Fundamentals · chapter 34 · Stress, Adaptation, and Homeostasis
Stress and Adaptation
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.
Key points
Acute versus chronic stress
Acute stressful events are short lived, with prompt resolution and return to a steady state with little or no long-lasting results. Chronic stress, on the other hand, involves sustained effects of the stress response and no relief from the stimulated sympathetic nervous system, which can be detrimental to health.
Individual stress experience
People experience stress in different ways, based on factors such as past experiences, support systems, and overall attitudes. Whether the stress is from something perceived as positive or negative, however, the physiological responses involve the same basic chemical actions and reactions.
Hormonal stress pathway
When a person recognizes a stressor, their hypothalamus releases corticotropin-releasing hormone (CRH), which causes the anterior pituitary gland to secrete adrenocorticotropic hormone (ACTH).
Fight-or-flight effects
The SNS releases catecholamines: norepinephrine (noradrenalin), epinephrine (adrenaline), and dopamine. These chemicals generate the fight-or-flight response: heart rate and blood pressure increase, bronchioles dilate, and glycogen in the liver is converted to glucose.
Stress response resolution
Under normal circumstances, when the stressor has been resolved, the effects of SNS stimulation are opposed by its counterpart, the parasympathetic nervous system (PSNS). The stress hormones dissipate, and body processes normalize.
Distress manifestations
It manifests in many ways, including anxiety (a feeling of unease, worry, or nervousness), sadness, pain, and varied vague symptoms that make isolating the cause difficult.
Stress signs and symptoms
The signs and symptoms of stress are similar to those of a stimulated SNS, such as tachycardia, hypertension (HTN), tachypnea, bronchiole and pupillary dilation, and release of glucose.
Chronic stress consequences
Chronic stress tends to be responsible for the negative physiological changes associated with the stress experience, such as chronic occurrences of HTN, gastrointestinal upset, anxiety disorder, and heart failure (HF). Chronic distress can also damage or reduce the function of various body systems, including the immune system, increasing the risk of infection or autoimmune disorders.
Support systems and stress
People who do not have supportive systems of family or friends are more prone to chronic stress, as a caring environment and positive relationships decrease levels of stress hormones.
Eustress perception
Whether a person experiences eustress or distress typically depends on their perception of the stressor, which may itself reflect personality and attitude toward the stressor.
Eustress and development
The experience of eustress is essential for healthy development, as it supports the brain’s ability to respond to events in beneficial ways. The source of eustress may be psychological or physiological, and results tend to be constructive, with associated feelings of accomplishment and excitement.
Adaptive stress changes
Adaptation includes the body’s own physiological changes following exposure to a stressor. These adaptive changes are necessary for survival and ultimately a return to homeostasis; however, individuals can also play a more active role in adaptation by learning and practicing stress management techniques and coping strategies.
Nursing role in adaptation
Because adaptation can be adaptive and effective or maladaptive and ineffective, the focus of nursing care is to help patients adapt to stress in positive ways that lead to healthy changes. Nurses play key roles in helping patients identify stress and stressors, minimize maladaptive behaviors, learn coping skills, and increase effective adaptation.
Nursing and homeostasis
When nurses treat stressed patients, what they are mainly treating are symptoms of alterations to homeostasis, as well as the body’s compensatory mechanisms as it attempts to resolve the perceived threats and return to a steady, stable state.
Terms to know
- stress
- A physiological response by the body to a stimulus, or stressor, is called stress.
- homeostasis
- The body has an innate drive for homeostasis, or physiological balance.
- distress
- Stress that is perceived negatively is called distress.
- eustress
- Positive stress, or eustress, is stress that initiates a positive response or feeling.
- Physiological stressors
- Physiological stressors are physical stimuli that initiate the body’s innate stress response.
- Adaptation
- Adaptation describes the body’s response to stress.
- allostasis
- The process of the body making ongoing changes in response to stress is called allostasis (Guidi et al., 2021).
- Physiological homeostasis
- Physiological homeostasis is a state of equilibrium in which the body’s physical systems are in balance.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
The graded version needs JavaScript. Every question is below anyway, with the answer and why.
Every question here, with the answer
A dehydrated client receiving an IV fluid bolus says she feels dizzy when she sits up. Which instruction by the nurse is most important?
- Walk to the bathroom alone to build strength.
- Change positions slowly and call for help before getting up to the commode.
- Drink large amounts of water to raise the blood pressure.
- Stay flat in bed and do not use the call light.
Answer: Change positions slowly and call for help before getting up to the commode.
With dehydration, blood pressure can drop too low with position changes, so the client should move slowly and not get up alone. Walking alone risks a fall, the client cannot keep fluids down, and discouraging use of the call light is unsafe.
A client who was just fired tells the nurse, "The boss had it out for me all along." Which defense mechanism is the client using?
- Rationalization
- Displacement
- Regression
- Projection
Answer: Rationalization
Rationalization is justifying behavior with a logical explanation, and blaming a boss after being fired is the textbook example. Projection transfers qualities to another person, displacement redirects emotion to another target, and regression returns to past behaviors.
A client with COPD in a severe exacerbation is very anxious but has no personal or family history of anxiety. How should the nurse interpret the anxiety?
- It indicates an underlying anxiety disorder that needs a psychiatric diagnosis.
- It is unrelated to the client's disease.
- It is likely a physiologically stress-induced response to air hunger.
- It is a maladaptive coping mechanism.
Answer: It is likely a physiologically stress-induced response to air hunger.
Clients in a severe COPD exacerbation are usually very anxious because air hunger is frightening, and this anxiety is physiologically stress-induced with the disease as the stressor. It does not by itself indicate an anxiety disorder or maladaptive coping.
A client asks why stress makes their heart race and their blood pressure rise. Which explanation is accurate?
- The sympathetic nervous system releases catecholamines that produce the fight-or-flight response.
- Stress lowers cortisol, which increases heart rate.
- Only negative stress triggers these physical changes.
- The parasympathetic nervous system releases catecholamines during stress.
Answer: The sympathetic nervous system releases catecholamines that produce the fight-or-flight response.
The SNS releases norepinephrine, epinephrine, and dopamine, which raise heart rate and blood pressure in the fight-or-flight response. The PSNS opposes these effects after the stressor resolves, cortisol is released rather than lowered, and positive and negative stress involve the same basic reactions.
A nurse is helping a client under chronic stress identify maladaptive coping. Which behaviors are maladaptive coping mechanisms? Select all that apply.
- Avoidance
- Risky behaviors
- Self-deprecation
- Using social support systems
- Procrastination
Answer: Avoidance, Risky behaviors, Self-deprecation, Procrastination
Maladaptive coping mechanisms include avoidance, procrastination, self-harm, eating disorders, risky behaviors, and self-deprecation. Establishing and using social support systems is a positive coping mechanism.
A nurse is teaching a stressed client strategies to develop positive coping skills. Which strategies should the nurse include? Select all that apply.
- Create supportive interpersonal relationships.
- Use the same coping method that works for everyone.
- Reframe emotions through positive self-talk.
- Participate in active relaxation.
- Participate in religious or spiritual routines.
Answer: Create supportive interpersonal relationships., Reframe emotions through positive self-talk., Participate in active relaxation., Participate in religious or spiritual routines.
Recommended strategies include active relaxation, regulating emotions, positive self-talk, supportive relationships, positive activities, and religious or spiritual routines. Coping methods should be individualized because coping is not one-size-fits-all.
Where every quote comes from
Section 34.1 Stress and Adaptation of Fundamentals of Nursing by Christy Bowen, Lindsay Draper, Heather Moore, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.