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SEMINAR
ON
STRESS AND ADAPTATION
PRESENTED BY GUIDED BY
Neyyoor. Neyyoor.
PRESENTED ON
-07-2012
1
STRESS AND ADAPTATION
INTRODUCTION.
TERMINOLOGY.
2
Tics: Tic is a sudden, repetitive, non-rhythmic motor movement involving
muscle groups.
Fidgeting: The act of moving about restlessly.
OBJECTIVES.
Definition.
Stress:
Stress is a demand made upon the adaptive capacities of the mind and body.
Stress is a scientific concept which has suffered from the mixed blessing of
being too well known and too little understands.
Stress is the non- specific response of the body to any demand, whether it is
caused by or results in pleasant or unpleasant conditions.
-Hans Selye, 1936.
Stress is the body’s reaction to a change that requires a physical, mental or
emotional adjustment or response.
-Angela Morrow, 2011.
Stress is defined as a physical, mental or emotional response to events that
causes bodily or mental tension.
Stressor:
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Coping:
Adaptation:
The changes that take place as a result of stress and coping are called
adaptation.
Adaptation is generally considered a person’s capacity to flourish and
survive even with adversity.
Stress Response:
Stress Management:
TYPES OF STRESS.
Stress due to an excess of adaptive demands placed upon the person. The
demands are so great that they lead to bodily and mental damage.
For Example.
The optimal amount of stress which helps to promote health and growth.
For Example.
Acute stress is the temporary type of stress. Acute stress is the result of
short term stresses. Acute stress occurs, is usually quite intense, and then
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disappears quickly. (ie) immediate reaction to the stressor. This is also known as
fight and flight response.
Acute stress happens when something happens to excite the brain and
body.
For Example.
The person seeing snake in the middle of the road, increases the blood
pressure, heart rate and respiratory rate and oxygen and glucose enter the thigh and
back muscles, making body to run away or to beat the snake. Once the snake just
leaves, the body goes back to homeostasis, in which the blood pressure, breathing
rate, body temperature and glucose in the blood stress to normal level.
Episodic acute stress is a more severe type of acute stress. People who
suffer from this type of stress experience symptoms every day, not just once in a
while. Episodic stress, if not properly managed, can lead to chronic stress.
For Example.
Life spins out of control with one disaster after another an illness, a
divorce, and loss of employment within a short time span.
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5.Chronic Stress or Long Term Stress.
For Example.
SOURCE OF STRESS.
1. General classification.
Internal stressor.
External stressor.
Developmental stressor.
Situational stressor.
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2.According to location.
Physical.
Physiologic.
Psychosocial.
4.According to duration.
Stressor sequence.
Distant Stressors.
5.Others.
Post-traumatic stress.
Background stress.
Imaginative.
Vicarious.
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1. General classification.
Internal Stressors.
For Example
Infection.
Diseases,
Anxiety
Nervous anticipation of event.
Negative self-talk.
External Stressors.
For Example
Developmental stressors.
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to lope with because they are accepted and the person has some time to prepare for
them.
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Developmental stage Stressors
Continuing education.
Parenting children.
Older Adults
Decreasing physical abilities and health.
Changes in residence.
Major life changes (Retirement, loss of life
partner, loss of friends).
Loss of income.
Cost of health care.
Adjusting to loss of independence.
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Situational stressors.
For Example.
Marriage.
Birth of a child.
New job.
Death of a family member.
Divorce.
Illness.
Automobile accident.
Natural disaster.
2.According to location.
Physical stressors.
For Example.
Physiological stressors.
Psycho social stressors are external stressors that arise from the work,
family dynamics, living situation, social relationships and other aspects of daily
lives.
For Example.
4.According to duration.
Stressor sequence.
Stressful events sequences happen when there is a traumatic event that
causes additional stressors. An example of this is if you are a victim of a natural
disaster and then have to deal with the loss of loved ones, belongings, and pulling
your life back together.
Distant Stressor.
Distant stressors are stress that happened a long time ago but continue to
affect your immune system negatively because of emotional and cognitive issues.
Some examples of distant stressors include
Child abuse
Prisoner of war
Loss of a loved one
War trauma.
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5.Others.
Post-traumatic stress.
Posttraumatic stress is exposure to any event those results
in psychological trauma. This event may involve the threat of death to oneself or to
someone else, or to one's own or someone else's physical, sexual, or psychological
integrity, overwhelming the individual's ability to cope.
Background stress.
Background stressors are hassles of everyday life, they are the
persistent nagging, irritations at home, school and work that affect as all.
For Example.
While in sleep the phone bell constantly rings and it is repeatedly a
wrong number.
Imaginative.
Feeling stressed causes the body to undergo changes in levels of certain
hormones.
For Example.
Acne, hair loss.
Vicarious.
Taking the place of another person or thing acting or serving as a substitute.
Causes of stress.
Particular situations that cause stress, workplace, struck in traffic and need to
STRESS CYCLE.
Stress follows a cycle of events which circle around and around, each step
increasing the severity of next step. The stress cycle can be interrupted at any point
with stress management program.
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Stressor.
The thing that causes the stress avoids the stressors to manage them.
Reaction to stress.
Once there is a stressor the next step is the reaction to it. The body
begins a huge chemical change to prepare the person to confront stressor.
The techniques to break the stress cycle by changing the reaction to stress
are cognitive-behavioral therapy, reframing, affirmation, visualization and spiritual
practices.
Stress and its effects on the body. The effects are tightness of neck
muscles, headache, exhaustion, irritability, increased colds and insomnia.
After a sustained period of chronic stress with little or no relief, the body
will wear down. This can invite more serious diseases like high blood pressure,
heart problems, diabetes, skin conditions, asthma, arthritis, depression and even
cancer.
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Increased sensitivity to stress:
When the body is fighting diseases, the emotions are worn and exhausted
and sensitivity to stress increases. Overtime, smaller and smaller stressor will
initiate the same stress reaction that a big event used to get.
If the cycle is not breaked, the cycle continues and produces now another
stressor.
Stages of Stress.
Alarm stage.
Resistance stage.
Exhaustion stage.
Alarm stage.
The first stage is initiated with a threat. This is short term reaction. All the
bodily activity is increased in response to a stressor. This starts the body’s “fight-
fight” reaction, causing the release of adrenalin.
Resistance stage.
If the threat persists with the person, he enters the second stage. In the
resistance stage he makes much effort to cope up with his level of stress.
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Exhaustion stage.
It leads to illness and injury. Burn out is the effect of this stage. If the
stressful situation is not resolved, he may become chronically stressed. The body’s
needs for energy resources exceed its ability to produce them.
Models of Stress.
Transaction model was given by Lazarus (1966) WHO stated that the
stimulus theory and the response theory don not consider individual differences.
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For Example.
Interims of illness, one may respond with denial, another with anxiety and
still another with depression. In contrast to selye, WHO focuses on physiologic
components or responses as part of his concept of stress.
Psychosomatic model.
Psychic phase.
Psychosomatic phase.
Somatic phase.
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Organic phase.
This phase is marked by the full involved of a so-called disease state, with
physiological changes such as an ulcerated stomach or chronic hypertension
becoming manifest.
For Example.
Stage 1 (irritability).
Stage 2 (hypertension).
Stage 3 (palpitation)
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Social Environmental Model.
Social sector refers to the social cultural context of one’s life. It may include
religion, caste. Language, dress and other such factors.
Stage-1.
Stage-2.
Job and organizational loads have increased causing minor changes that
are quite manageable.
Stage-3.
Job and organizational loads have become unmanageable and interact with
intrapsychic loads. This is the stage at which the negative consequences of stress
become apparent. Most of the stress related diseases emerges at this point.
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Stage -4.
Bounce Model.
Pestonjee (1983) has also developed a model to explain how one lope with stress
reactions. It is called the bounce model because the behavioral decompensating
taking place due to stress tends to get reflected in interpersonal and other reactions.
The reactions are received and analyzed by the environment, which in turn bounces
back signals to the individual to bring about a change either at organism level or at
the response level.
e
n
Stressors v
i
Intrapsychic organism Response r
o
n
External (physical)
m
e
External (social) n
t
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Cognitive Response.
Problem solving
Structuring.
Self-control or self-discipline.
Suppression.
Fantasy.
Natural response.
Cortisone.
Thyroid.
Endorphin.
Sex hormones.
Digestive tract.
Sugar and insulin.
Cholesterol.
Racing heart beat.
Air supply.
Blood.
Skin.
Senses.
Emotional Response.
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Behavioral Response.
Anxiety.
Fear.
Ego defense mechanism.
Anger.
Depression.
THEORIES OF STRESS.
Whether a person considers that they have the resources to meet the
demands of the stressor.
a) Primary appraisal.
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Example.
b) Secondary appraisal.
It includes feelings of not being able to deal with problems.
Example.
Object resources.
Condition resources.
Employment, personal relationships.
Personal resources.
Skill or self-efficacy.
Energy resources.
o Phobia.
o Anxiety.
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Phobia-Phobia is intense and irrational fears that are associated with specific
events and situations.
Example: claustrophia.
6) Cognitive theory.
Example.
People living near nuclear power plant who had difficulty in coping with
the stress that was produced by the fear that the nuclear emissions would affect
their health, found it difficult to keep their minds from thinking about the
accidents. When taking examinations.
7) Emotional theory.
Example.
Headache
Upset stomach
Dry mouth
Chest pain.
Difficulty falling sleep.
Fatigue.
Loss of appetite or overeating.
Lack of concentration.
Memory problems.
Irritability.
Short-temper.
Anxiety.
Abusive behavior.
Depression.
Damaged relationships.
Physiological.
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Skin is pallid because of constriction of peripheral blood vessels, an
effect of norepinephrine.
Sodium and water retention increase due to release of minerals cortiliods
which increases blood volume.
Rate and depth of respiration increase because of dilation of the
bronchioles promoting hyperventilation.
Urinary output decreases.
Stooping posture.
Trembling.
Teeth grinding.
Twitching.
Tics.
Fast, shallow or difficulty in eating.
Pain and tension in muscles giving rise to headache.
Migration.
Eye pain.
Neck pain.
Low back pain and pain in the limbs.
Pain in the limbs.
Tiredness and ready fatigable.
No or reduced menstrual bleeding.
Lack of interest in sex or frank impotence.
Mouth may be dry.
Peristalsis of the intestines decreases resulting in possible constipation
and flatus.
For serious threats, mental alertness improves.
Muscle tension increases to prepare for rapid motor activity or defense.
Blood sugar increases because of release of glucocorticoids and
gluconeogenesis.
Anxiety.
Mild anxiety produces a slight around state that enhances perception
learning and productive abilities.
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Example. Person seeks information and asks questions.
Moderate anxiety increases the around state to a point where the person
expresses feelings of tension.
Behavioural.
Sociological.
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Family discord.
Assault.
Act of violence.
Fits of rage.
Unreasonable fears.
Anxieties.
Listlessness.
Hyperactivity and irritability.
Dizziness.
Fainting.
Ringing in the ears.
Insomnia.
Recurrent vivid dreams of post tragic events.
Lethargy.
Lack of interest in food.
Withdrawal from human interactions.
EFFECTS OF STRESS.
Skin disorders
Eczema
Pruritus.
Urticarial.
Psoriasis.
Respiratory disorders.
Asthma.
Hay fever.
Tuberculosis.
Cardio vascular disorders.
Coronary artery disease.
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Essential hypertension.
Congestive heart failure.
Metabolic disorders.
Hyper thyroidism.
Hypothyroidism.
Diabetic mellitus.
Cushing syndrome.
Gout.
Cancer.
Accident proneness.
Decreased immune response.
Menstrual irregularities.
STRESS ASSESSMENT.
There are 10 questions that ask you about your feelings and thoughts during the
last month. In each case, you will be asked to respond by selecting one of five
responses indicating how often you felt or thought a certain way.
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STRESS ADAPTATION.
1. Avoidance.
Example.
2. Compensation.
Example.
A small boy who wants to be on the football team instead becomes a great
singer.
3. Denial.
Example.
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4. Displacement.
Example.
A husband and wife are fighting and the husband becomes. So angry he hits a
door instead of his wife.
5. Identification.
An attempt to manage anxiety by initiating the behavior of someone feared or
respected.
Example.
A student nurse imitates the behaviours she observes one of her instructions
using with clients.
6. Conversion.
Example.
Developing nausea that causes the person to miss the major exam. Feeling back
pain when it is difficult to continue carrying the pressures of life.
7. Intellectualism.
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Example.
When her husband dies, the wife relieves her pain by thinking, it’s better
this way, he was in so much pain.
8. Introjection.
A form of identification that allows for the acceptance of other’s norms and
values into oneself.
Example.
A seven year old tells his little sister. Don’t talk to strangers. He has
interjected this value from the instructions of patients and teachers.
9. Minimization.
Not acknowledging or accepting the significance of one’s own behavior,
making it less important.
Example.
10.Projection.
Example.
A husband forgets to pay a bill and blames his wife for not giving it to him
earlier.
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11.Rationalization.
Example.
A mother spanks her toddler too hard and says it was all right because
he couldn’t feel it through the diaper’s anyway.
12.Reaction formation.
A mechanism that causes people to act exactly opposite to the way they
feel.
Example.
13.Regression.
Resorting to an earlier more comfortable level of functioning that is
characteristically less demanding and responsible.
Example.
An adult throws a temper tan drum when he does not get his own way. A
critically in client allows the nurse to bathe and feed him.
14.Repression.
Example.
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A teenager seeing his friend killed in a car accident becomes amnesic about
the circumstances surrounding the accident.
15.Sublimation.
Displacement of energy associated with more primitive sexual or aggressive
drives into socially acceptable activities.
Example.
A person with excessive sexual drives invests psychic energy into a well-
defined religious value system.
16.Substitution.
Example.
A women wants to marry a man exactly like her dead father and settles for
someone who looks a little bit like him.
17.Undoing.
Example.
A father spanks his child and the next evening brings home a present for
him.
Hans selye developed this model to describe how people respond to stress.
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Physiological response.
In addition to adopt globally, the body can also react locally, that is one
organ or a part of the body reacts alone. This is referred to as the local adaptation
syndrome (LAS). One example of this LAS is inflammation.
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2.RESISTANCE
3. EXHAUSTION
HOMEOSTASIS RECOVERY
DEATH
1. ALARM
Stock phase
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Selye (1976) proposed that both the gas and LAS have three stages.
Alarm Reaction.
Resistance Reaction.
Exhaustion Reaction.
Alarm Reaction.
The initial reaction of the body’s the alarm reaction, which alerts the body’s
defenses. Selye (1976) divided this stage into two parts.
Shock phase.
Counter shock phase.
Shock phase.
Resistance Reaction
The second stage in the GAS and LAS syndromes, the stage of resistance,
is when the body’s adaptation takes place. In other words, the body attempts to
cope with the stressor and to limit the stressor to the smallest area of the body that
can deal with it.
Exhaustion Reaction.
During the third stage, the stage of exhaustion, the adaptation that the body
made during the second stage cannot be maintained. This means that the ways used
to cope with the stressor have been exhausted. If adaptation has not overcome the
stressor, the stress effects may spread to the entire body. At the end of this stage,
the body may either rest and return to normal or death may be the ultimate
consequence.
Exercise.
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Regular exercise promotes physical homeostasis by improving muscle tone and
controlling weight.
Sleep and rest restore energy levels, allows the body to repair itself, and
promote mental relaxation.
Leisure activities.
Leisure activities are activities that provide joy and satisfaction. Making
time for and relaxation reduces stress.
Time management.
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People who manage their time efficiently and organize their life routines feel
more in control and therefore less stressed. Time management also includes
saying no, a need to be liked, strong sense of responsibility. Try to make everyone
happy by agreeing to all requests for assistance.
Coping.
Types.
Problem focused coping.
Emotion focused coping.
Escape coping.
Long term coping strategies.
Short term coping strategies.
Effective or adaptive coping.
Ineffective or maladaptive coping.
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Problem focused coping refers to efforts to improve a situation by making
changes or taking some action.
Escape coping.
Example.
It can reduce the stress to a tolerable limit temporarily but are ineffective
wags to permanently deal with reality.
Adaptive coping.
Adaptive coping helps the person to deal effectively with stressful events and
minimizes distress associates with them.
Maladaptive coping.
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Maladaptive coping can result in unnecessary distress for the person and
others are associated with person or stressful event.
STRESS MANAGEMENT.
4 A’S
Alter the
stressor Accept the
stressor
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Learn how to say No
Refusing to accept the added responsibilities taking more than to handle is the
receipe for stress.
If someone consistently causes stress limit the time spending with him or
end the relationship entirely.
Be willing to compromise.
If they are expecting someone to change the behavior, bend a little to find
happy ground.
Be more assertive.
Deal with the problem and doing the best to anticipate and prevent them.
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Poor time management cause lot of stress plan a head and act accordingly.
Reframe problems.
Example.
In traffic, listening to favorites radio station or enjoy some alone time. Look at
the big picture.
Eliminate the words such as always, never, should and must. These are marks
of self-defeating thoughts.
Accept the things that can’t change. Accept the things as they are.
Acceptance may be difficult. It’s easier against the situation that can’t change.
Don’t try to control the uncontrollable.
Many things in life are beyond the control, particularly the behaviour of
other people.
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When facing major challenges look at them and learn from the mistake.
Learn to forgive.
Accept the fact that we live is an important world and that people make
mistakes. Free from negative energy by forgiving and moving on.
PREVENTION OF STRESS.
Primary Prevention.
Health education.
Environment change.
Social support.
Community wide programme.
Mile stone programme.
High risk.
Secondary prevention.
Tertiary prevention.
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Stress management techniques focus on discharging tension or
simplifying one’s life to modify stressors or control stress responses.
• Nutrition.
Exercise.
• Relaxation technique.
• Medication.
• Guided imagery.
• Bio feedback.
Bio feed backis method that uses the mind to control the body function
that the body normally regulates automatically.
• Acupuncture.
• Chiropractic adjustment.
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It involves manual realignment of the vertebrae.
• Therapeutic touch.
• Massage.
• Reflexology.
• Humor.
Reading and telling jokes, viewing fusty movies help release tension and
anger and increase coping abilities.
• Listening to music.
Music soothes and relaxes when its vibrations are in harmony with body
frequencies.
Painting, working with day and engaging in other art activities help to
express emotions and release endorphins.
Like other forms of exercise release pent-up physical tension and emotions.
• Journal writing.
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Helps the person to reflect on experiences and express emotions.
PREVENTION OF STRESS.
Primary Prevention.
Health education.
Environment change.
Social support.
Community wide programme.
Mile stone programme.
High risk.
Secondary prevention.
Screening and early detection.
Emergency treatment, counseling, Crisis intervention and
psychotherapy.
Tertiary prevention.
Promoting vocational training and rehabilitation.
Organizing after care programme.
Providing partial hospitalization.
Effects.
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Overwhelmed (fatigue, anger, overwhelmed)
Burn out.
Complex syndrome of behaviours.
Exhaustion.
Physical and emotional depletion.
Negative attitude.
Self-concept.
Feeling of helplessness and hopelessness.
NURSING PROCESS.
Nursing Assessment.
Identify the person verbalization on coping and inability to cope.
Assess the problem solving ability.
Find out if the client denies problems or weakness unspite of
evidence to contrary.
Recognize the non-acceptance of health status changes.
Rule out the family physical and emotional support for the client.
Evaluate the neglect of the client on health.
Assess the community participation.
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Identify the possible stressors from the community.
Categorize the level communication with different situations.
Subjective data.
Objective data.
Careful observation made on the following.
Stress.
Uncomfortable.
Irritable.
Sleepless with bun ken eyes.
Anxiety.
Nursing Diagnosis.
Physical domain.
Constipation.
Delayed growth and development.
Diarrhea.
Disturbed energy field.
Disturbed sleep pattern.
Fatigue.
Imbalanced nutrition.(less than or more than)
Nausea.
Pain (back ache)
Risk for imbalanced fluid volume.
Risk for injury.
Sleep deprivation.
Behavioural Domain.
Ineffective health maintenance.
Ineffective therapeutic regimen management.
Cognitive domain.
Disturbed thought processes.
Impaired memory.
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Emotional domain.
Anxiety.
Decisional conflict.
Defensive coping.
Fear.
Grieving (anticipatory or dysfunctional).
Impaired adjustment.
Ineffective coping.
Ineffective denial.
Low self esteem. (chronic or situational)
Interpersonal relationships domain.
Caregiver role strain.
Compromised or disabled family coping.
Impaired Parenting.
Impaired social interaction.
Ineffective community coping.
Interrupted family process.
Post-trauma syndrome.
Relocation stress syndrome.
Social isolation.
Spiritual domain.
Hopelessness.
Spiritual domain.
Interventions.
Establish therapeutic relationship.
D – decision making.
E – empathy and encouragement.
A – answering the questions immediately and honestly.
R – respect the eluent values.
Explain about stress illness, treatment and prognosis. Give
positive support to the client.
Encourage the client to ask questions.
Assess the coping ability and new mechanism used by the client.
Advice the client by formulation.
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Assist the client in finding alternative life style modification,
participation, spiritual needs, learning new activates and
behaviors.
Encourage the client on self care activities.
Identify the strength and weakness and give appropriate rewarding
on the client strength.
A-Z of stress intervention.
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Evaluation.
Nurse collects the data needed to determine whether the client gols and
outcomes have been achieved, like identifying nursing diagnosis, outcomes and
interventions.
JOURNAL ABSTRACT.
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and dying concern. Prophylactic and curative measures are important for nurses at
both personal s well as organization level.
CONCLUSION.
Black board
Chart
Overhead projector.
Flannel board.
Flash card.
Power point.
BIBLIOGRAPHY.
Textbook.
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Kozhier,b.Erb,G.(2008).Fundamental of Nursing Concepts,Process and
Practice.(18th ed.).Pearson Publication.New Jersley.Pg no.1061.
Journal.
Gracia, C(2010). Conceptualization and measurement of coping during
adolescence.National institute of health.Nurs.Schlorash.42(2).Pg.No.166-185.
Electronic Version.
Stress.www.wikepedia.org/wiki/stress.biology.com.
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Hans Selye’s. General Adaptation Syndrome. www.essence of stress.relief.com.
News.
De stress helpline for class X, XII students, May, 27,2012. New Delhi.
Oct 7, 2009.
Helping children cope with stress. The Hindu Andhra Pradesh. April 19, 2011.
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