Stress and Stress management 

Stress and Stress management  150 150 Tony Guo

Stress and Stress management 



  • The inability to cope with perceived demands or threats to one’s mental, emotional, and spiritual well-being
  • What is considered stressful varies from person to person and from one situation to another

Types of Stress

  • Many different sources of stress
    • Physiologic 
      • Pain, Excessive noise, Starvation, and Infection
    • Emotional/psychologic (Positive or negative)
      • Diagnosis of cancer, Death of spouse, Caring for disabled child, and Marital problems
  • Stressors can be physiologic or emotional/psychologic. 
  • Your perception of these stressors will determine whether they cause stress. 
  • Events or circumstances become stressful when you perceive them to be


Factors affecting response to stress

  • Internal influences
    • Age, health status, personality, previous experience with stress
  • External influences 
    • Cultural and ethnic influences, socioeconomic status, social support, timing of stressors


  • Key personal characteristics
    • Resilience
      • Resourceful, flexible, and having good problem-solving skills
    • Hardiness
      • Courage and motivation to turn potential disaster into opportunities for personal growth
    • Attitude
      • Helps prevent disease and prolong life
    • Being optimistic
      • Helps avoid illness and increases speed of recovery


  • Stress response
    • Increases
      • Cardiac output
      • Blood glucose levels
      • Oxygen consumption
      • Metabolic rate


Interrelation of Body systems

  • Neurochemical links among the nervous, endocrine, and immune systems. The communication among these 3 systems is bidirectional travels back and forth through neuropeptides, cytokines, and endocrine hormones respectively
    • Central nervous system
      • The hypothalamus has many functions that assist in adaptation to stress by secreting neuropeptides that communicate with immune systems and endocrine systems
      • The cerebral cortex evaluates the stressor in light of past experiences and future consequences
      • The limbic system is an important mediator of emotions and behavior. When the limbic system is stimulated, emotions, feelings, and behaviors can occur that ensure survival and self-preservation.
      • The reticular formation contains reticular activating system (RAS), which sends impulses contributing to alertness to the limbic system and cerebral cortex. When the RAS is stimulated, it increases its output of impulses, leading to wakefulness. Stress usually increases the degree of wakefulness and can lead to sleep disturbances.
    • Immune system
      • Cytokines are released that communicate with the central nervous systems and endocrine system
      • Stress affects immune function by 
  • Decreasing the number and function of natural killer cells
  • Decreasing lymphocyte proliferation
  • Altering production of cytokines (soluble factors secreted by white blood cells and other cells, e.g., interferon, interleukins)
  • Decreasing phagocytosis
  • Endocrine system
    • The SNS stimulates the adrenal medulla to release epinephrine and norepinephrine
    • The stress response involves increases in cardiac output (resulting from the increased heart rate and increased stroke volume), blood glucose levels, oxygen consumption, and metabolic rate

Fight-or-Flight Reaction

  • The “Fight-or-Flight” reaction leads to the alarm reaction responses resulting from increased sympathetic nervous system (SNS) activity
    • Heart
      • Increased heart rate
      • Increased stroke volume
  • Increased cardiac output leads to increased systolic BP and Redistribution of blood to vital organs
  • Blood vessels
    • Peripheral vasoconstriction
      • Increased systolic BP
      • Redistribution of blood to vital organs
  • Lungs 
    • Increased respiration rate
    • Shallow breathing
  • Adrenal medulla
    • Increased epinephrine
    • Increased norepinephrine
      • Prolonged SNS response
  • Liver
    • Glycogenolysis
      • Increased blood glucose
  • Gastrointestinal system
    • Decreased secretions
    • Decreased peristalsis
      • Decreased digestion



  • All three parts are important in your life and in determining who you are. What goes on in your mind influences every part of the body. Your body and your mind are affected by how connected you feel to your spirit (soul). Spirit is the life force within you that gives life, energy, and power. You are a spiritual being with a mind that affects every aspect of your body.
    • When your mind is healthy, your body can resist illness better. 
    • When your body is healthy, your feelings are more positive.
    • When your spirit is renewed and energized, your mind is alert and your body feels good. The well-being of your spirit is linked to your mental, emotional, and physical health.
  • The connections among the mind, body, and spirit can lead to a person being healthy or the effects of  stress on mind, body, and spirit connections can lead to illness


Effects of Stress on Health

  • Long-term exposure to catecholamine from excessive activation of the SNS
    • Increases risk of CV diseases
    • Decreases control of metabolic conditions
    • Makes us more susceptible to infection
    • Linked to leading causes of death, impaired cognitive function, and negative changes in lifestyle behaviors

Coping Strategies

  • Emotion-focused coping: Managing emotions that one feels when a stressful event occurs 
    • Purpose:  To help decrease negative emotions and help create a feeling of
  • Problem-focused coping: Finding solutions to resolve problems causing stress
    • Purpose:  Allows one to look at a challenge objectively and take action to address the problem and reduce the stress


Relaxation Strategies

  • Relaxation response is a state of physiologic and psychologic rest
    • Opposite of the stress response
    • Characterized by decreased sympathetic nervous system activity
  1. Relaxation Breathing
  • The way one breathes affects every aspect of life
  • Simplest and most effective way to stop the stress response is to breathe deeply and slowly
  • Relaxation (abdominal) breathing
    • Performed while sitting, standing, or lying down
    • Involves primary use of the diaphragm and less use of the upper chest and shoulders
    • Abdomen gently moves in and out
  1. Medication
  • Concentrated focus on
  • A sound
  • Object
  • Visualization
  • The breath
  • Movement
  1. Prayer
  • Form of meditation
  • Spiritual communication with God or an object of worship
  1. Imagery
  • Imagery can also be used to specifically target a disease, problem, or stressor
  1. Music
  • Diversion from a stressful situation 
  • Music decreases anxiety and pain while eliciting the relaxation response
  • About 60-80 beats/min is considered soothing
  1. Massage
  • Range of techniques
  • Manipulate soft tissues and joints
  • Important form of touch


Nursing Management

  • Signs and symptoms of stress response
  • Physical
    • Increased HR and BP, hyperventilation, or headache
  • Behavioral
    • Anxiety, irritability, or impaired speech
  • Cognitive
    • Self-reports of forgetfulness or indecision
  • First step in managing stress is awareness of its presence
    • Stressful feelings will be expressed
    • Facilitate and enhance coping strategies
    • Interventions depend on severity of stress experience
  • Most coping and relaxation strategies can be taught in 10-15 minutes
  • Choose a strategy to best suit the patient and situation
  • Give directions calmly and slowly in short, simple sentences


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