stressors Physiological functioningPhysiological functioning PersonalityPersonality Behavioral CharacteristicsBehavioral Characteristics Level of personal controlLevel of personal control

• Availability of support systemAvailability of support system• Feelings of competenceFeelings of competence• Cognitive appraisal, Economic StatusCognitive appraisal, Economic Status

The MANIFESTATIONS OF The MANIFESTATIONS OF STRESSSTRESS

INDICATORS OF STRESSINDICATORS OF STRESS PhysiologicPhysiologic PsychologicalPsychological CognitiveCognitive Verbal-MotorVerbal-Motor

Physiological IndicatorsPhysiological Indicators Dilated pupilsDilated pupils DiaphoresisDiaphoresis Tachycardia, tachypnea, Tachycardia, tachypnea,

HYPERTENSION, increased blood flow to HYPERTENSION, increased blood flow to the musclesthe muscles

Increased blood clottingIncreased blood clotting BronchodilationBronchodilation Skin pallorSkin pallor Water retention, Sodium retentionWater retention, Sodium retention OliguriaOliguria Dry mouth, decrease peristalsisDry mouth, decrease peristalsis HyperglycemiaHyperglycemia

Remember these Physiologic Manifestations Remember these Physiologic Manifestations of Stress of Stress

Pupils dilate to increase visual Pupils dilate to increase visual perception when serious threats perception when serious threats to the body ariseto the body arise

Sweat production (diaphoresis) Sweat production (diaphoresis) increases to control elevated increases to control elevated body heat due to increased body heat due to increased metabolismmetabolism


Heart rate or pulse rate increases Heart rate or pulse rate increases to transport nutrients & to transport nutrients & byproducts of metabolism more byproducts of metabolism more effectivelyeffectively

Skin becomes pale (Pallor) Skin becomes pale (Pallor) because of constriction of because of constriction of peripheral blood vessels to shunt peripheral blood vessels to shunt blood to the vital organs. blood to the vital organs.


BP increases due to BP increases due to vasoconstriction of vessels in vasoconstriction of vessels in blood reservoir (skin, kidneys, blood reservoir (skin, kidneys, lungs), due to secretion of renin, lungs), due to secretion of renin, Angiotensin I and IIAngiotensin I and II

Increased rate/depth of respiration Increased rate/depth of respiration

with dilation of bronchioles, with dilation of bronchioles, promoting hyperventilation and promoting hyperventilation and increased oxygen uptakeincreased oxygen uptake


Mouth may become dry, urine Mouth may become dry, urine output may decrease. The output may decrease. The peristalsis of the intestines peristalsis of the intestines decreases leading to decreases leading to constipationconstipation

For serious threats, there is For serious threats, there is improved mental alertnessimproved mental alertness


Increased muscle tension to Increased muscle tension to prepare for rapid motor prepare for rapid motor activity/defenseactivity/defense

Increased blood sugar Increased blood sugar (glucocorticoids & (glucocorticoids & gluconeogenesis) to supply gluconeogenesis) to supply

energy source to the body.energy source to the body.

Psychological indicatorsPsychological indicators

This includes anxiety, This includes anxiety, fear, anger, depression fear, anger, depression and unconscious ego and unconscious ego defense mechanismsdefense mechanisms

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Stress