stress mgt powerpoint

8/2/2019 Stress Mgt Powerpoint

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STRESS AND STRESS MANAGEMENT:

IMPLICATION ON DISEASE PATTERNS

BY

ILO IJEOMA J. PG/MSC/11/61014

NNABUENYI CHINYELU J.P. PG/MSC/11/60952

NWODOH CHIJIOKE OLIVER PG/MSC/11/60941

OBIJAKU GRACE PG/MSC/10/54893-ONUH AKUDO BEATRICE PG/MSC/11/61025

LECTURER: DR. (MRS) A.N. ANARADO

MARCH, 2012.



INTRODUCTION

• Very often than not, some of our daily life-encounters which are called stressors activate aforce from within our body known as stress.

• It makes us react in certain ways that ordinarily we

would not, propelling us to achieve higher lifegoals and prepares us for the usual “fight or flight” responses in emergencies when moderatelyactivated.

• However, the effect of stress can aggravate somehuman diseases or even be a cause of themespecially if prolonged, hence the need to keep itin check to prevent this deleterious effect.



OBJECTIVES

• To define the concept of stress

• To identify causes of stress

• To explain types of stress

• To discuss physiology/pathophysiology andmanifestations of stress

• To explain how the body can adapt to stress

• To discuss the implication of stress on disease

patterns and management of stress



DEFINITION OF STRESS

• Stress is pressure or worry caused by the

problems in somebody’s life (Oxford Advancedlearners Dictionary, 2001).

• It is the physical, physiological or psychologicalforce that disturbs equilibrium in one’s body(Taber’s Cyclopaedic Medical Dictionary, 2001).

• It is also defined as reactions of the body toforces of a deleterious nature, infections, andvarious abnormal states that tend to disturb itsnormal physiologic equilibrium (homeostasis)

(Stedman’s Medical Dictionary, 2000).



DEFINITION OF STRESS CONT’D

• Stress can therefore be deduced to mean anabnormal force that disrupts the stability of human body system.

• Simply, stress can be described as that feelingone develops when wanting to handle more thanhe/she is used to.



CAUSES OF STRESS

These are classified into two, internal and external

causes.

• Common external causes of stress include: majorlife changes, work, relationship difficulties,financial problems, being too busy, children andfamilies, etc.

• On the other hand, common internal causes of stress are things like inability to accept

uncertainty or one not being able to accept whathe/she cannot change, pessimism or negative self talk, unrealistic expectation, perfectionism, lack of assertiveness or bottling up of one’s feeling,etc.



TYPES OF STRESS

• Eustress. This is a type of stress that is normal

and exciting, and keeps us vital (e.g. racing tomeet a deadline).

• Acute stress. It is a very short-term type of stressthat can either be positive (eustress ) or negative(distress).

• Episodic acute stress. This is where acute stressseems to be rampant and has become a way of

life, creating life of relative chaos. E.g. preparationfor examinations as a student.

• Chronic stress. This is a type of stress that seemsnever ending and inescapable. Example is thestress of a bad marriage.



PHYSIOLOGY/PATHOPHYSIOLOGY OF STRESS

• When stressor(s) stimulate external sensory organsand internal sensors, they send signal to the nervecentres in the brain.

• The nerve centres then signal the hypothalamus,which integrates response to achieve homeostasis.

• Neural and endocrine pathways are activated

firstly with the sympathetic nervous system (SNS)discharge, followed by sympathetic-adrenalmedullary (SAM) discharge.

• .



PHYSIOLOGY/PATHOPHYSIOLOGY OF STRESS CONT’D

• If the stressor persists, third response (activationof hypothalamic-pituitary system (HPS)) occurs.

• SNS discharge causes the release of

norepinephrine at nerve endings, increasing thefunction of vital organs and general body arousal.

• This SNS discharge will also cause peripheral

vasoconstriction, thereby increasing bloodpressure, limiting bleeding in the event of trauma,etc.




• The effect of the SNS will also lead to increase inblood glucose to provide more energy, dilation of pupils and increased mental activity.

• SAM discharge causes stimulation of the medullaof the adrenal gland by the SNS, causing furtherrelease of epinephrine and norepinephrine into the

blood stream.

• These effects of SAM discharge prolong the aboveactions under SNS discharge and also increase the

metabolic rate.




• HPS response occurs when the stress persistsafter the above responses, involving HP pathway.

• The hypothalamus secretes corticotrophinreleasing hormone (CRH), which stimulates theadrenal cortex to produce glucocorticoid (cortisol).

• This cortisol stimulates protein catabolism, liveruptake of the amino acids and their subsequentconversion to glucose (gluconeogenesis).




• The cortisol also inhibits glucose uptake (anti-insulin action) by many body cells except those of the heart and brain.

• Also in this HPS response, antidiuretic hormone(ADH) and aldosterone from posterior pituitaryand adrenal cortex respectively are also releasedto promote sodium and water retention.

• Growth hormone (GH), glucagon and endorphinare also secreted to stimulate the uptake of aminoacids by cells and to enhance pain threshold.



MANIFESTATIONS OF STRESS

• Physiologically, the pupils dilate, sweatproduction (diaphoresis) increases, the heartrate increases, the skin becomes pallid, bloodpressure increases, renin secretion increases,

sodium and water retention increases, and willlead to increase in cardiac output.

• Others include increased rate and depth of

respirations, decreased urinary output, possibledryness of the mouth, decreased peristalsis,improved mental alertness, increased muscletension and increased blood sugar, etc.



MANIFESTATIONS OF STRESS CONT’D

• Psychologically, stress manifests in form of anxiety, fear, depression, problem solving,structuring, self control (discipline), suppression,

fantasy or day dreaming, and the use of prayer.

• Other psychological manifestations of stressinclude: crying, verbal abuse, laughing,screaming, hitting and kicking, and holding andtouching.

•



MANIFESTATIONS OF STRESS CONT’D

• Lastly, psychological manifestations of stressalso occur in form of unconscious ego defensemechanism such as:

• Denial;• Rationalization;

• Compensation;

• Repression and• Regression.



ADAPTATION TO STRESS

• This is categorized into two as General Adaptation Syndrome (GAS) and Local AdaptationSyndrome (LAS).

• GAS has three phases namely: Alarm, resistance,and exhaustion.

• Alarm Phase is when the “fight-or-flight” response is activated by SNS with the release of catecholamines and the onset of adrenocortical

response.



ADAPTATION TO STRESS CONT’D

• Resistance phase occurs with increased activityof cortisol to adapt the body to the stressor.

• If exposure to the stressor persists, the body

then moves to the third phase of the syndromeknown as exhaustion with increase inendocrine activity.

• LAS on the other hand include the inflammatoryresponse and repair processes that occur at thelocal site of tissue injury; but when the localinjury is severe enough, the GAS is activated as

well.



ADAPTATION TO STRESS CONT’D

• Adaptation to stress can also fall in threeinterrelated modes:

• Physiologic;

• Psychologic and

• Sociocultural.



IMPLICATION OF STRESS ON DISEASE

PATTERNS

• Stress can cause, induce or aggravate manyhuman diseases due to increased sympatheticnervous system activity and an out pouring of

adrenaline/noradrenaline, cortisol and otherstress related hormones in this state.

• In the cardiovascular system for instance,effects of epinephrine, SNS and cortisol lead totachycardia, palpitation, increased cardiacoutput and blood pressure and increase in low

density lipoprotein (LDL) and triglycerides in the



IMPLICATION OF STRESS ON DISEASE

PATTERNS CONT’D

• These can aggravate or lead to hypertension,atherosclerosis, ischemic heart diseases, heartattack, transient ischemic attack and stroke.

• Stress also affects the secretion of T-cell whichaffects the immune system, producingsuppressive and autoimmune actions on it.

• This state exacerbates and predisposes the bodyto colds; other viral infections, including HIV,and other systemic or local infections.



IMPLICATION OF STRESS ON DISEASEPATTERNS CONT’D

• In gastrointestinal tract (GIT), the effect of stress on SNS and the shunting away of bloodfrom GIT to vital organs can lead to or worsen

diseases like peptic ulcer, irritable bowelsyndrome, dyspepsia, etc.

• Furthermore, the released cortisol in stressful

state causes gluconeogenesis and inhibits theuptake of glucose by many body cells.

• This causes hyperglycemia and worsens

diabetes mellitus.



IMPLICATION OF STRESS ON DISEASEPATTERNS CONT’D

• Also, due partly to tension on the muscles of theback during stress, back ache, stiffness of the neck and head ache are associated to stress sometimes.

• Other conditions implicated by stress which canlead to a diseased state if not checked are:insomnia, eating disorders, depression, diaphoresis,

etc.



MANAGEMENT OF STRESS

• Assessment. Elicit the signs and symptoms

present in the client that are suggestive of stress.

• Diagnoses. Form clusters and arrive at thesuitable nursing diagnoses for the client.

• Some of the nursing diagnoses relating to clientsexperiencing stress are: Anxiety, Ineffectivecoping patterns, Impaired thought processes,etc.



MANAGEMENT OF STRESS CONT’D

• Planning. Having formulated the diagnoses, the

nurse should develop plans of the care incollaboration with the client and significantsupport persons.

• Implementation. General guidelines to

minimize the client’s anxiety and stress are:

• Support the client and family at a time of illness

• Orient the client to the hospital or agency

• Give the client in a hospital some way of maintaining identity




• Provide information when the client hasinsufficient one

• Repeat information when the client has difficulty

remembering• Encourage the client to participate in the plan of

care

• Give the client time to express feelings andthoughts

• Ensure that expectations are within the client’s capabilities




• Be sensitive to specific situations andexperiences that increase anxiety and stress forclients

• Assist a client to make a correct appraisal of asituation

• Provide an environment in which a person canfunction independently to some degree without

assistance• Reinforce positive environmental factors and

recognize negative ones to help reduce stress• Arrange for other clients with similar experiences

to visit




• Bring clients and their support persons into

contact with people in community agencies whocan help them make valid plans.

• Communicate competence, understanding, andempathy rather than stress and anxiety

• Encourage humor as a means of coping withstressors




• Other specific interventions include:• Mediating clients’ anger• Usage of massage strokes or movements

• Teaching relaxation techniques• Teaching relaxation with a guided imagery.

• The use of biofeedback,

• Therapeutic touch usage• Evaluation. Having intervened, the nurse will

now collect data about the outcome of theintervention in accordance with the outcome

criteria earlier established in the care plan.



STRESS MANAGEMENT FOR NURSES

THEMSELVES

• Nurses can do this management using the abovetechniques for managing clients. In addition, thenurses should do the following:

• Recognize they are stressed• Determine what causes the stress and when it

occurs

•

Determine alternative actions to deal with thestress constructively

• Plan a daily relaxation programme withmeaningful quiet times to reduce tension

•



STRESS MANAGEMENT FOR NURSESTHEMSELVES CONT’D

• Establish an activity programme to direct energyoutward

• Become more assertive to overcome feeling of

powerlessness in relationship with others. Learnto say no

• Manage time better by delegating to others andcombining tasks

• Take a course in biofeedback, yoga, meditation,or some other advanced relaxation techniques

• Learn to accept failures and learn from them



STRESS MANAGEMENT FOR NURSESTHEMSELVES CONT’D

• Learn to ask for help, and share your feelingswith colleagues

• Learn to support your colleagues in times of

need. Give them a time to “ventilate” feelingsand listen to their concerns

• Learn to handle problems constructively insteadof defensively

• Accept what cannot be changed. There arecertain limitations in every situation

• Finally, nurses must learn how to laugh and

have fun.



SUMMARY/CONCLUSION

• This work has dealt with the meaning of stress,its various forms, and what triggers it.

• It also showed us what we will see in an

individual and we will know he/she is in stress,how the body adjusts to accommodate stress,and how we can adequately manage thiscondition when we see them.



SUMMARY/CONCLUSION CONT’D

• To help the society better, it isrecommended that nurses and otherhealth practitioners should equip

themselves with adequate knowledgeabout stress so as to manage andenlighten their clients and relevant others

on what is tress, its causes, managementand preventive measures.



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