STRESS AND STRESS MANAGEMENT: IMPLICATION ON DISEASE PATTERNS

BY
ILO IJEOMA J. NNABUENYI CHINYELU J.P. NWODOH CHIJIOKE OLIVER OBIJAKU GRACE ONUH AKUDO BEATRICE PG/MSC/11/61014 PG/MSC/11/60952 PG/MSC/11/60941 PG/MSC/10/54893PG/MSC/11/61025

LECTURER: DR. (MRS) A.N. ANARADO MARCH, 2012.

INTRODUCTION
Very often than not, some of our daily lifeencounters which are called stressors activate a force from within our body known as stress. It makes us react in certain ways that ordinarily we would not, propelling us to achieve higher life goals and prepares us for the usual fight or flight responses in emergencies when moderately activated. However, the effect of stress can aggravate some human diseases or even be a cause of them especially if prolonged, hence the need to keep it in 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 and manifestations 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 somebodys life (Oxford Advanced learners Dictionary, 2001). It is the physical, physiological or psychological force that disturbs equilibrium in ones body (Tabers Cyclopaedic Medical Dictionary, 2001). It is also defined as reactions of the body to forces of a deleterious nature, infections, and various abnormal states that tend to disturb its normal physiologic equilibrium (homeostasis) (Stedmans Medical Dictionary, 2000).

DEFINITION OF STRESS CONTD

Stress can therefore be deduced to mean an abnormal force that disrupts the stability of human body system. Simply, stress can be described as that feeling one develops when wanting to handle more than he/she is used to.

CAUSES OF STRESS
These are classified into two, internal and external causes. Common external causes of stress include: major life changes, work, relationship difficulties, financial problems, being too busy, children and families, etc. On the other hand, common internal causes of stress are things like inability to accept uncertainty or one not being able to accept what he/she cannot change, pessimism or negative self talk, unrealistic expectation, perfectionism, lack of assertiveness or bottling up of ones feeling, etc.

TYPES OF STRESS
Eustress. This is a type of stress that is normal and exciting, and keeps us vital (e.g. racing to meet a deadline). Acute stress. It is a very short-term type of stress that can either be positive (eustress ) or negative (distress). Episodic acute stress. This is where acute stress seems to be rampant and has become a way of life, creating life of relative chaos. E.g. preparation for examinations as a student. Chronic stress. This is a type of stress that seems never ending and inescapable. Example is the stress of a bad marriage.

PHYSIOLOGY/PATHOPHYSIOLOGY OF STRESS
When stressor(s) stimulate external sensory organs and internal sensors, they send signal to the nerve centres 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-adrenal medullary (SAM) discharge. .

PHYSIOLOGY/PATHOPHYSIOLOGY OF STRESS CONTD

If the stressor persists, third response (activation of hypothalamic-pituitary system (HPS)) occurs. SNS discharge causes the release of norepinephrine at nerve endings, increasing the function of vital organs and general body arousal. This SNS discharge will also cause peripheral vasoconstriction, thereby increasing blood pressure, limiting bleeding in the event of trauma, etc.

PHYSIOLOGY/PATHOPHYSIOLOGY OF STRESS CONTD

The effect of the SNS will also lead to increase in blood glucose to provide more energy, dilation of pupils and increased mental activity. SAM discharge causes stimulation of the medulla of the adrenal gland by the SNS, causing further release of epinephrine and norepinephrine into the blood stream. These effects of SAM discharge prolong the above actions under SNS discharge and also increase the metabolic rate.

PHYSIOLOGY/PATHOPHYSIOLOGY OF STRESS CONTD

HPS response occurs when the stress persists after the above responses, involving HP pathway. The hypothalamus secretes corticotrophin releasing hormone (CRH), which stimulates the adrenal cortex to produce glucocorticoid (cortisol).

This cortisol stimulates protein catabolism, liver uptake of the amino acids and their subsequent conversion to glucose (gluconeogenesis).

PHYSIOLOGY/PATHOPHYSIOLOGY OF STRESS CONTD

The cortisol also inhibits glucose uptake (antiinsulin action) by many body cells except those of the heart and brain. Also in this HPS response, antidiuretic hormone (ADH) and aldosterone from posterior pituitary and adrenal cortex respectively are also released to promote sodium and water retention.

Growth hormone (GH), glucagon and endorphin are also secreted to stimulate the uptake of amino acids by cells and to enhance pain threshold.

MANIFESTATIONS OF STRESS Physiologically, the pupils dilate, sweat production (diaphoresis) increases, the heart rate increases, the skin becomes pallid, blood pressure increases, renin secretion increases, sodium and water retention increases, and will lead to increase in cardiac output. Others include increased rate and depth of respirations, decreased urinary output, possible dryness of the mouth, decreased peristalsis, improved mental alertness, increased muscle tension and increased blood sugar, etc.

MANIFESTATIONS OF STRESS CONTD

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 stress include: crying, verbal abuse, laughing, screaming, hitting and kicking, and holding and touching.

MANIFESTATIONS OF STRESS CONTD

Lastly, psychological manifestations of stress also occur in form of unconscious ego defense mechanism such as: Denial; Rationalization; Compensation; Repression and Regression.

ADAPTATION TO STRESS

This is categorized into two as General Adaptation Syndrome (GAS) and Local Adaptation Syndrome (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 CONTD

Resistance phase occurs with increased activity of cortisol to adapt the body to the stressor. If exposure to the stressor persists, the body then moves to the third phase of the syndrome known as exhaustion with increase in endocrine activity. LAS on the other hand include the inflammatory response and repair processes that occur at the local site of tissue injury; but when the local injury is severe enough, the GAS is activated as well.

ADAPTATION TO STRESS CONTD

Adaptation to stress can also fall in three interrelated modes: Physiologic; Psychologic and Sociocultural.

IMPLICATION OF STRESS ON DISEASE PATTERNS

Stress can cause, induce or aggravate many human diseases due to increased sympathetic nervous system activity and an out pouring of adrenaline/noradrenaline, cortisol and other stress related hormones in this state. In the cardiovascular system for instance, effects of epinephrine, SNS and cortisol lead to tachycardia, palpitation, increased cardiac output and blood pressure and increase in low density lipoprotein (LDL) and triglycerides in the

IMPLICATION OF STRESS ON DISEASE PATTERNS CONTD

These can aggravate or lead to hypertension, atherosclerosis, ischemic heart diseases, heart attack, transient ischemic attack and stroke. Stress also affects the secretion of T-cell which affects the immune system, producing suppressive and autoimmune actions on it. This state exacerbates and predisposes the body to colds; other viral infections, including HIV, and other systemic or local infections.

IMPLICATION OF STRESS ON DISEASE PATTERNS CONTD

In gastrointestinal tract (GIT), the effect of stress on SNS and the shunting away of blood from GIT to vital organs can lead to or worsen diseases like peptic ulcer, irritable bowel syndrome, dyspepsia, etc. Furthermore, the released cortisol in stressful state causes gluconeogenesis and inhibits the uptake of glucose by many body cells. This causes hyperglycemia diabetes mellitus. and worsens

IMPLICATION OF STRESS ON DISEASE PATTERNS CONTD

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

Other conditions implicated by stress which can lead 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 the suitable nursing diagnoses for the client. Some of the nursing diagnoses relating to clients experiencing stress are: Anxiety, Ineffective coping patterns, Impaired thought processes, etc.

MANAGEMENT OF STRESS CONTD

Planning. Having formulated the diagnoses, the nurse should develop plans of the care in collaboration with the client and significant support persons. Implementation. General guidelines to minimize the clients 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

MANAGEMENT OF STRESS CONTD

Provide information when the client has insufficient 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 and thoughts Ensure that expectations are within the clients capabilities

MANAGEMENT OF STRESS CONTD

Be sensitive to specific situations and experiences that increase anxiety and stress for clients Assist a client to make a correct appraisal of a situation Provide an environment in which a person can function 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

MANAGEMENT OF STRESS CONTD

Bring clients and their support persons into contact with people in community agencies who can help them make valid plans. Communicate competence, understanding, and empathy rather than stress and anxiety Encourage humor as a means of coping with stressors

MANAGEMENT OF STRESS CONTD

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 the intervention in accordance with the outcome criteria earlier established in the care plan.

STRESS MANAGEMENT FOR NURSES THEMSELVES Nurses can do this management using the above techniques for managing clients. In addition, the nurses should do the following: Recognize they are stressed Determine what causes the stress and when it occurs Determine alternative actions to deal with the stress constructively Plan a daily relaxation programme with meaningful quiet times to reduce tension

STRESS MANAGEMENT FOR NURSES THEMSELVES CONTD

Establish an activity programme to direct energy outward Become more assertive to overcome feeling of powerlessness in relationship with others. Learn to say no Manage time better by delegating to others and combining 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 NURSES THEMSELVES CONTD Learn to ask for help, and share your feelings with colleagues Learn to support your colleagues in times of need. Give them a time to ventilate feelings and listen to their concerns Learn to handle problems constructively instead of defensively Accept what cannot be changed. There are certain 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 this condition when we see them.

SUMMARY/CONCLUSION CONTD

To help the society better, it is recommended that nurses and other health practitioners should equip themselves with adequate knowledge about stress so as to manage and enlighten their clients and relevant others on what is tress, its causes, management and preventive measures.

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