THE STRESS RESPONSE''

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THE STRESS RESPONSE..

• In Patients and Families Experiencing Acute
  Medical / Surgical / Traumatic Disorders

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What were going to talk about..

• What is stress?
• What are the physiologic responses to stress?
  Short Vs Long Term effects?
• What are some of the psychological responses to
  stress?
• What are some of the nursing diagnoses,
  collaborative problems and nursing interventions
  related to stress?
• Why is stress discussed here in the Acute or
  Advanced medical/surgical setting?

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Definition of Stress

• Stress has been defined as a situation that
  exists when an organism is faced with a stimulus
  that causes a disequilibrium in physiological
  and/or psychological functioning.

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Stress Research/Researchers

• Hans Selye
• Research dating back to 1930s
• Became aware of similarities in peoples reaction
  to external and internal demands
• First became aware of Fight or Flight
  Mechanisms-Physiological Response
• Herbert Benson
• Initial book The Relaxation Response
• New research and writings related to the
  hypothesis that there is connection between
  spirituality, healing and dealing with stress
  

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Sort Term Responses to Stress

• Quick, short acting physical responses designed
  to shunt blood and energy away from organs not in
  need, to those most critical organs and
  systems
• Brain
• Heart
• Endocrine system
• Central Nervous system

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Sequence of Events
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Key Hormones in the Early Stress Response

• Cathecholimines Epinephrine
• ? heart rate
• ? blood pressure
• ? blood to
  skeletal muscles ( for escape)
• ? blood to GI
  tract and kidneys
• Cortisol ? release of stored calories
  ? inflammation
• ? pain
• ?immune system
• Glucagon ? blood glucose, glucogeneisis?Stress
  Diabetes-actually from several sources
• Vasopressin ? vessel constriction
• Aldosterone ? Na retention, retain fluids

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Long Term Effects The Battle Goes On Longer...

• GI Tract ? blood flow leads to ?mucous
  production, leads to unprotected organ walls,
  leads to ulceration, bleeding
• Kidneys ? in blood supply can lead to A.T.N.
• Muscle/Skin ?blood leads to muscle wasting, skin
  breakdown
• Metabolism ?Metabolic rate
• Immune system ? stress leads to immune
  suppression leads to increased risk for infection

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Psychological Responses to Stress

• Hyper-activity/Hyper-alertness
• Anxiety, Fear
• Re-experiencing phenomena
• PTS syndrome
• Loss of control issues
• Role change issues
• Disorientation/Confusion
• Regression back to childish behaviors
• Sensory overload/deprivation

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Nursing Diagnoses Coping-Stress Tolerance as a
Functional Pattern

• Impaired adjustment
• Caregiver role strain
• Ineffective Individual coping
• Ineffective community coping
• Family coping potential for growth

• Post Trauma syndrome
• Rape Trauma syndrome
• Relocation stress syndrome
• Risk for self- mutilation
• Risk for violence

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Collaborative Problems Related To Stress

• PC Arrhythmias
• PC Myocardial Infarction
• PC Infection, sepsis, septic shock
• (altered immune system)
• PC Depression
• PC Hypertension
• PC Headaches

• PC Irritable Bowel Syndrome
• PC Peptic Ulcer Disease, GI Bleed
• PC Fatigue
• PC Eating disorders
• PC Insomnia
• PC Sexual Dysfunction

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Nursing Interventions

• Triage process prioritize and treat the
  physical, lifethreatening consequences first
• Weave in the psychosocial interventions as you
  provide care
• LISTEN
• Never forget family , they are very stressed

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Physical Interventions

• Fluid / Electrolyte restoration
• Blood, Blood products, autotranfusion,
• fluids
• Maintain Oxygenation
• O2 sat and po2 should be 90 or greater
• airway maintenance/intubation
• Sustaining Renal function
• Fluid resuscitation, diuretics to
• maintain u/o of at least 30cc/hr
• Dialysis to sustain through A.T.N.

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Physical Interventions cont.

• Monitor / treat blood sugar alterations
• Sliding scales, Insulin
• Infection Prevention/Control
• Sterile technique, clean environment
• I. C. Precautions
• Antibiotics
• Promoting Nutrition
• Enteral/Parenteral if cannot eat
• Skin/ Muscle Protection
• ROM, Turning/self Turning bed

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Psychological Interventions

• Share the WHYs
• Allow pt/family CONTROL whenever possible
• Listen
• Care/ but have your own emotions in balance
• Be gentle, be calm
• Relaxation techniques
• Appropriate humor