chapter 12 - Stress, Adaptation, and Anxiety

a nonspecific response to any demand made on the body

any situation, event, or agent that produces stress

universal experience, can be positive or negative
may be internal or external
neutral
individual perception of stressor determines effect of stress response

the inner force an individual uses to respond or adapt to stress

reactions affect the entire body

affects only the involved body part

structural and chemical changes as the body attempts to maintain homeostasis - these responses to stressors

crisis or alarm: body readies itself to handle stressors - cool, pale skin, shivering, sweating of palms (severe may cause dilated pupils, dry mouth pounding heart, nausea, diarrhea)

adaptation or resistance: body attempts to defend against stressor through fight-or-flight response - body becomes physiologically ready to defend itself

exhaustion - if adaptive energy can't deal with prolonged or overwhelming stress

LAS - the physiologic response to a stressor or a specific part of the body - usually a temporary process that resolves when the traumatized area is restored to its preinjury state - if not resolved the individual then experiences the GAS as the entire body becomes affected

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

irritability, feelings easily hurt, sadness, depression, feeliings of pleasure and accomplishment reduced

impaired memory and judgment, confusion, unable to concentrate, poor decision making, altered perceptions, delayed response

pacing, rapid speech, insomnia, withdrawal, easily startled

alienation, social isolation, feeling of emptiness

type of stress resulting in positive outcomes

stressors evoking an ineffective response

an ongoing process whereby individuals adjust to stressors and change - the nurses's goal is to identify and support the client's positive adaptive responses. Adaptation is a holistic response that involves all dimensions of an individual.

the way the body responds to stressors affecting the functioning of the body - may be GAS or LAS

involves the use of defense mechanisms and mentally learning to accept new situations

involves education, communication, problem-solving ability, and perception of people and the world

involves social relationships with family, friends, and coworkers who may provide support in times of stress

involves beliefs about a supreme being and a positive sense of life's purpose and meaning

Sweaty palms
Trembling
Rapid pulse rate
Easily startled
Speech is rapid
Shallow rapid respirations

include all the ways an individual may react to stress

occurs when a person is taught a behavior until it becomes an automatic response

degree of danger perceived by the individual, immediate needs of the individual, amount of support from others, individual's belief in his own ability to handle the stressful situations, individual's previous successes and failures in coping, number of concurrent or cumulative stresses being handled by the individual

measures for coping with stress that require a minimal amount of energy

using support people
relaxing to relieve tension
changing behavior
developing more realistic goals
solving problems

unconscious functions protecting the mind from anxiety

measures used to avoid conflict and stress - because they prevent the individual from making progress toward resolving and accepting stress

occurs when stressors surpass the ability to cope - an acute stage of disorganization - characterized by extreme anxiety, disorganized behavior, and inability to function

immediate intervention for a successful resolution

subjective response occuring 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

increased degree of alertness
increased vigilance
increased motivation
readiness for action
slight increase in vital signs

subjective distress
decreased perception and attention
alert only to specific information
possible tendency to complain or argue
possible headache, diarrhea, nausea, or vomiting

increased subjective distress
feeling of impending danger
selective attention
distorted communication
distorted perception
feelings of fatigue

major perception distortion
immobilization; inability to function
feelings of terror
possible harm to self and others

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

a dynamic process whereby an individual's response to a stressor leads to an alteration in behavior, and is an inevitable part of life.

eustressful or distressful
externally imposed or self-initiated
can occur abruptly or have gradual onset
requires energy to effect, and to resist

change agent - person who intentionally creates and implements change
change agents seek ways to make improvements
use critical thinking to develop innovative, creative solutions

nurses can be very instrumental in helping clients both understand their anxiety and learn measures to cope with and control their feelings of stress

types or patterns of stressors
usual response to stressful situations
cause-and-effect among stressors and thoughts, feelings, and behaviors
history of successful coping

anxiety, ineffective coping
powerlessness
impaired adjustment
disturbed thought processes
defensive coping
fear
post-trauma syndrome
impaired social interaction
spiritual distress
hopelessness
fatigue
disturbed sleep patterns

identify when stress and anxiety increases
describe ways to decrease the effects of usual stressors
identify positive and negative stressors
group stressors into categories
demonstrate correct use of selct stress-management exercises

meet basic needs
minimize environmental stimuli
verbalize feelings
involves family/significant others
use stress-management techniques
use crisis interventions

exercise
relaxation techniques
cognitive reframing or thought stopping

must include client input
must evaluate client outcomes

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

develop active support systems
use time management and decision-making methods
focus on accomplishments
know personal limits
avoid harmful substances
nourish body with healthy diet, exercise and sleep
practice slow, focused breathing
vary tasks between mental and phsyical activities
maintain a sense of humor