Question

A 58-year-old man was admitted for abdominal surgery. He was extremely agitated and had several questions for the health care team. He often asked the same question in a different way. Following surgery, he was lethargic but seemed to be resting comfortably. Shortly after transfer back to the floor, he awoke in pain and was quite agitated. After receiving medication for his pain, he was able to rest. On the third day postoperatively, his wife was obviously upset when she came to visit, although she was trying to hide her feelings. Eventually, she admitted that a notice had arrived in the mail notifying him that his employer had declared bankruptcy and closed down. The patient became very distressed. Later, after his wife left, he became despondent, complaining of a headache and wondering how long he would have to remain in hospital. He told the nurse that he was worried about his benefit plan and whether his hospital costs would be covered.

1. Based on the patient history and the signs and symptoms, discuss the stages of stress response that the patient is experiencing and might experience in the future. (See Three Stages in Stress Response—GAV.)

2. Discuss other problems that this patient might experience as a result of stress and the underlying physiological cause of these problems. (See Stages in Stress Response, Significant Effects of the Stress Response.)

Answer 1

1. Based on the patient history and the signs and symptoms, discuss the stages of stress response that the patient is experiencing and might experience in the future. (See Three Stages in Stress Response—GAV.)

Stress is a state of mind produced by a change in environment that is perceived as challenging, threatening or damaging to person's equilibrium.

Stressors are events or situations causing changes to homeostatis of the body. Stressors are physical, physiological and psychological.

Stress response is a cascade of neural and hormonal events that cause imbalance in equilibrium , with a disease outcome which is due to failure of the normal process of adaptation to stress.(ref. Brunner & suddharth , Medicalsurgical nursing , 10 th edition Pg.no 80-96)

Phases of stress response:

• Alarm phase- The Flight-or-fight response is activated by the release of catecholamines and the onset of adrenocorticotrophic hormone-adrenal cortical response .Alarm reaction is defensive. The man was extremely agitated and was asking several questions for the health care team and often asked the same questions in a different way due to the alarming response to surgery
• Resistance phase- After the initial shock of a stressful event and having a fight-or-flight response, the body begins to adapt to the environment. It releases a lower amount of cortisol, and your heart rate and blood pressure begin to normalize. Although your body enters the recovery state, it remains on high alert for a while.Irritability, frustration and cannot concentrate may be present in resistance stage.He awoke with pain and still agitated.After receiving medication ,he was able to rest because he is recovering.
• Exhaustion phase: Struggling with stress for long periods can drain your physical, emotional, and mental resources to the point where your body no longer has strength to fight stress.He became despondent, complaining of a headache and wondering how long he would have to remain in hospital(after his wife told about bankruptcy of his employer) He told the nurse that he was worried about his benefit plan and whether his hospital costs would be covered.He may feel hopeless from all this.

The longer time dealing with stress may lead to dangerous health problems.Prolonged stress increases the risk of hypertension, stroke, heart disease, and depression. There is high risk for infections and cancer due to a less active immune system because of stress.

2. Discuss other problems that this patient might experience as a result of stress and the underlying physiological cause of these problems. (See Stages in Stress Responss e, Significant Effects of the Stress Response.)

The patient may experience sleep difficulty, unable to concentrate, headaches , unexplained fears, anxiety, Isolation from family activities or peer relationships, other muscular aches, poor coping, less grades in school, depression, mood disorders, loss of appetite, overeating, weight gain or weight loss,etc.

Physiologic response to stress are low immunity , erectile dysfunction, Gastrointestinal ulcers, GERD, infertility, digestion problems, eating disorders, hypertension, diabetes, abortion, headaches, back and shoulder pain,body aches, myocardial infarction and other cardiac problems , etc.