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Friday, October 19, 2007

Stress :: Fundamental Of Nursing :: Review For Nursing Licensure Examination

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Review For Nursing Licensure Examination :: Fundamental Of Nursing :: Stress Slide Transcript
Slide 2: Personal definition What is Stress?

Slide 3: Stress and Adaptation STRESS   A condition in which the person responds to changes in the normal balanced state  Selye: non specific response of the body to any kind of demand made upon it Any event – environmental / internal demands  or both tax or exceed the adaptive resources of an individual, social system or tissue systems

Slide 4: Stress and Adaptation STRESSOR  Any event or stimulus that causes an individual  to experience stress They may neither positive or negative, but  they have positive or negative effects  Internal Stressor (illness, hormonal change, fear)  External Stressor (loud noise, cold temperature)  Developmental Stressor  Situational Stressor

Slide 5: Stress and Adaptation  COPING- a problem solving process that the person uses to manage the stresses or events with which he/she is presented.

Slide 6: Stress and Adaptation  ADAPTATION- the process by which human system modifies itself to conform to the environment. It is a change that results from response to stress.

Slide 7: Stress and Adaptation SOURCES OF STRESS 2. Internal 3. External 4. Developmental 5. Situational

Slide 8: Stress Characteristics It is a universal phenomenon.   It is an individual experience.  It provides stimulus for growth and change.  It affects all dimension of life.  It is not a nervous energy.

Slide 9: Effects of Stress on the Body Physical- affects physiologic homeostasis  Emotional- affects feeling towards self  Intellectual- influences perception and  problem solving abilities Social – can alter relationships with others  Spiritual- affects one’s beliefs and values 

Slide 10: Effects of Stress on the Body Metabolic Disorders CVD    Coronary artery disease Hyper/hypothyroidism   Essential hypertension Diabetes   CHF Cancer  GIT disorders  Accident proneness   Constipation Skin disorders   Diarrhea Eczema   Duodenal ulcer Pruritus   Anorexia nervosa Urticaria   Obesity Psoriasis   Ulcerative colitis Respiratory disorders Menstrual irregularities   Musculoskeletal disorders  Asthma   RA Hay fever   LBP Tuberculosis   Migraine Headache  Muscle tension

Slide 11: GENERAL THEORETICAL FRAMEWORKS FOR UNDERSTANDING STRESS Stress can be defined differently by the three models  STIMULUS  RESPONSE  TRANSACTION

Slide 12: Stress and Adaptation Models of Stress STIMULUS based models 2. RESPONSE based models 4. TRANSACTION based models 6.

Slide 13: Stress as a Stimulus Holmes and Rahe 1967: They studied the  relationship between specific life changes such as divorce or death, and the subsequent onset of illness. Focus: disturbing events within the  environment

Slide 14: Stress as a Transaction The transactional stress theory includes  cognitive, affective, and adaptive responses from person and environment interaction. The person responds to perceived environmental changes by coping mechanisms. Transactional theory of stress emphasizes that  people & groups differ in their sensitivity & vulnerability to certain types of events, as well as in their interpretations & reactions

Slide 15: Stress As a Response Disruptions caused by harmful stimulus or  stressors Specifies particular response or pattern of  responses that may indicate a stressor Selye (1976): developed models of stress,  that defines stress as a non-specific response of the body to any demand made on it

Slide 16: Stress As a Response Focus: reactions of the BODY  Selye used the term “stressor’ as the  stimulus or agents that evokes a stress response in the person . A stressor may be anything that places a  demand on the person for change or adaptation.

Slide 17: Stress As a Response Hans Selye (1976) “ non-specific response of  the body to any kind of demand made upon it He called it “non-specific” because the body goes through a number of biochemical changes and re-adjustments without regard to the nature of the stress producing agents. Any type of stressor may produce the same  responses in the human body

Slide 18: Stress As a Response Advantage : response to stress is  purely physiologic; determines physiological response to stress Disadvantage: does not consider  individual differences in response pattern

Slide 19: Stress as a response SELYE proposed two Stress adaptation responses 2. General Adaptation Syndrome 3. Local Adaptation Syndrome

Slide 20: General Adaptation Syndrome Physiologic responses of the whole body to  stressors Involves the Autonomic Nervous System,  and Endocrine System Occurs with the release of adaptive hormones  and subsequent changes in the WHOLE body

Slide 21: General Adaptation Syndrome Three stages adaptation to stress for both GAS/LAS: Stressor Alarm reaction Counter- shock Phase Shock phase Epinephrine Cortisone Normal state Stages of resistance Stages of exhaustion Rest Death

Slide 22: General Adaptation Syndrome I. ALARM REACTION  Initial reaction of the body; “ fight OR flight” responses  Mobilizing of the defense mechanisms of the body and mind to cope with stressors.  SHOCK PHASE- the autonomic nervous system reacts; release of Epinephrine and Cortisol  COUNTERSHOCK PHASE- reversal of the changes produced in the shock phase

Slide 23: General Adaptation Syndrome II. STAGE OF RESISTANCE:  The BODY stabilizes, hormonal levels return to normal, heart rate, blood pressure and cardiac output return to normal 2 things may occur:  Either the person successfully adapts to the stressors and returns to normal, thus resolving and repairing body damage; or  The stressor remains present, and adaptation fails (ex. Long-term terminal illness, mental illness, and continuous blood loss)

Slide 24: General Adaptation Syndrome III. STAGE OF EXHAUSTION:  Occurs when the body can no longer resist stress and body energy is depleted.  The body’s energy level is compromised and adaptation diminishes.  Body may not be able to defend self that may end to death.

Slide 25: Stress and Adaptation A-R-E ALARM: sympathetic system is mobilized! RESISTANCE: adaptation takes place EXHAUSTION: adaptation cannot be maintained

Slide 26: GAS Hypothalamus Anterior Pituitary Gland Adrenal Gland Adrenal Cortex Adrenal medulla

Slide 29: Adrenal gland

Slide 30: Adrenal Gland

Slide 31: Adrenal Gland

Slide 32: Hormonal Changes Adrenal Cortex Adrenal Medulla MINERALOCORTICOIDS NOREPINEPHRINE   Aldosterone   Peripheral vasoconstriction  Na+ retention  Decreased blood to  WATER retention kidney  Protein anabolism  Increased renin GLUCOCORTICOIDS  (angiotensin)  Cortisol EPINEPHRINE   (Anti-inflammatory) Tachycardia   Protein catabolism Increased myocardial activity   Gluconeogenesis Increased Bronchial dilatation  Increased Blood clotting  Increased Metabolism  Increased Fat Metabolism 

Slide 33: Local Adaptation Syndrome Localized responses to stress  Ex. Wound healing, blood clotting, vision, response to pressure Adaptive: a stressor is necessary to stimulate it  Short- term  Restorative: assist in homeostasis 

Slide 34: Local Adaptation Syndrome Reflex Pain response:  Localized response of the CNS to pain  Adaptive response and protects tissue from further damage  Involves a sensory receptor, a sensory serve to the spinal cord, a connector neuron, motor nerve, effector’s muscles. Example: unconscious removal of hand from a hot surface, sneezing, etc. Inflammatory Response:  Stimulated by trauma or infection, thus preventing it to spread; also promotes healing  Pain, heat, redness, swelling

Slide 35: FACTORS INFLUENCING RESPONSE TO STRESS Age, Sex  Nature of Stressors  Physiological functioning  Personality  Behavioral Characteristics  Level of personal control  Availability of support system   Feelings of competence  Cognitive appraisal, Economic Status

Slide 36: The MANIFESTATIONS OF STRESS INDICATORS OF STRESS  Physiologic  Psychological  Cognitive  Verbal-Motor

Slide 37: Physiological Indicators Dilated pupils  Diaphoresis  Tachycardia, tachypnea, HYPERTENSION,  increased blood flow to the muscles Increased blood clotting  Bronchodilation  Skin pallor  Water retention, Sodium retention  Oliguria  Dry mouth, decrease peristalsis  Hyperglycemia 

Slide 38: Remember these Physiologic Manifestations of Stress Pupils dilate to increase visual perception  when serious threats to the body arise Sweat production (diaphoresis) increases to  control elevated body heat due to increased metabolism

Slide 39: Remember these Physiologic Manifestations of Stress Heart rate or pulse rate increases to transport  nutrients & byproducts of metabolism more effectively Skin becomes pale (Pallor) because of  constriction of peripheral blood vessels to shunt blood to the vital organs.

Slide 40: Remember these Physiologic Manifestations of Stress BP increases due to vasoconstriction of  vessels in blood reservoir (skin, kidneys, lungs), due to secretion of renin, Angiotensin I and II Increased rate/depth of respiration with  dilation of bronchioles, promoting hyperventilation and increased oxygen uptake

Slide 41: Remember these Physiologic Manifestations of Stress Mouth may become dry, urine output may  decrease. The peristalsis of the intestines decreases leading to constipation For serious threats, there is improved mental  alertness

Slide 42: Remember these Physiologic Manifestations of Stress Increased muscle tension to prepare for  rapid motor activity/defense Increased blood sugar (glucocorticoids &  gluconeogenesis) to supply energy source to the body.

Slide 43: Psychological indicators  This includes anxiety, fear, anger, depression and unconscious ego defense mechanisms

Slide 44: Anxiety  A state of mental uneasiness, apprehension, or helplessness, related to anticipated unidentified stress  Occurs in the Conscious, subconscious, or unconscious levels

Slide 45: Levels of Anxiety 4 Levels of Anxiety:  Mild  Moderate  Severe  Panic

Slide 46: Levels of Anxiety Mild- increased alertness, motivation and  attentiveness Moderate- perception narrowed, selective  inattention and physical discomfort

Slide 47: Levels of Anxiety Severe- behaviors become automatic, details  are not seen, senses are drastically reduced, very narrow focus on specific details, impaired learning ability. Panic- overwhelmed, unable to function or to  communicate, with possible bodily harm to self and others, loss of strong displeasure

Slide 48: Anxiety

Slide 49: ANXIETY MODERATE CATEGORY MILD SEVERE PANIC Increased Narrowed Inability to Distorted Perception arousal focus focus perception and attention Communication Increased Voice Difficult to Trembling questioning tremors understand unpredictable response Focus on Easily particular distracted object VS changes NONE Slight Tachycardia Palpitation, Increase , choking, chest Hyperventil pain ation

Slide 50: Fear It is a mild to severe feeling of apprehension  about some perceived threat. The Object of fear may or may not be based  on reality.

Slide 51: Anxiety versus fear ANXIETY FEAR State of mental Emotion of apprehension uneasiness Source may not be Source is identifiable identifiable Related to the future Related to the present Vague Definite Result of Result of discrete physical psychological or or psychological entity, emotional conflict definite and concrete events

Slide 52: Anger Subjective feeling of strong  displeasure It is an emotional state consisting of  subjective feeling of animosity or strong displeasure

Slide 53: Depression Emotional Symptoms: Behavioral signs: Tiredness  irritability  emptiness  inability to concentrate  numbness  difficulty making  Physical signs decision loss of appetite  loss of sexual desire  weight loss  crying  constipation  sleep disturbance  headache  social withdrawal  dizziness 

Slide 54: Unconscious Ego defense mechanism These are PSYCHOLOGIC adaptive  mechanisms Mental mechanisms that develop as the  personality attempts to DEFEND itself, establishes compromises among conflicting impulses and allays inner tensions

Slide 55: Unconscious Ego defense mechanism The unconscious mind working to protect the  person from anxiety Releases tension 

Slide 56: COGNITIVE MANIFESTATIONS Thinking responses that include problem  solving, prayer, structuring, self control, suppression and fantasy Thinking responses of the individual toward  stress

Slide 57: COGNITIVE MANIFESTATIONS PROBLEM SOLVING: Use of specific steps  to arrive at a solution STRUCTURING: manipulation of a situation  so that threatening events do not occur

Slide 58: COGNITIVE MANIFESTATIONS SELF CONTROL / DISCIPLINE:  assuming a sense of being in control or in charge of whatever situation SUPPRESSION: willfully putting a thought /  feeling out of one’s mind

Slide 59: COGNITIVE MANIFESTATIONS FANTASY / DAYDREAMING: “ make  believe” or imagination of unfulfilled wishes as fulfilled PRAYER: identification, description of the  problem, suggestion of solution, then reaching out for help or support to the supreme being

Slide 60: VERBAL / MOTOR MANIFESTATIONS First hand responses to stress 

Slide 61: VERBAL / MOTOR MANIFESTATIONS CRYING: feelings of pain, joy, sadness are  released VERBAL ABUSE: release mechanism toward  non living objects, and stress producing events LAUGHING: anxiety reducing response that  leads to constructive problem solving

Slide 62: VERBAL / MOTOR MANIFESTATIONS SCREAMING: response to fear or intense  frustration and anger HITTING AND KICKING: spontaneous  response to physical threats or frustrations HOLDING AND TOUCHING: responses to  joyful, painful or sad events

Slide 64: COPING  A problem solving process or strategy that the person uses to manage the out-of-ordinary events or situations with which he/she is presented.  Successfully dealing with problems

Slide 65: Coping related terms Adaptive coping- helps person  deal effectively with stress Maladaptive coping- results in  unnecessary distress for the person and stressful events

Slide 66: MODES OF ADAPTATION 1. Physiologic mode (biologic adaptation) Occurs in response to increased or altered demands  placed on the body & results in compensatory physical changes. 2. Psychological Mode Involves a change in attitude & behavior toward  emotionally stressful situations. (Ex. Stopping smoking) 3. Socio-cultural Mode Changing persons behavior in accordance with the  norms, conversions, & beliefs of various groups (leaving in new country)

Slide 67: CHARACTERISTICS OF ADAPTIVE RESPONSES All attempts to maintain homeostasis  Whole body or total organism response  Have limits (Physiologic, Psychologic/Social)  Requires time  Varies from person to person  Maybe inadequate or excessive (infection/allergy 

Slide 68: MANIFESTATIONS OF ALTERED COPING  Addictive behaviors  Physical illness  Anxiety and depression  Violent behaviors

Slide 69: Applying the Nursing Process A  D  P  I  E 

Slide 70: Assessment 1. Utilize the Nursing History  Subjective data- such as the functional pattern, risk pattern and dysfunctional pattern. 2. Physical Examination – centered on the changes in the ANS and NES. Objective data- Physical assessment, Diagnostic tests and procedures 3. Laboratory Examination

Slide 71: Diagnoses Utilize those accepted by NANDA 2. Anxiety 7. Fear 3. Caregiver role strain 8. Impaired adjustment 4. Compromised family coping 9. Ineffective coping 5. Decisional conflict 10. Ineffective Denial 6. Defensive coping 11. Post-trauma Syn 7. Disabled Family coping 12. Relocation Stress Syn

Slide 72: Planning There are four important guidelines to be followed in choosing nursing goals. The nurse must choose goals geared :  To eliminate as many stressors as possible  To teach about the effects of stress to the body  To teach how to cope with stress  To teach on how to adjust to stress

Slide 73: Planning Examples of Patient outcome criteria are: After 3 hours/ 4days: 1. The patient will identify sources of stress in his/her life 2. The patient will identify usual personal coping strategies for stressful situations 3. The patient will define the effect of stress and coping strategies on activities of daily living

Slide 74: Implementation There are essentially three ways to manage Stress:  Eliminate the causes/sources of stress  Produce a relaxation response in the body  Suggest a change in lifestyle, if possible

Slide 75: Implementation Stress reduction techniques: Proper nutrition  Regular exercise, physical activity & recreation  Meditation, Breathing exercises, creative imagery,  YOGA Communication, time management, expression of  feeling, talking it out, organizing time Biofeedback  Therapeutic touch  Relaxation response , Problem Solving Techniques 

Slide 76: Implementation Minimize anxiety  Support the client and the family  Orient the client to the hospital  Give the client in a hospital some way of maintaining identity.  Provide information when the client has insufficient information.

Slide 77: Implementation Massage  These include effleurage (stroking), friction, pressure, petrissage (kneading or large, quick pinches of the skin, subcutaneous tissue and muscle), vibration and percussion.  Purposes -enhances or induces relaxation before sleep   -stimulates skin circulation Duration: 5-20 minutes 

Slide 78: Implementation Progressive Relaxation  Jacobson (1930), the originator of the Progressive relaxation technique

Slide 79: Implementation Guided Imagery  Imagery is \"the formation of a mental representation of an object that is usually only perceived through the senses\" (Sodergren 1985). Example: Visual -A valley scene with its many greens Auditory -Ocean waves breaking rhythmically Olfactory -Freshly baked bread Gustatory -A Juicy hamburger Tactile-proprioceptive -Stroking a soft, furry cat

Slide 80: Implementation Biofeedback is a technique that brings under  conscious control bodily processes normally thought to be beyond voluntary command. muscle tension, heartbeat, blood flow, peristalsis, & skin temperature – can be voluntarily controlled feedback provided through:  a. temperature meters (that indicate temp. changes)  b. EMG (electromyogram) that shows electric potential created by contraction the muscles

Slide 81: Implementation Therapeutic Touch  “a healing meditation, because the primary act of the nurse (healer) is to \"center\" the self and to maintain that center (mental concentration and focusing) throughout the process.

Slide 82: Implementation CRISIS INTERVENTION  A technique of helping the person go through the crisis  To mobilize his resources  To help him deal with the here and now  A five step problem solving technique designed to promote a more adaptive outcome including improved abilities to cope with future crises

Slide 83: Evaluation The evaluation of the plan of care is based on  the mutually established expected outcomes. It is important to observe BOTH verbal and  non-verbal cues when evaluating the usefulness of the plan.

Slide 84: Stress Management for Nurses Plan daily relaxation program   Establish a regular pattern of exercise  Study assertive techniques. Learn to say “no”  Learn to accept failures  Accept what cannot be changed  Develop collegial support  Participate in professional organization  Seek counseling





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