Chapter 12: Stress and Adaptation - Physical Examination & Health Assessment PDF

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Chapter 12: Stress and Adaptation I. WHAT IS STRESS A. Stress: disturbance in a person’s normal balanced state B. Stressor: a stimulus that the person perceives as a challenge or threat; initiates physical or emotional response C. Coping responses: voluntary/involuntary responses aimed at restoring equilibrium D. Adaptations: changes that take place as a result of stress or coping E. Homeostasis: maintained external and internal equilibrium F. *stress is not always bad, can keep you motivated G. TYPES OF STRESSORS 1. Distress/Eustress a) Distress:threatens health b) Eustress: protective 2. External/Internal a) External: death of a family member, excessive heat b) Internal: anxiety, diseases 3. Developmental/Situational a) Developmental: can be predicted to occur; easier to cope with (1) Ex. leaving home, starting new job b) Situational: unpredictable (1) Ex. car crash, illness 4. Physiological/Psychosocial a) Physiological stressors: affect body structure or function b) Psychosocial stressors: external stressors that arise from work, family dynamics, living situation, etc II. HOW DO COPING AND ADAPTATION RELATE TO STRESS? A. Coping strategies: thinking processes and behaviots a person uses to manage stressors 1. I.e problem solving, daydreaming, making lifestyle changes B. Adaptive coping (effective): making healthy choices that reduce the negative effects of stress C. Maladaptive coping (ineffective): does not promote adaption 1. Overeating, overworking, oversleeping, substance abuse D. THREE APPROACHES TO COPING 1. Altering the Stressor: person takes actions to remove or change the stressor 2. Adapting to Stressor: changing thoughts/behaviors on stressor 3. Avoiding the Stressor: can be both toxic and healthy a) Toxic: avoiding to get a lump checked out b) Healthy: leaving a person that causes too much stress E. OUTCOME OF STRESS 1. Stress results in adaption or disease 2. Outcome depends on balance btwn strength of stressors and effectivemess of the coping method F. PERSONAL FACTORS INFLUENCE ADAPTATION 1. Adaptation occurs when a person has supports and coping abilities adequeate to

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enable him to deal with the stessor 2. Perception of the Stressor a) Realistic or exaggerated b) I.e having a mastectomy: woman a “i am more than just a breast” vs woman b “ i will be so ugly, i wont be a woman” 3. Overall Health Status a) Being an already healthy person helps you cope with new health issues 4. Support System a) May include freinds, family, counseling groups, church grous or other like minded people who share common interests 5. Hardiness a) People who thrive despite overwhelming stressors -> “hardiness” 6. Other Personal Factors a) Age, developmental level, life experiences HOW DO PEOPLE RESPOND TO STRESSORS A. General Adaptation Syndrome (GAS) (initiated by pituitary gland) 1. Alarm stage “Fight or Flight” a) Shock phase: cerebral cortex first perceives a stressor and sends out messages to activate endocrine and sympathetic nervous systems. Epinephrine (adrenaline) and various other hormones prepare the body for fight or flight. b) Countershock phase: all the changes produced by the shock phase are reversed and the person becomes less able to deal with immediate threat c) Increased blood volume, blood glucose, epinephrine/norepinephrine amounts, heart rate, blood flow to muscles, oxygen intake and mental alertness d) Pupils of the eyes dilate to produce greater visual field 2. Resistance Stage a) the body stabilizes and responds in an opposite manner to the alarm reaction. Hormone levels, heart rate, blood pressure, and cardiac output return to normal, and the body repairs any damage that may have occurred. However, if the stressor remains, and there is no adaptation, the person enters the third stage, exhaustion. 3. Exhaustion Stage a) occurs when the body can no longer resist the effects of the stressor and when the energy necessary to maintain adaptation is depleted. The physiological response is intensified, but the person's energy level is compromised, and adaptation to the stressor diminishes. The body is unable to defend itself against the impact of the event, physiological regulation diminishes, and, if the stress continues, death may result B. Local Adaptation Syndrome (LAS) 1. Localized body response; involves only a specific body part, tissue or organ. 2. Reflex Pain Response a) Withdrawing from source of pain (i.e hot stove)

b) Reflex: involuntary, predictable response 3. Inflammatory Response a) Reaction to cell injury; either by pathogens or by physical, chemical or other agents b) Symptoms of inflamation: pain, heat, swelling, redness and loss of function c) Vascular Response: immediatley after injury, blood vessels at site constrict to control bleeding. Injured cells release histamine -> vessels dilate to increase blood flow (hyperemia). Tissue becomes edematous (swollen). Leukocytes move into area to fight infection d) Cellular Response: phagocytes migrate to site of injury and engulf bacteria, foreign bateria and damaged cells. (1) Pus: accumulation of dead white cells, digested bacteria dn debris e) Exudate Formation: (1) Exudate: fluid and WBC that move from circulation to site of injury f) Healing (1) Healing is the replacement of tissue by regeneration or repair (2) Regeneration is replacement of the damaged cells with identical or similar cells (3) Repair: scar tissue replaces original tissue C. PSYCHOLOGICAL RESPONSES TO STRESS 1. biopsychosocial : consist of interactions among biological, psychological, and social factors. 2. Anxiety: response to the anticipation of danger; feels worried, nervous, uneast, and fearful; nausea, trembling and sweating (emotional response) 3. Fear: emotion or feeling of apprehension (dread) from identified danger, threat, or pain (cognitive response) 4. Ego Defense Mechanisms: unconcscious mental mechanisms that make a stressful situation more tolerable 5. Anger: strong, uncomfortable feeling of animosity, hostility, extreme indignation or displeasure. a) Hostility: when anger becomes destructive either verbally or physically 6. Depression: sometimes associated with unresolved anger and result from stress. Long term depression is concerning. D. SPIRITUAL RESPONSES TO STRESS 1. Vary among individuals 2. Prayer is common as a first response during the alarm stafe E. COPING MECHANISMS 1. Compensation is making up for a deficiency in one aspect of self-image by strongly emphasizing a feature considered an asset. 2. Conversion is unconsciously repressing an anxiety-producing emotional conflict and transforming it into nonorganic symptoms.

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3. Denial is avoiding emotional conflicts by refusing to consciously acknowledge anything that might cause intolerable emotional pain. 4. Displacement is transferring emotions, ideas, or wishes from a stressful situation to a less anxiety-producing substitute. 5. Identification is patterning behavior after that of another person and assuming that person's qualities, characteristics, and actions. 6. Dissociation is experiencing a subjective sense of numbing and a reduced awareness of one's surroundings. 7. Regression is coping with a stressor through actions and behaviors associated with an earlier developmental period WHAT HAPPENS WHEN ADAPTATION FAILS? A. Continual stress can lead to exhaustion and disease B. Stress Induced Organic Responses 1. a result of repeated central nervous system stimulation and elevation of certain hormones, continual stress brings about long-term changes in various body systems. People who use maladaptive coping strategies (e.g., overeating, substance abuse) create additional stress on the body, further contributing to disease C. Somatoform Disorders: conditions that have physical symptoms but no known organic cause; from unconscious denial, repression, and displacement of anxiety. 1. Hyopchondriasis: person is preoccupied with the idea that he is or will become seriously ill. He is not “faking it”, he truly believes it 2. Somatization: anxiety and emotional turmoil are expressed in physical symptoms, loss of physical function, pain that changes location often, and depression. The patient is unable to control the symptoms and behaviors, 3. Pain Disorder: emotional pain manifests physically; location does not change but inconsistent level of pain 4. Malingering: conscious effort to escape unpleasant situations; calling in sick to avoid work D. Stress Induced sychological TResponses 1. Crisis: an event in a person’s life drastically changes tthe persons’s routine and he perceives it as a threat to self AND the person’s usual coping methods are ineffective. Usually sudden and unexpected events 2. 5 phases a) Precrisis. In response to the event and the anxiety, the person uses her usual coping strategies; has no symptoms; denies feeling stress; and may even report a sense of well-being. b) 2. Impact. If the usual strategies are not effective, anxiety and confusion increase. The person may have trouble organizing her personal life and may feel the stress but minimize its severity. c) 3. Crisis. The person experiences more anxiety and tries new ways of coping, such as withdrawal, rationalization, and projection (refer to Table 12-1). The person recognizes the problem but denies that it is out of control.

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d) 4. Adaptive. The person redefines the threat and perceives the crisis in a realistic way. She begins to think rationally and does some positive problem-solving, regains some self-esteem, and is able to begin socializing again. Adaptation is more likely if the person can use effective coping strategies and if situational supports are available. e) 5. Postcrisis. The aftermath of a crisis may have both positive and negative effects on functioning. The person may have developed better ways of coping with stress. Or she may be critical, hostile, and depressed, and may use maladaptive strategies (e.g., overeating or substance abuse) to deal with what has happened. 3. Burnout: when nurses cannot cope effectively with the physical and emotional demands of the work place 4. PTSD: specific response to a violent, traumatizing event or physical/emotional abuse. Flashbacks and reliving the events HEALTH PROMOTION ACTIVITIES A. Promote adequate nutrition B. Help the client establish a routine that includes regular excersize C. Teach the client the importance of getting ⅞ hrs of sleep per day D. Encourage participation in leisure activities E. Help client manage time, balance responsibilities and prioritize tasks F. Advise clients to avoid maladaptive behaviors as excess alcohol, caffiene, sweets, smoking and illicit drugs Stress management techniques: A. Meditation, biofeedback, reiki/therapeautic touch, humor, etc...