Chapter 30

Stress and Coping

 Stress
Any situation in which an individual reacts to
something
• Hot weather
• Cold weather
• Poverty
• Car accident
• Wedding
 Stressors
• Heat
• Cold
• Hunger
• Fear
• Joy
• ……………
 Response
• Response to stressors is : COPING
 Response to stress
• Physical –illness
• Emotional-feelings
• Social--relationships
• Spiritual-beliefs, values
• Intellectual—perception, problem solving

• Whole person!
 Homeostasis
• All stress responses are aimed at
restoring or maintaining homeostasis
• Homeostasis results in adaptation
 i.e.
• Cold weather
• Peripheral vessels constrict and blood is
shunted to the core
• Shivering since muscle movement
produces heat
• Hair stands up to protect against cold air
 GAS
• General Adaptation syndrome
• Directly by physical event
• Indirectly by psychological event
Alarm reaction
Resistance
Exhaustion
p. 598 last paragraph
 General Adaptation Model
• Four factors that influence the ability to
adapt
• 1. ability to cope with stress
• 2. peer group norms to deal with stress
• 3. social environment resources: people
• 4. social environment resources: i.e.
money
 Alarm reaction
• The fight or flight
response
 Resistance
• Adaptation begins.
[either successful or
not].
• If successful:
everything returns to
normal
• If not successful:
 Exhaustion Phase
• Effects of stress can spread to entire body

HTNto
Return Death
normal
Relaxation
Techniques,
Medications, Change
in Life style:
HOMEOSTASIS
 Primary appraisal
• The neighbor's dog is running loose again!
 Primary appraisal
• The neighbor's dog is running loose again
 Secondary appraisal
• I’m gonna get the gun
and shoot the d..dog
• I’m gonna call the
police
• I’m gonna call animal
control
• I’m gonna call the
neighbor
 Secondary Appraisal
• What?
 Stimulus based model
• Proposes that certain events have a
certain effect on one’s health
• Not individualized rather generalized
• List of major life events from most
stressful to least stressful
• Holmes and Rahe
 Psychological Indicators of Stress
• ANGER
• ANXIETY
• FEAR
• DEPRESSION
• UNCONSCIOUS EGO DEFENSE
MECHANISMS
•UNCONSCIOUS
EGO DEFENSE MECHANISMS:::
 Ego-defense mechanism
• Compensation: outstanding verbal abilities
while math skills are weak
• Denial: i.e alcoholism
• Displacement: yelling at the dog instead of
yelling at boss
 Ego-defense mechanism
• Identification
 Ego-defense mechanism
• Regression
 Ego-defense mechanism
• Conversion:
repressing
emotional conflict
and somatizing
 Anxiety
Anxiety is part of life. Depends on level if
intervention is needed.
Feeling of impending doom (which makes
you cautious when you cross a street)
Often due to perceived lack of control
Can greatly impact quality of life, is very
stressful
 Anxiety
• Mild-broad perceptual field, critical thinking
is good
• Moderate-focused, able to solve problems
and focus. Critical thinking ability limited
• Severe-perceptual field very limited, sense
of impending doom
• Panic-perceptual field is altered, great fear
 Case study
• 62 year old female, 4 children, all born at
home. No chronic diseases. Went to ER
for severe N/V, and severe pain to R
shoulder, R chest and abdomen. Medical
Dx: acute cholecystitis
• Cholecystectomy planned
• For now: i.v. antibiotics, morphine via
PCA, NPO
 Case study con’t
• BP: 168-87
• HR: 108
• RR: 24
• Temp: 98.0
• c/o headache, heart burn
• Sweaty palms
• Restlessness
• Denies pain, denies
nausea
• States, “This is
frightening, I just don’t
understand”
 Anxiety case study
• Nursing Dx: Anxiety r/t unfamiliarity with
environment and situational crises

• Or

• Anxiety r/t change in health status and

perceived threat of death
 Anxiety case study
• Desired outcomes/evaluation criteria:
Client will verbalize feelings; identify coping
strategies that have helped in the past; will
be able to sleep/rest appropriately as
evidenced by at least 6 hours of
uninterrupted sleep every night; report
anxiety reduced to manageable level;
 Interventions
• You tell me!
 Relaxation techniques
• Imagery
• Progressive muscle
relaxation
• Prayer
• Meditation
• Box 30-14 on page
664 P & P
 Factors to be considered
• How is stress perceived?
What does this mean to you?
• Is adequate support available?
Do you have family? Do you get
along with them? Do they support
you?
 Think!
• Situational?
• Maturational/Developmental?
• Sociocultural?
 Critical Thinking
• 42 year old male, lost his job 2 months
ago. c/o lethargy, apathy, began drinking
every evening; states that lately wife is
constantly angry with him; states “I don’t
drink too much”
• Compromised Family Coping
• Ineffective Coping
• Ineffective Denial
BURNOUT
 A TE W ORK
SEPAR L IFE
H O M E
AND T
L E
E GO
EXERCIS DO
I Z E SOMETHING
CIAL
SO FUN

REALIZE AREA LAUG

OF CONTROL H
E
HAVE A LIF
Stress and Adaptation
Thank you