🧠 1. What Is Stress?

Stress = any actual or perceived threat to homeostasis.

• Affects physical + mental well-being.
• Nurses must also recognize their own stress, including burnout, compassion fatigue, and second victim syndrome.

Key Terms

• Stressors → Events causing stress.
• Appraisal → How a person interprets the stressor.
• Trauma → Stress response from severe events.

⚡ 2. General Adaptation Syndrome (GAS)

The body’s 3-stage response to stress.

1) Alarm Stage (Fight-or-Flight)

• ↑ HR, ↑ RR, ↑ BP
• ↑ glucose
• Pupils dilate

💡 Example: Athlete injured → increased heart rate (Quick Quiz 1).

2) Resistance Stage

• Body stabilizes → attempts to repair damage
• Hormone levels normalize

3) Exhaustion Stage

• After prolonged stress → body can no longer resist
• Leads to allostatic load (long-term wear & tear)

allostatic, sounds like staying with all the load

💡NCLEX TRAP:

If patient has persistent high cortisol, they are in resistance, NOT alarm. If the question mentions complications of long-term stress, answer is usually allostatic load.

🤒 3. Immune Response to Stress

Stress → ↑ cortisol → decreased immune function → higher infection risk.

Chronic stress → immunosuppression → illness.

Examples:

• Student with exams → gets sick
• Caregiver → frequent colds

🧩 4. Psychological Stress Response

Includes:

• Coping (efforts to manage stress)
• Defense mechanisms (unconscious protection processes)

🔥 5. Types of Stress

1. Acute Stress

• Short-term, sudden
• Example: Car accident

💡 NCLEX TRAP: Do NOT teach complex coping skills during the acute panic phase. Stabilize first.

2. Chronic Stress

• Ongoing roles/problems
• Caregiver burden
• Long-term job stress

3. Crisis

Three types:

• Developmental (life stages: puberty, marriage, retirement, starting school, empty nest)
• Situational (job loss, Illness diagnosis, car accident, divorce)
• Adventitious (natural disasters, crime, fires, assault, terrorism)
• Unexpected + external disaster
• It’s not part of everyday life, unexpected and uncontrollable.

💡 Quick Quiz 2: Chest pain + job loss → Situational crisis.

4. Secondary Traumatic Stress

• Secondary traumatic stress (STS) in nursing occurs when a healthcare professional develops psychological distress from a patient's traumatic experience.
• Nurses are repeatedly exposed to traumatic events, such as severe injuries, abuse, or death, through their patients.
• Leads to emotional exhaustion

💔 6. Compassion Fatigue & Second Victim Syndrome

Compassion Fatigue

Combination of burnout + secondary traumatic stress

Symptoms:

• Emotional exhaustion
• Reduced ability to feel empathy
• Physical, mental, emotional problems

Second Victim Syndrome

• Occurs after causing harm or a med error
• Nurse feels guilt, anxiety, depression, trauma

💡 NCLEX TRAP: If a nurse feels guilty AFTER a med error → Second Victim Syndrome, NOT burnout.

🧠 7. Nursing Theories Related to Stress

Neuman Systems Model

• Uses systems approach
• Focuses on stressors + patient’s reaction to stress

Roy’s Adaptation Model

• Patient can modify external stimuli to adapt

Pender’s Health Promotion Model

• Encourages health promotion & stress management

👤 8. Factors Influencing Stress & Coping

Situational Factors

• Job changes
• Illness
• Caregiver burden

Maturational Factors

• Vary by life stage
• Children: physical stressors
• Adolescents: identity/peer stress
• Adults: major life roles
• Older adults: loss, health decline

Sociocultural Factors

• Poverty
• Violence
• Family expectations
• Cultural norms

🩺 9. Nursing Process: Stress & Coping

🔍 Assessment

• “Tell me what is causing your stress.”
• “How are you coping?”
• “What do you think triggered this?”

NEVER assume what the stressor is.

📚 Nursing Diagnoses

• Anxiety
• Despair
• Difficulty coping
• Risk for post-trauma response
• Stress overload

🎯 Planning

Outcomes should involve:

• Effective coping
• Family coping
• Caregiver emotional health
• Psychosocial adjustment

🤲 Implementation

1. Health Promotion

• Reduce stress-producing situations
• Increase resistance to stress
• Learn stress-reduction skills
• Maintain regular exercise & rest

2. Coping Skills / Techniques

• Support systems
• Time management
• Guided imagery
• Visualization
• Progressive muscle relaxation
• Assertiveness training
• Journal writing
• Mindfulness-based stress reduction (MBSR)
• Workplace stress management

3. Acute Care

• Crisis intervention

4. Restorative Care

• Follow-up
• Long-term coping strategies

🔎 Evaluation

• Ask: “Has your stress been reduced?”
• Remember: Coping takes time.

📝 Quick Quiz

Quiz 1:

Athlete in stress → Increased HR

Quiz 2:

Job loss crisis → Situational

⚡ High-Yield Exam Tips

• Alarm = fight/flight; Resistance = stabilization; Exhaustion = burnout.
• GAS = physiological, not emotional.
• Allostatic load = long-term stress wear & tear.
• Situational vs. maturational stress is a common exam trap.
• Compassion fatigue ≠ burnout (but related).
• Compassion fatigue = burnout + secondary trauma.
• Second victim syndrome = after causing patient harm (med error).
• Don't teach complex coping during panic or crisis.
• Coping strategies must be individualized.
• Always assess perception before giving advice.

⭐The #1 NCLEX Rule for Stress Questions

Always prioritize physiological stability FIRST.

• Chest pain? → Before coping.
• Suicidal? → Safety intervention.
• Trouble breathing? → ABCs.
• Vital signs unstable? → Fix that first.

Only THEN → coping, teaching, planning.