STRESS, ADAPTATION, AND ANXIETY

1. CHAPTER 12 STRESS, ADAPTATION, AND ANXIETY Revised by L. May, RN 2009

2. STRESS • Nonspecific response to any demand made on the body. • Any situation, event, or agent that produces stress is a stressor. • A stressor is a stimulus that evokes the need to adapt. • Stressors can be internal or external.

3. RESPONSES TO STRESS • Adaptive energy –the inner force an individual uses to respond or adapt to stress. • General stress reactions affect the entire body. • Local stress affects only the involved body part. • Is temporary. Resolves when the affected part goes back to normal

4. GENERAL ADAPTATION SYNDROME • Stage One: crisis or alarm–body readies itself to handle stressors. Physiologic changes occur (cool pale skin, shivering, diaphoresis on palms and soles of feet) • Stage Two: adaptation or resistance–body attempts to defend against stressor through fight-or-flight response. Body readies itself to stay and fight or get up and flee. • Stage Three: exhaustion–if adaptive energy can’t deal with prolonged stress.

5. LOCAL ADAPTATION SYNDROME • The physiologic response to a stressor on a specific part of the body. • Usually a temporary process that resolves when the traumatized area is restored to its pre-injury state.

6. SIGNS AND SYMPTOMS OF STRESS • Physiologic (Stuff that happens to the body): pulse rate, blood pressure increase, breathing rapid, shallow, blood thickens, dizziness, sweaty palms, headache, pupils dilated, nausea, appetite change, constipation, diarrhea, increased urination, twitching, trembling, increased level of blood glucose, cortisol.

7. SIGNS AND SYMPTOMS OF STRESS (continued) • Psychological (mood): irritability, feelings easily hurt, sadness, depression, feelings of pleasure and accomplishment reduced. • Cognitive (Reasoning): impaired memory and judgment, confusion, unable to concentrate, poor decision making, altered perceptions, delayed response.

8. SIGNS AND SYMPTOMS OF STRESS (continued) • Behavioral: pacing, rapid speech, insomnia, withdrawal, easily startled. • Spiritual: alienation, social isolation, feeling of emptiness.

9. OUTCOMES OF STRESS • Eustress: a type of stress resulting in positive outcomes. (here comes the Bride) • Distress: stressors evoking an ineffective response.

10. ADAPTATION • An ongoing process whereby individuals adjust to stressors and change. • They use the minimal amount of energy to cope with stress • Physiologic adaptation –how body responds to stressors affecting function. • Psychological adaptation –defense mechanisms, learning to mentally accept new situations.

11. ADAPTATION (continued) • Cognitive adaptation –education, communication, problem-solving, and perception of people and the world. • Social adaptation –social relationships with family, friends, and coworkers.

12. ADAPTATION (continued) • Spiritual adaptation –beliefs about supreme being and positive sense of life’s purpose and meaning.

13. COPING MEASURES • All the ways an individual may react to stress. • Individuals may learn to conserve their adaptive energy through conditioning. • Conditioning occurs when a person is taught a behavior until it becomes an automatic response. (becomes 2nd nature) • Teaching a dog to sit • Applying oxygen to patient who is SOB

14. FACTORS AFFECTING AN INDIVIDUAL’S ABILITY TO COPE • Degree of danger perceived by individual • Immediate needs of individual • Amount of support from others • Individual’s belief in own ability to handle the stressful situation • Previous successes and failures in coping • Concurrent or cumulative stresses

15. ADAPTIVE MEASURES • Measures for coping with stress that require a minimal amount of energy • Having support people • Relaxing to relieve tension • Changing behavior • Developing more realistic goals • Solving problems

16. DEFENSE MECHANISMS • Unconscious functions protecting the mind from anxiety. • Used to gain and maintain psychological homeostasis. • Happen automatically. • Only considered maladaptive when the only way individual responds to threat or limits ability to function.. • Table 2-12

17. MALADAPTIVE MEASURES • Used to avoid conflict and stress. • Prevent the individual from making progress towards resolving and accepting stress. • May include somatic disorders, rituals, excessive use of alcohol or drugs, excessive eating, withdrawal from reality.

18. CRISIS • An acute state of disorganization. • Ex: The 15 minutes right before a major exam • Occurs when stressors surpass the ability to cope. • Coping mechanisms are no longer adequate. • Is time limited.

19. ANXIETY • A subjective response occurring when person experiences a real or perceived threat to well-being. • Diverse feeling of dread or apprehension. • The psychological response to a threat. • The most common emotional response to stress. • Mild, moderate, severe and panic (p225)

20. SEVERE ANXIETY

21. ANXIETY AND ILLNESS • Anxiety often increases during illness and the recovery process. • Illness occurs when adaptive attempts are unsuccessful. • An ill person has fewer usable adaptive resources to cope with stressors. • Nurses must be sensitive to stress and the many changes caused by illness.

22. CHANGE • Inevitable and constant. • May be eustressful or distressful. • Can be externally imposed or self-initiated. • Can occur abruptly or have gradual onset. • Requires energy to effect, and to resist.

23. NURSE AS CHANGE AGENT • Change agent –person who intentionally creates and implements change. • Change agents seek ways to make improvements. • Change agents use critical thinking to develop innovative, creative solutions.

24. THE NURSING PROCESS • Nurses can be very instrumental in helping clients both understand their anxiety and learn measures to cope with and control their feelings of stress.

25. ASSESSMENT Thorough assessment of stress and anxiety levels includes asking the client about: • Types or patterns of stressors. • Usual response to stressful situations. • Cause-and-effect among stressors and thoughts, feelings, and behaviors. • History of successful coping.

26. NURSING DIAGNOSES • Anxiety; ineffective coping • Ineffective denial • Powerlessness • Impaired adjustment • Ineffective role performance • Disturbed thought processes • Defensive coping

27. NURSING DIAGNOSES (continued) • Fear • Post-trauma syndrome • Impaired social interaction • Spiritual distress • Hopelessness • Fatigue • Disturbed sleep pattern

28. PLANNING/OUTCOME IDENTIFICATION • Identify when stress and anxiety increase. • Describe ways to decrease the effects of usual stressors. • Identify positive and negative stressors. • Group stressors into categories. • Demonstrate correct use of select stress-management exercises.

29. IMPLEMENTATION • Meet basic needs. • Minimize environmental stimuli. • Verbalize feelings. • Involve family/significant others. • Use stress-management techniques. • Use crisis intervention.

30. STRESS MANAGEMENT TECHNIQUES • Exercise • Relaxation techniques • Cognitive reframing or thought stopping

31. EVALUATION • Must include client input. • Must evaluate client outcomes.

32. STRESS MANAGEMENT FOR THE NURSE: BURNOUT • Caused by high stress levels. • State of physical, emotional exhaustion. • Several work-related factors can contribute: heavy workload, critically ill clients, conflict in work environment, mandatory overtime, “floating” to other units, little work-related social support.

33. MANAGING PROFESSIONAL STRESS • Develop active support systems. • Use time management and decision-making methods. • Focus on accomplishments. • Know personal limits.. • Avoid harmful substances.

34. MANAGING PROFESSIONAL STRESS (continued) • Nourish body with healthy diet, exercise, and sleep. • Practice slow, focused breathing. • Vary tasks between mental and physical activities. • Maintain a sense of humor. • Learn how to separate your life from your new career