The document discusses various stressors and their effects on physical and mental health, defining stress and outlining models of the stress response. It also examines the nurse's role in assessing a patient's stressors, coping mechanisms, and diagnosing conditions related to maladaptive stress responses such as anxiety or impaired adjustment. Crisis intervention is also addressed, with summaries of several common models for responding to crises.

1. Stressors and reaction related to
disease process
Submitted to : Mr. Imran khan
(asst. professor)

3. Definitions
• The non-specific response of the body to any demand
placed upon it. (Hans Selye)
• Stress should be restricted to conditions where an
environmental demand exceeds the natural regulatory
capacity of an organism.(Bruce McEwen and Jaap
Koolhas)
• Relationship between the person and the environment
that is appraised by the person as taxing or exceeding his
or her resources and endangering his or her well-
being.(Lazarus and Folkman , 19

4. Stressors

5. Definitions
• A stressor is any event or stimulus that causes an
individual to experience stress.
• An internal or external event or situation that creates the
potential for physiological, emotional, cognitive or
behavioral changes.
• When a person faces stressors, responses are referred to
as coping strategies, coping responses or coping
mechanisms.

6. Sources of stress
Internal stressors
• Originate within the person e.g., Infection or feeling of
depression
External stressors
• Originate outside the individual e.g., to move to another city,
• death in the family or pressure from peers.

7. Cont…
Developmental stressors
• Occur at predictable time throughout an individual’s life
Situational stressors
• Are unpredictable and may occur at any time during life.
• It can be either positive or negative . e.g.,
-death of the family member
-marriage or divorce
-birth of child
-illness

8. Stress effects

9. Cont…
Common effects of stress on your body
• Headache
• Muscle tension or pain
• Chest pain
• Fatigue
• Change in sex drive
• Stomach upset
• Sleep problems

10. Effect on mood

11. Cont..
Common effects of stress on your mood
• Anxiety
• Restlessness
• Lack of motivation or focus
• Feeling overwhelmed
• Irritability or anger
• Sadness or depression

12. Effects on behavior

13. Cont…
Common effects of stress on your behavior
• Overeating or under eating
• Angry outbursts
• Drug or alcohol abuse
• Tobacco use
• Social withdrawal
• Exercising less often

15. Physical stressors
• Cold
• Heat
• Chemical agents
• Lack of rest and sleep
• Excessive drinking
• Isolation or crowding

16. Physiological stressors
• Pain
• fatigue
• illness injuries
• inadequate sleep or nutrition
• hormonal fluctuations etc.,

17. Psychosocial stressors
• Fear
• anxiety
• phobia
• losing a loved one
• financial problems etc.

18. Environmental stressors
• noise
• pollution
• traffic
• weather
• crowd etc.

19. Relation between Stress and
disease

20. Cont..
• Relating life events to illness has been a major focus of
psychosocial studies. Researchers suggest that people under
constant stress have a high incidence of psychosomatic
disease.

21. Psychological responses to stress
• After recognizing a stressor, a person consciously or
unconsciously reacts to manage the situation. This is term as
the mediating process .a theory developed Lazarus emphasize
cognitive appraisal and coping as imp. Mediators of stress.

22. Physiologic response to stress
• A physiology response to a stressors whether it’s is physical,
psychological, or psychosocial, is a protective and adaptive
mechanism to maintain the body’s homeostatic balance

24. Stimulus based model
• Acc. To this model stress is defined a s a stimulus, a life event,
or a set of circumstances that arouses physiological and
psychological reactions that may increase the individuals
vulnerability to illness.
• Holmes and Rahe develop the social readjustments rating
scale
• (SRRS) consisting of 43 life changes or events which are both
positive and negative in nature and considered stressful.

25. Cont…
• The SRRS provides the general impressions of stressors in the
person life.
• The more stressors a person experiences in a short period (1
to 2 years) the more likely that physical illness, mental
disorders or other stress responses will follow
.
• This theory also explain that many people with high scores on
the SRRS
• Do not subsequently experience serious problem. In addition ,
low scores do not guarantee a life free of danger of stress

26. Model

27. Response based model
• Selyes stress response is characterized by a chain or pattern of
physiologic events called the general adaption syndrome.

28. General adaption syndrome
Alarm reaction
• Heart rate and strength of cardiac muscle contraction
increases
• Blood vessels supplying to the skin and viscera constrict; at
the same time blood vessels supplying to skeletal muscles and
brain dilate; thus decreasing blood supply to organs which do
immediate active response

29. Cont…
• RBC production is increased leading to an increase in the
ability of the blood to clot. This helps to control bleeding
• Liver converts glycogen into glucose and releases it into the
blood stream; this provides energy needed to fight the
stressor.
• The rate of breathing increases and respiratory passage
widen to accommodate more air.

30. Resistance Reaction
• It is initiated by regulating hormones secreted by
hypothalamus.
• It is a long-term reaction.
• Regulating hormones are
• Corticotrophin Releasing Hormone (CRH)
• Growth Hormone Releasing Hormone (GHRH)
• Thyrotrophic Releasing Hormone(TRH)

31. Cont…
• CRH stimulates the anterior pituitary to increase its
secretion of adrenocorticotrophic hormone(ACTH). The
action of these hormones helps to control bleeding,
maintain blood pressure etc.
• GHRH stimulates anterior pituitary to secrete human
growth hormone(HGH).
• TRH causes the anterior pituitary to secrete thyroid
stimulating hormone (TSH). The combined action of HGH
and TSH help to supply additional energy to the body

32. Exhaustion stage
• At this stage, cells start to die, and the organs weaken.
• A long – term resistance reaction put heavy demand on
the body, particularly on the heart, blood vessels, and
adrenal cortex, which may suddenly fail under strain.
• Immune system is exhausted and function is impaired
resulting in decomposition.
• The result can manifest itself in obvious illnesses such as
ulcers, depression, diabetes, trouble with the digestive
system or even cardiovascular problems, along with
other mental illnesses.

33. Model

34. Transaction - based model
• Transactional theories of stress are based on the work of
LAZARUS (1966). The Lazarus transactional stress theory
encompasses a set of cognitive affective and adaptive (coping)
responses that arise out of person – environment are
inseparable, each affects and is affected by the other.
• Lazarus recognizes that certain environmental demands and
pressure produce stress in substantial number of people.

35. Model

36. Reaction related disease process

37. Physical and mental reactions
• Violent
• Major depression
• Mania
• Schizophrenia
• Personality disorder
• Panic attack
• Catatonic stupor
• Hysterical attacks

38. Behavioral reactions
• Delusions
• Hallucinations
• Agitation
• Dysphoria
• Anxiety
• Euphoria
• Sleep and nighttime behavior

40. Cont…
• The term coping is used to refer to the process by which
a person attempt to mange stressful demands. It takes
two major forms. A person can focus on the specific
problem or situation that has arisen, trying to find some
way of changing it or avoiding it in the future, this is
called problem focused coping. problem focused coping
strategy helps to resolve or change a person’s behavior or
situation or manage life stressors. These are-
- Learning problem solving methods
- Applying the process to identify problems
- Role play interactions with others

42. Cont…
Adaptive
• When the problem is solved in a rational or a productive way
and the anxiety is reduced.
Palliative
• If the solution temporarily reduces the anxiety but the
problem still exist and must be dealt with again at a later
time.

43. Cont…
Maladaptive
• If successful attempt are made to decrease the anxiety
without attempting to solve the problem coping strategies
Dysfunctional
• The individual who does not attempt to reduce the
anxiety or solve the problem is considered to have
dysfunctional management of the stressor and emotional
response

44. Example

45. Defense mechanism
• Defense mechanism are methods of attempting to protect
self and cope with basic drives or emotionally painful
thoughts, feelings or events
• Relevance to nursing practice: the nurse must recognize and
understand maladaptive defense mechanism that patient use.
The nurse has to carefully point out these mechanisms and
work with patients to encourage such behaviors and
discourage adaptive ones

47. Nurses role

48. ASSESSMENT:
♦On the scale of 1 to 10, where 1 is very minor and 10 is
extreme, how would you rate the stress you are experiencing
in the following areas?
• Home
• Work or school
• Finance
• Recent illness or loss of loved one
• Your health
• Family responsibilities
• Relationships with friends/parents/partner
• Recent hospitalization
• Other(specify)

49. Cont…
♦how long have you been dealing with these stressors?
♦how do you usually handle stressful situations?
if the client does not adequately describe, prompt with the
following:
• Cry
• Get angry
• Talk to someone(who)
• Withdraw from the situation
• Control others or situation
• Go for a walk or perform physical exercise
• Try to arrive at a solution

50. Cont…
• Pray
• Laugh joke or use some other expression of humor
• Mediate or use some other relaxation technique such as yoga
♦how do well does your usual coping strategy work?

51. Diagnosis
• Anxiety
• Compromised family coping
• Decisional conflict
• Defensive coping
• Disabled family coping
• Fear
• Impaired adjustment
• Ineffective coping
• Ineffective denial
• Relocation stress syndrome

53. Crisis
• A crisis is an overwhelming reaction to a
threatening situation in which a person’s usual
problem solving strategies fail to resolve the
situation resulting in a state of disequilibrium.

54. TYPES OF CRISIS
• Developmental (Maturational) Crisis
• Situational Crisis
• Adventitious Crisis

56. Models
• Triage assessment system
• Gilliland’s six step model
• Seven-stage model of crisis intervention
• ABC model of crisis intervention

57. Triage assessment system
• It was developed by Myer (2001), who posts
that it is necessary to assess crisis reactions in
three domains: affective(emotional)
cognitive(thinking)
behavioral(actions)

58. Gilliland’s six step model

59. Seven-stage model of crisis
intervention

60. ABC model of crisis intervention

61. Questions

62. Evaluation