J Carino Jomillo, PTRP, RN

Definitions and
Perspectives:
Stress – in addition to being itself, and
the result of itself, is also the cause of
itself. (Wallis 1983)
Adaptation – responses directed at
stabilizing internal biological processes
and the preservation of self-esteem.
Stressor – is anything that is perceived
as challenging, threatening, or
demanding. Can be internal or external.
Homeostasis – various physiologic
mechanisms within the body respond to
internal changes to maintain relative
constancy in the internal environment.
 Perception
Of
stressor

Sources
Coping
For
Mechanisms
support

A balance is achieved when the perception of the

stressful event is realistic and support and coping
mechanisms are adequate.
Figure 1. A realistic perception of a stressful event, sources for
emotional support, and appropriate coping mechanisms are
cimponents of a system of balance during stress.
Perception Coping
Of Sources Mechanisms
stressor For
support

An imbalance can occur if the perception of the

event is exaggerated or if sources for support or
coping mechanisms are inadequate.
 Physiologic Homeostasis
 Local Adaptation System (LAS) —
involves only one specific body part
• Reflex pain response
• Inflammatory response
 General Adaptation Syndrome —
biochemical model of stress (Hans Selye)
• Alarm reaction
• Resistance
!
• Exhaustion WHAT!!
 Alarm Reaction
 Person perceives stressor, defense
mechanisms activated
 Fight-or-flight response
 Hormone levels rise, body prepares
to react
 Shock and counter-shock phases
 Resistance
 Body attempts to adapt to stressor.
 Vital signs, hormone levels, and
energy production return to normal.
 Body regains homeostasis or
adaptive mechanisms fail.
 Exhaustion
 Results when adaptive mechanisms
are exhausted
 Body either rests and mobilizes it’s
defenses to return to normal or dies
The General Adaptation Syndrome (GAS)
THREAT
THREAT

Alarm Reaction

Neuroendocrine Activity

Heart Rate
 Blood Pressure
 Peripheral Vasoconstriction
 Metabolism
 Water Retention
 Glucose
Dilated Pupils
Dilated Bronchi
Mental Alertness

Fight-or-Flight Response
GAS…

Stage of Resistance

Neuroendocrine activity
Returns to normal
Local Adaptation Syndrome (LAS)
Coping and Defense Mechanism

RECOVERY
Stage of Exhaustion
GAS…

Stage of Exhaustion

Vasodilation
Blood Pressure
Pulse and Respirations
Panic, Crisis

Exhaustion

Rest and Recovery DEATH

 Psychological Homeostasis
 Love and belong needs
 Safety and security needs
 Self-esteem needs
 Effects of Stress on Basic Human Needs
 Physiologic
• Change in appetite, activity, or sleep
• Change in elimination patterns
• Increased pulse, respiration, blood pressure
 Safety and Security
• Feels threatened and nervous
• Uses ineffective coping mechanisms
• Is inattentive
 Love/Belonging
• Is withdrawn and isolated
• Blames others for own faults
• Demonstrates aggressive behaviors
• Becomes overly dependent on others
 Self-Esteem
• Becomes a workaholic
• Exhibits attention-seeking behaviors
 Self-Actualization
• Refuses to accept reality
• Centers on own problems
• Demonstrates lack of control
Emotional Responses to Stress
 Depression
 Anger
 Anxiety (most common)
• Mild
• Moderate
• Severe
• Panic
 Coping Mechanisms
 Crying, laughing, sleeping, cursing
 Physical activity, exercise
 Smoking, drinking
 Lack of eye contact, withdrawal
 Limiting relationships to those with
similar values and interests
Task-Oriented Reactions to Stress
 Attack behavior
 Withdrawal behavior
 Compromise behavior
 Defense Mechanisms
 Compensation
 Denial
 Displacement
 Introjection
 Projection
 Rationalization
 Defense Mechanisms
(continued)
 Reaction formation
 Regression
 Repression
 Sublimation
 Undoing
 Adaptation to Acute and
Chronic Illness
 General tasks — e.g., maintaining
self-esteem and personal
relationships
 Illness related tasks — e.g., handling
pain and disability
 Effects of Long-Term Stress
 Affects physical status
 Increases risk for disease or injury
 Compromises recovery and return to
normal function
 Is associated with specific diseases
 Family Stressors
 Changes in family structure and roles
 Anger and feelings of helplessness
and guilt
 Loss of control over normal routines
 Concern for future financial stability
 Factors Affecting Stress
and Adaptation
 Sources of stress
 Types of stressors experienced
 Personal factors
 Categories of Stress
 Developmental stress
• Occurs when person progresses through
stages of growth and development
 Situational stress
• Does not occur in predictable patterns
 Types of Stressors
 Physiological
• Chemical agents, physical agents,
infectious agents, nutritional
imbalances, hypoxia, genetic or immune
disorders
 Psychosocial
• Includes real and perceived threats
 Stressful Activities in
Nursing Profession
 Assuming responsibilities for which
not prepared
 Working with unqualified personnel
 Working in environment in which
supervisors are not supportive
 Caring for patient in cardiac arrest or
dying person
 Experiencing conflict with peers
 Teaching Healthy ADLs
 Exercise
 Rest and sleep
 Nutrition
 Use of support systems
 Use of stress management
techniques
Stress Management Techniques
 Relaxation
 Meditation
 Anticipatory guidance
 Guided imagery
 Biofeedback
 Crisis intervention
 Crisis Intervention
 Identify the problem
 List alternatives
 Choose from alternatives
 Implement the plan
 Evaluate the outcome
 Evaluating the Plan of Care
 Patient verbalizes causes and effects of
stress and anxiety.
 Patient identifies and uses sources of
support.
 Patient uses problem solving to find solution
to stressors.
 Patient practices healthy lifestyle habits and
anxiety-reducing techniques.
 Patient verbalizes decrease in anxiety and
increase in comfort.
 The Recent Life Changes Questionnaire
Life Changes Event LCU
Health
An injury or illness which:
Kept you in bed a week or more, or sent you to the hospital 74
Was less serious than above 44
Major dental work 26
Major change in eating habits 27
Major change in sleeping habits 32
Major change in your usual type/amount of recreation 28
Work
Change to a new type of work. 51
Change in your work hours or condition 35
Change in your responsibilities at work:
More responsibilities 29
Fewer responsibilities 21
Promotion 31
Demotion 42
Transfer 32
Troubles at work:
With your boss 29
With your coworkers 35
With persons under your supervision 35
Other work troubles 28
 Major business adjustment 60
Retirement 52
Loss of job:
Laid off from work 68
Fired from work 79
Correspondence course to help you in your work 18
Personal and Social
Change in personal habits 26
Beginning or ending school or college 38
Change of school or college 35
Change in political beliefs 24
Change in religious beliefs 29
Change in social activities 27
Vacation 24
New, close, personal relationship 37
Engagement to marry 45
Girlfriend or boyfriend problems 39
Sexual difficulties 44
“Falling out” of a close personal relationship 47
An accident 48
Minor violation of the law 20
Being held in jail 75
 Death of a close friend 70
Major decision regarding your immediate future 51
Major personal achievement 36
Home and Family
Major change in living conditions 42
Change in residence:
Move within the same town or city 25

Move to a different town, city, or state 47

Change in family get-togethers 25
Major change in health or behavior of family member 55
Marriage 50
Preganancy 67
Miscarriage or abortion 65
Gain a new family member:
Birth of a child 66
Adoption of a child 65
A relative moving in with you 59
Spouse beginning or ending work 46
Child leaving home:
To attend college 41
Due to marriage 41
For other reasons 45
 Change in arguments with spouse 50

In-law problems 38

Change in martial status of your parents:

Divorce 59

Remarriage 50

Separation from spouse

Due to work 53

Due to marital problems 76

Divorce 96

Birth of grandchild 43

Death of spouse 119

Death of other family member:

Child 123

Brother or Sister 102

Parent 100

Financial

Major change in finances

Increased income 38

Decreased income 60

Investment and/or difficulties 56

Loss or damag of personal property 43

Moderate purchase 20

Major purchase 37

Foreclosure on a mortgage or loan 58

RLCQ places the individual at greater
susceptibility to physical or psychological
illness.
The questionnaire may be completed
considering life stressors within a 6-month
or 1-year period.
Six-month totals equal to or greater than
300 LCU’s or 1-year totals equal to or
greater than 500 LCU’s  considered
indicaitve of HIGH recent life stress thus
increasing the risk of illness for the
individual.
 When an individual’s stress
response is sustained over a long
period, the endocrine system
involvement results in which of the
following?
a. Decreased resistance to disease
b. Increased libido
c. Decreased blood pressure
d. Increased inflammatory response
 Client Bendita regularly develops nausea
and vomiting when she is faced with a
stressful situation. Which of the following
is most likely a predisposing factor to
this maladaptive response by Bendita?
a. Bendita inherited her mother’s “nervous” stomach.
b. Bendita is fixed in a lower level of development.
c. Bendita has never been motivated to achieve
success.
d. Bendita’s mother pampered her and kept her home
from school when she was ill as a child.
 Thank you for listening…

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