1. Concepts Related to Stress and
Adaptation

2. Stress
Provides stimulus for change and growth
– Some positive, necessary
– Too much
• Poor judgment, physical illness, inability to cope
• Affects all dimensions of person’s life
– Changes in internal and external environments
• Essential to adapt for survival
– “Fight or Flight”

3. Define the Concept of Stress
Hans Selye -General Adaptation Syndrome
– Describes physiological events during stress response
• STRESSORS – internal or external stimuli that cause stress
– Physiological, psychological, social, environmental, developmental,
spiritual or cultural
– Internal or external
• STRESS – any situation where nonspecific demand requires
an individual to respond or take action
• Perception may initiate the stress response

4. Physiological Adaptation
Body’s ability to maintain homeostasis
– Controlled by nervous and endocrine systems
• Unconscious responses – automatic
• Negative feedback system
– Adjust heart and respiratory rates, blood pressure, temperature,
fluid and electrolyte balances, hormone secretions, level of
consciousness
• Medulla oblongata
• Reticular formation
• Pituitary gland

5. Medulla Oblongata
Controls vital functions necessary to
survival
– Heart rate, blood pressure, respiration

6. Reticular Formation
Small cluster of neurons in brain stem and
spinal cord
Controls vital functions, continuously
monitoring physiological status of body
through connections with sensory and
motor tracts

7. Pituitary Gland
Pituitary gland, attached to hypothalamus
– Produces hormones necessary for adaptation
to stress
• Secretions of thyroid, gonadal and parathyroid
hormones
– Hormone levels fall, secretions increase
– Hormone levels rise, secretions decrease

8. Limitations of Homeostatic
Control
Healthy-meet day to day needs
– Only short term control over body’s equilibrium
• Cannot adapt to long-term changes in hormones or vital
functions
– Illness, injury or prolonged stress decreases adaptive
capacity
• Results in inadequate homeostatic control or breakdown of
feedback system
– Leads to further illness or death
– Severe stress
• Hormones insufficient in quantity to provide physiological
energy needed for coping
– Condition deteriorates, functioning declines

9. Models of Stress Related to
Nursing Practice
Selye’s GAS model
– Stress- nonspecific response of body to any
demand made on it
• Physiological response of the whole body
– No individual responses
– Useful determining physiological responses

10. Adaptation Model
People experience anxiety and increased stress
when unprepared to cope with stressful
situations
4 factors determine if situation is stressful
– Person’s experience with similar stressors, support
systems and overall perception of the stressor
– Practices and norms of peer group
• Can they talk about it?
– Impact of social environment in assisting
individual to adapt to stressor
– Resources available

11. Stimulus-based Model
Focuses on disturbing or disruptive events
in the environment
– Change is normal
– Perceptions are irrelevant
– All have common threshold

12. Transaction-based Model
Views person and environment in
dynamic, reciprocal, interactive
relationship
– Stress originates from relationship between the
person and the environment

13. Factors Influencing Response to
Stressors
Physiological functioning
Personality
Behavioral characteristics
Nature of stressor
– Perception of intensity or magnitude
– Scope
– Duration
– Other stressors
– Predictability
– Resources available
– Support group

14. Adaptation
Processes physiological or psychosocial
dimensions change in response to stress
– An attempt to maintain optimal functioning
– Requires active response from whole person

15. Dimensions of Adaptation
Physical
– Local adaptation and general adaptation syndrome
Developmental
– Success in past, more likely to succeed now
Emotional
– Physiological defense mechanisms, personality strengths
Intellectual
– Education, problem solving, communication skills, realistic
perception
Social
– Social network
Spiritual

16. Local Physiological Adaptation
Response of body tissue, organ or part to
the stress of trauma, illness or other
physiological change
– Blood clotting, wound healing,
accommodation to light, response to pressure
• Localized
• Adaptive, needs stressor to stimulate it
• Short term
• Restorative

17. Localized Adaptation Syndrome
Reflex pain response
– CNS responds
• Protects from further tissue damage
– Sensory receptor, sensory nerve to spinal cord,
connector neuron in spinal cord, motor nerve from spinal
cord, effector muscle
• Pull hand from hot surface

18. Localized Adaptation Syndrome
Inflammatory Response
– Stimulated by trauma or infection
• Localizes infection, prevents spread, promotes healing
– Local pain, swelling, heat, redness, change in functioning
• First phase – changes in cells and circulatory system
– Vasoconstriction, histamine release, increased blood flow,
increasing WBC’s, capillary permeability increased
• Second phase – release or exudate
• Third phase – repair of tissue by regeneration or scar
formation

19. 3 Phases of General Adaptation
Syndrome
Physiological response of whole body to
stress
– Involves many body systems
• Primarily autonomic nervous system and endocrine
system

20. Alarm Reaction
Mobilizes defense mechanisms of body and mind to
cope with stressor
– Hormone levels rise to increase blood volume
– Increase blood glucose levels to make energy available
– Epinephrine and norepinephrine increase
• “fight or flight”
– Increased heart rate, blood flow to muscles, oxygen intake, greater
mental alertness
– Pupils dilate for greater visual field
• May last a minute to many hours
– Extreme or long term
• May threaten life
– If stressor still present after initial alarm reaction, progresses to next
phase

21. Resistance Phase
Body stabilizes
– Hormone levels, heart rate, blood pressures and
cardiac output return to normal
– Attempting to adapt
• If stress can be resolved, body repairs damage
• If stressor remains present and adaptation fails, enters
third phase

22. Exhaustion Phase
When body can no longer resist stress and
energy is depleted
– Physiological response is intensified
• Energy is compromised
• Adaptation diminishes
– Body cannot defend itself
• Physiological regulation diminishes
– If stress continues, death may result

23. Behavioral Responses to Stress
Psychological adaptive behaviors
(Coping Mechanisms)
– Constructive
• Help accept challenge to resolve conflict
– Destructive
• Do not help cope with stressor
– Affect reality orientation, problem-solving abilities, personality and
in severe cases, ability to function
– Task oriented
• Use problem solving skills to cope with threat
– Ego-defense mechanisms
• Regulate emotional distress, protecting from anxiety and stress

24. Task-oriented Behaviors
Use cognitive abilities to reduce stress, solve
problems, resolve conflicts
– Enable one to cope realistically with demands of
stressor
• Attack behavior – act to remove or overcome a stressor
or satisfy a need
• Withdrawal behavior – removing the self physically or
emotionally from the stressor
• Compromise behavior – changing the usual method of
operating, substituting goals, or omitting the satisfaction
of needs to meet other needs or to avoid stress

25. Ego-defense Mechanisms used as
Stress Responses
Unconscious behaviors that offer psychological
protection from a stressful event
– Help protect against feelings of worthlessness and anxiety
• Can become distorted, becomes destructive
– Compensation
• Make up for deficiency by exaggerating strength
– Conversion
• Transfer conflict into nonorganic symptom
– Denial
• Refuse to consciously acknowledge
– Displacement
• Transfer emotions to less anxiety-producing substitute
– Identification
• Pattern behavior after another

26. Effects of Prolonged Stress
 Developmentally
– Unable to complete devekopmental task
• Repeated stress can lead to maturational crisis
 Intellectually
– Short term memory impaired
– Ability to learn impaired
 Emotionally
– Relate to prior experiences
 Family
– Respect client’s ideals of family
• Poor communication and maladaptive behaviors may affect outcome
 Lifestyle
– Smoking, drinking, obesity, homosexuality
• Set aside personal judgments
 Sociocultural
– Individualized beliefs
 Spiritual
– Individualized

27. Spiritual
Religion and spirituality are not the same
Religion
– System of organized beliefs and worship
Spirituality
– Unique capacity for love, joy, caring, compassion and
for finding meaning in life’s difficult experiences
During stress, one relies on their faith, but may
abandon their practices out of disillusionment
and anger

28. Assessment of Stress
 Physiological – objective
– Elevated B/P
– Increased neck, shoulder and back tension
– Elevated pulse and respirations
– Sweaty palms
– Cold hands and feet
– Slumped posture
– Fatigue
– Tension headache
– Upset stomach
– High pitched voice
– Nausea, vomiting and diarrhea
– Appetite change, weight change
– Urinary frequency
– Abnormal labs
• Elevated adrenocorticotropic hormone, cortisol, catecholamine levels,
hyperglycemis
– Restless
• Difficulty falling asleep or frequent awakening
– Dilated pupils

29. Physical Disorders related to
Stress
Cardiovascular and gastrointestinal diseases
Some cancers
Immunological disorders
Migraine headaches
Infertility
Burnout
Exacerbates Parkinson’s and Tourette’s
syndrome

30. Levels of Stress
 Mild
– Few minutes to few hours
• Usually don’t affect health unless several at once
 Moderate
– Several hours to days
 Severe
– several weeks to several years
• More frequent and longer, the higher the health risk
• As stress increases, stress behaviors increase, decreasing energy and
adaptive responses
 Assess perception to decide level for patient
– several weeks to several years
• More frequent and longer, the higher the health risk
• As stress increases, stress behaviors increase, decreasing energy and
adaptive responses

31. Assessment of Stress (cont)
 Psychological
– Assess for destructive behaviors
 Developmental
– Assess where they are developmentally
• Any delays, are they new?
 Emotional
– Observe behavior
 Intellectual
– Assess learning, cognitive appraisal, attention span
 Family
– What do they consider effective emotional support
• Do they have it?
 Lifestyle
– Smoking, obesity, drug abuse, chronic sleep deprivation
– Regular exercise, adequate rest, nutritious diet
 Sociocultural
– Be aware of cultural differences
 Spiritual
– Examine how beliefs and values have changed
 What does client expect?

32. Nursing Diagnoses Related to
Stress
 Need defining characteristics
– Identify etiology
 Activity intolerance
 Anxiety
 Caregiver role strain
 Coping, ineffective family or individual: compromised or
disabling
 Fatigue
 Fear
 Growth and development, altered
 Hopelessness
 Injury, risk for
 Self-esteem disturbance

33. Stress Management Techniques
Goals
– Reduce frequency of stress-inducing situations
– Decrease physiological response to stress
– Improve behavioral and emotional responses
to stress

34. Stress Management Techniques
Health promotion
– Regular exercise
– Good nutrition
– Adequate rest
– Effective time management
• More in control of life
– Prioritize tasks
– Interactions with positive support systems
– Humor

35. Acute Care
Crisis Intervention
– Therapeutic technique to help resolve immediate stress
problem
• Addresses immediate, urgent need for stress reduction
– Crises
• When one encounters problems or stress situations they are unable
to cope with in usual fashion
• SITUATIONAL
– External
• Symptoms transient, episode brief
• new baby, role change, acute illness, family change
• DEVELOPMENTAL
– Internal
• Unable to complete developmental tasks of stage
• can occur at any point
•

36. Crisis Intervention
Resolution of conflict depends on realistic
perception, use of adequate coping
mechanisms
– Health promotion

37. Restorative Care
Assist in life style changes that are healthy and stress
reducing
– SMOKING CESSATION
– HUMOR
• Use appropriately
– Laughing alleviates stress, releases endorphins
– SPIRITUALITY
• Prayer, meditation or reading religious material
– SELF ESTEEM
• Stress positive characteristics
– RELAXATION TECHNIQUES
• Guided imagery, progressive relaxation, meditation, biofeedback
– STRESS MANAGEMENT

38. Stress in Workplace
Stress is working women’s number one problem
– Stressors: workload, institutional policies, conflict
with co-workers, dealing with death, conflict with
physicians, inadequate preparation to deal with
emotional needs of clients and families
• Level of stress depends on personality, health status,
previous experiences with stress, coping mechanisms
– Job stress = Burnout
• Depletes energy to deal with it
• Sense of helplessness and negativism
• No positive rewards
• Anger or apathy
– Identify stressors and strive to eliminate them