stress and adaptation with theories of stress

2. STRESS & ADAPTATION
Presenting By,
S. Anusha
M.sc(N), ACON.

3. INTRODUCTION
Stress is simply a reaction to a stimulus that
disturbs our physical (Or) mental
equilibrium. In the other words, it’s an
omnipresent part of life.
A stressful event can trigger the “flight-or-
fight” response.

4. Concept Of Stress & Stressors
• Stress is any situations in which a non-specific
demand requires an individual to respond (or)
take action. It involves physiological &
psychological response.
• Stress can lead to negative (or) counter
productive feelings (or) threaten emotional
well being

5. Cont..,
• It can threaten the way a person normally
perceives reality, solves problems, thinks in
general; & a person’s relationship & sense of
belonging
• In addition, stress can threaten a person’s
general outlook on life, attitude toward loved
one & health status.

6. Cont..,
• The stimuli preceding (or) precipitating the
change are called stressors
• Internal stressors – originate inside a person
Eg:- fever, pregnancy, emotion such as guilt.
• External stressors – originates outside a person
Eg:- a marked change in environmental
temperature, a change in family (or) peer
pressure.

7. TERMINOLOGIES
• STRESS: the non-specific response of the
body to any demand for change.
• STRESSORS: the event (or) situation causing
the stress (or) emotion focused through finding
ways to less the feelings of anxiety & angst
triggered by the stressful event
• APPRAISAL: it is the process of interpreting a
situation & determining if it is a stress.

8. Cont..,
• COPING: coping can be problem focused
through taking actions to directly work with
the stressor.
• ADAPTATION: it is the successful adjustment
to stress, ensuring continued health & well-
being.
• CRISIS: when stress overwhelms existing
coping mechanisms, person loose emotional
balance.

9. DEFINITION
• According to Selyle (1956), ―Stress is
defined as the pressure experienced by a
person in response to life demands. These
demands are referred to as stressors and
include a range of life events, physical
factors (e.g.: cold, hunger, haemorrhage,
pain), environmental conditions and personal
thoughts.

10. NORMAL COPING &
ADAPTATION TO STRESS
• Life is a dynamic process. Through constantly
changing environments, from the smallest
cellular components to the largest global levels,
stress is encountered.
• Successful adaptation to these changing
environments perpetuates survival.
• Historically, stress was described as encounters
with acute events leading to the “fight-(or)-
flight” response.

11. Cont..,
• In this context, stress was periodic short-term
events
• Changes & adjustments to changes are ongoing
& range from subcounscious levels to minimal
efforts to extreme endeavors.
• The process of appraisal, stress, coping &
adaptation are the elements of managing these
changes

12. Physiologic Function Relation To
Stress, Coping & Adaptation
HOMEOSTASIS:-
“it is a physiologic parameters that must be
maintained for the human body to survive under
emergency circumstances”
Necessitating the co-ordination of various systems,
such as regulation of PH, oxygen levels, blood
pressure, heart rate, blood glucose levels, fluid &
electrolytes & body temperature within the narrow
therapeutic ranges to maintain the body’s
homeostasis

14. Cont..,
ALLOSTASIS:
• It is a process of maintaining reestablishing
homeostasis in response to life’s changes &
challenges.
• This process of physiologic adjustments ensure
survival when environmental changes (or)
stressors are encountered.
• The allostasis response is managed through
physiologic mediators .

15. Physiologic Mediators Allostasis
• Higher cognitive areas of brain function
assimilate the stress information & interface
with other parts of the brain such as the
hypothalamus & brain stem.
• In turn, brain activity regulates autonomic,
neuro endocrine & immune system

16. 1. THE CNS:
• The CNS consists of the brain, spinal cord &
control behaviors in the body. The CNS regulates
sensory, integration, & motor function.
• In terms of stress, the brain is integral in the
process of stress perception & associated
physiologic response

17. Cont..,
• The limbic system is comprised of several
structures in the brain, including the hippocampus,
amygdala, thalamus & limbic cortex .
• Information about olfaction, emotions, behavior &
long-term memory is processed through this
system.
• A repeated stressor can turn into a chronic
stress situation in which the brain alter itself.

18. Cont..,
• This process of adaptive plasticity, however , can
be determined to the body (or) maladaptive.
• On positive side, the aberrant adaptation can be
reversible especially once the stressors is removed

19. 2.NEUROENDOCRINE REGULATION
• On stress is perceived by the limbic system, signals
will be sent to the hypothalamus.
• The basic functioning consists of secretion of
corticotrophin-releasing hormone (CRH) from the
hypothalamus,
• which in turn triggers the secretion
of adreno-corticotrophic hormone (ACTH)
• from the anterior pituitary.

20. Cont..,
• Under normal daily activity, glucocorticoids are
released in a circadian pattern, peaking in humans in
the early morning hours.
• Under the duress of stress, glucocorticoid levels can
elevated at any time.
• Cortisol is the primary glucocorticoid released from
the adrenal cortex.
• It is involved in numerous functions, includig
glucose, lipid, protein metabolism, immune activity
in the nervous, muscular, GI, CV & GU system.

21. Cont..,
• Additionally, cortisol influences behavior,
mood & cognitive function.
• Under acute stress, cortisol is protective of
mood where as under chronic stress it is
associated with depression & anxiety.

22. 3. AUTONOMIC REGULATION
• The autonomic nervous system is integral in
responding to actual (or) potential stress.
• The ANS response involves several systems
throughout the body by including contraction of
both smooth & cardiac muscles to regulate cv,
respiratory, GI, renal & endocrine function.
• The ANS has two main divisions
Sympathetic
parasympathetic

23. Cont..,
• During a stressful situation, the excitatory actions
will cause
pupil dilation,
 increased HR,
 force of contraction, bronchial dilation, &
 stimulation of converting glycogen to glucose.
• The sympathetic inhibitory responses decrease
activity in certain organs that would interfere with
other activities needed at that time.

24. Cont..,
• These inhibitory effects include:
• Decreasing digestion function.
• Inhibiting insulin secretion from the pancreas
• Preventing urination
• The resolution of stressful event, PNS activation
ensues
• Causing pupil constriction, decrease HR,
constriction of the bronchioles, increased
digestion, insulin secretion, thus helping the body
return to a state of dynamic equilibrium.

25. 4. IMMUNE REGULATION
• As a stress responder, the immune system is
activated to maintain homeastasis with acute
stress onset such as when trauma, infections &
autoimmune response occur.
• In particular, interleukin-6 (IL-6) one of the
proinflammatory cytokines expressed when the
immune system is activated stimulates activation
of the HPA axis.

26. Cont..,
• In contrast, long-term stress can inhibit
immune system function, creating
suspectibility to infections, allergies,
autoimmune disorders & cardiovascular
disease

27. MECHANISM OF
PHYSIOLOGICAL ADAPTATION
• The fight-(or)-flight response to stress, which is
arousal of the sympathetic nervous system,
prepares a person for action neuro-physiological
responses to stress function through negative
feedback.
• The process of negative feedback
Eg :-senses an abnormal such as lowered body
temperature & makes an adaptive response such
as initiating shivering to generate body heat.

28. Cont..,

29. Cont..,
• Three structures control the response of the body
to a stressors
Medulla
oblongata
Pituitary
gland
Reticular
formation

30. Medulla Oblongata
• The medulla oblangata, located in the lower
portion of the brain steam, controls HR, BP &
respiration.
• Impluses traveling to & from the medulla
oblongata increase (or) decrease these vital
function.

31. Reticular Formation
• The reticular formation, a small cluster of
neurons in the brainstem & spinal cord,
continously monitors the physiological status
of the body through connections with sensory
& motor tracts.

32. Pituitary Gland
• The pitutary gland is a small gland
immediately beneath the hypothalamus.
• It produce hormones necessary for adaptation
to stress such as adrenocorticotropic hormone,
which in this produces cortisol.

33. GENERAL ADAPTATION
SYNDROME
• GAS, a 3 stages reaction to stress, describes how the
body responds to stressors through
The alarm reaction
The resistance stage &
The exhaustion stage.
• It involves several body systems, especially the ANS,
endocrine system & responds immediately to stress.
• When the body encounters a physical demand such as
an injury. The pituitary gland initiates the GAS

34. Cont..,

35. Alarm Reaction
• Raises the hormone levels result in increased
blood volume, blood glucose levels, epinephrine
& norepinephrine amounts, HR, blood flow to
muscles, oxygen intake, & mental alertness
• If the stressor poses an extreme threat to life (or)
remains for a long time, the person progresses to
the second stage, resistance.

36. Resistance Stage
• During the reistance stage the body stabilizers &
responds in a manner opposite to that of the alarm
reaction.
• Hormone levels, HR, BP, & cardiac output results
to normal & the body repairs any damage that has
occurred.
• However, if the stress response is chronically
activated, a state of allostasis occurs.

37. Cont..,
• This chronic arousal with the presence of
powerful hormones causes excessive wear & tear
on the person is called allostatic load
• An increased allostatic load leads to chronic
illness.
• A persistant allopathic load can cause long-term
physiological problems such as chronic
hypertension, depression, sleep deprivation,
chronic fatigue syndrome & autoimmune
disorders.

38. Exhaustion Stage
• When the body is no longer able to resist the
effects of the stressor & has depleted the
energy necessary to maintain adaptation.
• The physiological response has intensified; but
with a compromised energy level, the person’s
adaptation to the stressors diminishes.

39. LOCAL ADAPTATION
SYNDROME
• the body produces many localized responses
to stress.
• This include blood clotting, wound healing
accommodation of the eye to light & response
to pressure.

40. Characteristics Of LAS
• The response is localized, it does not involve entire
body system
• The response is adaptive, meaning that a stressor is
necessary stimulate it.
Stress response is natural, protective & adaptive.
There are normal responses to stressors, stressors
encountered everyday circumstances increase
catecholamine excretion, which causes an increase
in HR & BP.

41. Cont..,
Physical & emotional stressors trigger similar
responses, magnitude & patterns may differ.
There are limits in ability to compensate
Magnitude & duration of stressors may be so
great that homeostatic mechanisms for adjustment
fail, leading to death.
Repeated exposure to stimuli results in adaptive
changes
There are individual differences in response to
some stressors

42. Cont..,
• The response is short term. It does not persist
indefinitely
• The response is restorative, meaning that the
LAS assist in resorting homeostasis to the
body region (or) part.

43. REACTION TO PSYCHOLOGICAL
STRESS
• The GAS is activated indirectly for psychological
threats, which are different for each person &
produce differing reactions.
• The intensity & duration of the psychological threat
& the number of other stressors that occur at the
same time affect the persons response to the threat.
• In addition, whether (or) not the person anticipated
the stressor influences its effect

44. Cont..,
• It is often more difficult to cope with an
unexpected stressor.
• Personal characteristics that influences the
response to a stressors include the level of
personal control, presence of a social support
system, & feelings of competence.

45. Cont..,
• The person identifying the event (or)
circumstance as a harm, loss, threat (or)
challenge, the person experiences stress is
“primary appraisal”
• If stress is present, focuses on possible coping
strategies is by “secondary appraisal”

46. 1. Task Oriented Behaviors
• Task –oriented behavior involve using cognitive
abilities to reduce stress, solve problems, resolve
conflicts & gratify.
• It enable a person to cope realistiably with the
demands of a stressor.
• The three general types of task-oriented behavior
are attack behavior, withdrawal behavior, &
compromise.

47. 2. Coping
• Coping mechanisms include psychological
adaptive behaviors.
• Such behaviors are often task oriented,
involving the use of direct problem-solving
techniques to cope with threats.

48. Cont..,

49. RESPONSE-BASED MODELS
OF
STRESS

50. MODELS OF STRESS
The stuart stress adaptation model :
the components of the stuart stress
adaptation model that parallel the balancing
factors in crisis intervention are highlighted.
Behaviors:
people in crisis experience many symptoms,
including those listed four phases of disaster
response:

51. Cont..,
PHASES RESPONSE
Heroic Begins at time of impact. A co-operative spirit exists among
survivors on they perform acts to save lives.
Honeymoon Begins to appear 2 weeks to 6 months after the disaster
massive relief efforts are begun. The community works
together, with the help of donated resources, to begin
community life again. Survivors feel a sense of security
disillusionment Lasts from several months to a year. Begins when supportive
agencies & services withdraw. A time of anger, resentment &
disappoinment. Survivors feel a sense of abondonment.
reconstruction Lasts for several years. Problem solving improves survivors
rebuild their community

52. Cont..,
• Sometimes these symptoms can cause further
problems.
Eg:- problems at work may lead to loss of a job,
financial stress & lowered self-esteem
• crises can also be complicated by old conflicts
that are brought out by the current problem,
making crisis resolution more difficult.

53. Precipitating Event
• To help identify the precipitating event, the nurse
should explore the patient’s needs, the events that
threaten those needs, & the time at which
symptoms appear.
• 4 kinds of needs that have been identified are
related to : - Self-esteem
- Role-mastery
-Dependency
- Biological functions

54. Perception Of Events
• Themes & surfacing memories of the patient
give further clues to the precipitating event,
current issues of concern are often connected to
past issues.
Eg:- a female patient who talks about the death of
her father, which occurred 3 yrs ago, may on
questioning reveal recent loss of a relationship
with a male.

55. Support System & Resources
• the patients living situation & supports in the
environment must be assessed
• Does the patient live alone (or) with family (or)
friends? Who offers understanding & strength?
• Assessing the patients support system is important
in determining who should came for the crisis
therapy sessions.

56. Cont..,
• Assessing the patients coping resources.
• If there is a high degree of suicidal & homicidal
risk along with weak outside resources,
hospitalization may be a safer & more effective
treatment.

57. Coping Mechanisms
• The nurse assess the patients strengths & previous
coping mechanisms.
 How has the patient handled other crises?
 How were anxieties relieved?
 Did the patient talk out problems?
 Did the patient leave the usual surroundings for a
period of time to things out from another perspective?
 Was physical activity used to relieve tension?
 Did the patient find relief in crying?

58. HANS SELYE’S MODEL

59. Cont..,
• Body :
As such he studied the physical effects of hormones
when the body.
• Non-specific Response:
Specific responses are logical reactions to
something.
Eg:-Shiver when we are cold. We perspire when we
are hot. Those are specific response by the body
to a stimulus of some kind

60. Cont..,
• Eg:- a non-specific response would be when you are
lying in bed on the verge of sleep & you hear a
disconcerting sound in the other room
• Heart beat quickers, BP increases, senses actually
become more acute
• This are non-specific responses body has activated
the fight-flight mechanism that are meant to prepare
you for a fight (or) remove from the situation

61. Cont..,
• Demands :
selye’s divided demands into 3
categories:
Disstressors : negative stressors.
Eustressors: positive stressors.
Neutrals : those stressors that by themselves
have neither a negative nor a positive effect on
us

62. BETTY NEUMAN’S MODEL

63. Cont..,

64. Stimulus-Based Model
Assumptions:
• Life change events are normal, they require, the
same type & duration of adjustment.
• People are passive recipients of stress, & their
perceptions of the events are irrelevant.
• All people have a common threshold of stimulus
& illness results at any point after the threshold.

65. Transcation-Based Model

66. LAZARUS & FOLKMAN MODEL

67. Cont..,
• The stressors as an individual perceptual response
rooted in psychological & cognitive processes.
• Stress originates from the relationship between
the person & the environment . This model
focuses on stress-related processes such as
cognitive appraisal & coping.

68. TYPES OF STRESS
• Stress includes work, family, chronic & acute
stress, daily hassles, trauma & crisis.
Post Traumatic Stress Disorder (PTSD)
It begins when a person experiences,
witness, or is confronted with a traumatic event
& responds with intense fear (or) helplessness.
Eg:- natural disaster, violent personal assault (Or)
vehicle crashes.

69. Cont..,
• Some people with PTSD experience flashbacks
(or) recurrent & intrusive recollections of the
event.
• Responses may also include self-destructive
behaviors such as suicide attempts & substance
abuse.
• There are 3 types of coping this means that
pervious ways are not effective & the person must
change.

70. Cont..,
There are 3 types of crises:
• Maturational (or) developmental crisis
• Situational crisis
• Disaster (or) Adventitious crisis

71. EFFECTS OF STRESS ON HEALTH
• Depression
• Dyspipesia
• Eating disorders
• Erectile dysfunction
• Fatigue
• Fibromyalgia
• hpyertension
• Headache
• Insomnia
• Low back pain
• Peptic ulcer disease
• Irritable bowel
syndrome
• Menstrual irregulaties
• Sexual dysfunction

72. Cont..,
• stress can have effects on cognitive function,
including poor concentration, memory problems,
distressing dreams, sleep disturbances & impaired
decision making.
• The CNS is capable of influencing the function of
the immune system.
• Stress induced immuno suppression may exacerbate
(or) increase the risk of progression of immune
based diseases such as:

73. Cont..,
• Sclerosis
• Asthma
• Rheumatoid arthitis
• Cancer
• Stressful life events can make a person more
susceptible to infection.
• For eg:- psychological stress may increase
one’s risk for developing the common cold.

74. Indicators Of Stress

75. Cont..,
2. Psychological Indicators
Mild anxiety
Anxiety Moderate anxiety
severe anxiety
• Fear
• Anger
• Depression

76. Cont..,
3. Cognitive Indicators Of Stress:
problem-solving
Structuring
Self-control
Suppression
fantasy

77. Factors Influencing Stress

78. MANAGEMENT
ASSESSMENT:-
• Identify actual (or) potential stressors.
• Identify patients appraisal of stresss.
• Obtain data regarding the patient’s pervious
experience with stress
• Determine the impact of illness on the
patient’s lifestyle

79. Nursing Diagnosis
Anxiety related to :
• Change in health status.
• Maturational (or) situational crisis.
Altered growth & development related to:
• Separation from significant others
• Situational crisis (eg:- unplanned pregnancy)
Caregiver role strain related to :
• Adjustment to medical diagnosis

80. Cont..,
Hopelessness related to:
• Long-term stress
• Lost belief in values
Ineffective family coping:
• Compromised (or) disability (or) ineffective
Individual coping related to:
• Inadequate coping methods
• Prolonged stress

81. Planning
• The general goals:
• Reduction in frequency of stress-including
situations
• Decreased physiological response to stress
• Improved behavioral & emotional responses to
stress.

82. Implementation
• Health promotion
• Regular exercise
• Time management
• Guided imagery & visualization
• Humor
• Relaxation technique
• Nutrition & diet
• rest

83. CRISIS INTERVENTION

84. INTRODUCTION
• Human beings have to maintain balance in life
whenever he is exposed to stressors (or) stressful
situations. He will try to adapt by his own way of
dealing with problem, by adapting adequate coping
strategy, with the help of situational support, he will
try to overcome from it.
• Crisis intervention aims to return the person to a pre-
crisis level of functioning & promote growth.

85. Definition
• “A state of equilibrium resulting from the
interaction of an event with the individuals (or)
families coping mechanisms, which are
inadequate to meet the demands of the
situations, combined with the individuals (or)
families perception of the meaning of the
event.”

86. Characteristics Of Crisis
• Crisis occurs in all individuals at one time
• Crisis is precipitated by specific identifiable
events.
• Crisis is acute, not chronic & will be resolved
in one way (or) another within a brief period.
• Crisis is personal in nature.
• A crisis situation contains the potential for
psychological growth (or) deterioration.

87. Types Of Crisis
• Baldwin (1978) has identified 6 classes of
emotional crisis which progress by degree of
severity.
Dispositional crisis
Crisis of anticipated life transition
Crisis resulting from traumatic stress
Maturational/developmental crisis
Crisis reflecting psychopathology
Psychiatric emergencies

88. CAPLAN CRISIS MODEL

89. Cont..,

90. Cont..,

91. Stuart crisis model
Individual
approach
Generic
approach
General support
Environmental
manipulation

92. Aguilera modified model

93. Signs & Symptoms

94. Crisis Therapy
Principles:
• By acceptance of the person
• Establishing rapport & positive concern social
relationship
• Let the family & the client understand that
coming for help is a good indication & sign of
strength & judgement.

95. Indications
• Abstinence
• Pediatric, geriatric
• Adolescent
• Suicide attempted
pupil
• Psychosomatic
patients
• Violent patients
• Accident victims
• Family crisis
• High risk families
• Severe depression
• Severe anxiety
• Marital conflicts
• Illicit drug abuse
• Traumatic events
• Intra group issues
• Client
management
issues

96. SETTINGS

97. Goals
• To return to pre-crisis level of functioning
• To provide real perception of the situation by
the client
• To assist the individual in managing the
intense & over whelming feelings with crisis
• To resolve the crisis situation

98. Techniques
• Catharsis
• clarification
• suggestion
• reinforcement of behavior
• support of defense
• raising self-esteem
• exploration of solution

99. CONCLUSION
• Stress is a central concept for understanding
both life & evaluation. All creatures face
threats to homeostasis, which must be met with
adaptive responses. our future as individuals &
a species depends on our ability to adapt to
potent stressors.

100. ANY doubts