Psychiatric Mental Health, part 6: Stress and General Adaptation Syndrome, Anxiety

by Cathy Parkes July 26, 2021 Updated: August 24, 2021

In this article, we'll cover the stress, the stages of general adaptation syndrome, and how to recognize and care for different levels of anxiety. Why does stress make you tired? How can a little bit of anxiety help you perform better on the NCLEX? We'll answer these questions and more!

This series follows along with our Psychiatric Mental Health Nursing Flashcards which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

Stress

Stress is the body’s physical and emotional reaction to physical, mental, or emotional pressure. One framework used to describe how the body reacts to stress is called general adaptation syndrome.

General adaptation syndrome

General adaptation syndrome is a framework for understanding the body's response to a stressor, and it contains three stages: alarm reaction, resistance, and exhaustion.

Alarm reaction stage

The first stage of general adaptation syndrome is the alarm reaction stage, during which the body has a fight-or-flight response to a stressor.

The fight or flight response is the way our bodies react to danger, whether real or imagined, and the body prepares to release hormones like adrenaline and cortisol, and modifies organ function to best serve you to take flight (run away) from danger, or to fight.

Signs and symptoms of the alarm reaction stage

During the alarm reaction stage, cortisol levels will increase as well as heart rate and blood pressure.

All of these bodily reactions prepare you to handle danger.

Cardiac output increases to flow blood to your muscles to prepare you to fight and increase your strength.

Blood pressure increases due to vasoconstriction, directing blood away from the gastrointestinal system (running away from danger is not a safe time to poop), and this vasoconstriction also makes you less likely to bleed out if you were to be injured.

Bronchodilation facilitates breathing to prepare you to run.

Pupil dilation occurs to allow you to see farther distances and secure yourself from threats.

Need to learn more about the sympathetic nervous system and our fight or flight response? Check out our Medical-Surgical Nursing Flashcards.

Resistance stage

After the alarm reaction stage, the body enters the resistance stage. After the initial shock of the stressor subsides, the body attempts to normalize its vital signs and its hormone levels.

Signs and symptoms of the resistance stage

Signs and symptoms of the resistance stage can include poor concentration, irritability, and frustration. If you have ever had a noticeable stressor and felt frustrated or irritable later in the day, this is a normal part of the body's response to stress.

Exhaustion stage

If the stress continues beyond the resistance stage, the body enters the exhaustion stage. During the exhaustion stage, the prolonged stress depletes the body's resources and weakens the immune symptoms.

The alarm reaction stage uses a lot of energy and the resistance stage is working hard to bring you to homeostasis, which is why prolonged periods of this are depleting to the body.

Signs and symptoms of the exhaustion stage

Symptoms associated with the exhaustion stage include fatigue, depression, and anxiety. Disease is another sign of the exhaustion stage, because the immune system is not functioning at full capacity.

Anxiety

Anxiety is an emotion characterized by feelings of uneasiness, worry, tension, or nervousness. We will describe four levels of anxiety, which include mild, moderate, severe, and panic-level anxiety, the characteristics and the symptoms of each level, and the nursing care of patients who have anxiety.

Mild anxiety

Mild anxiety is a normal, expected response to daily events in life. Mild anxiety heightens awareness, increases the perceptual field, allows for optimal functioning, and is also beneficial for learning.

So if you feel mild anxiety about taking the NCLEX, that's normal, expected, and might actually help you. Great news!

Need more NCLEX help? Check out the NCLEX Pack - Nursing Flashcards. This comprehensive flashcard bundle will help you prepare for your nursing school classes and exams, and focuses on just the information you need to level up!

Mild anxiety symptoms

Signs and symptoms of mild anxiety can include restlessness and irritability. It also increases an individual's motivation.

Moderate anxiety

Moderate anxiety causes decreased concentration, decreases the attention span and the perceptual field. Moderate anxiety may hinder problem-solving at this point.

Moderate anxiety symptoms

Signs and symptoms of moderate anxiety include increased heart rate and respiration rate, GI discomfort, and increased muscle tension.

Moderate anxiety nursing care

If you have a patient with mild-to-moderate anxiety, you can help your patient with problem-solving. Evaluate with your patient what coping mechanisms they have successfully used in the past. It's possible they can use those coping mechanisms again for the current situation.

Severe anxiety

If the body reaches severe anxiety, the perceptual field greatly decreases. Patients who have severe anxiety will have difficulty completing even a simple task, and effective learning is not possible at all at this level of anxiety.

Severe anxiety symptoms

Symptoms of severe anxiety can include a feeling of dread, headache, nausea, diarrhea, insomnia, palpitations, and hyperventilation.

Panic-level anxiety

Panic-level anxiety can cause a loss of contact with reality, and functioning and communication are really ineffective. Learning is not possible at all at this level of anxiety, and it can be life-threatening.

Panic-level anxiety symptoms

Panic level anxiety can include a feeling of terror or impending doom, hallucinations or delusions, dilated pupils, severe trembling, or diaphoresis (sweating). This is a very dangerous level of anxiety.

Panic-level anxiety nursing care

If your patient has severe or panic-level anxiety, problem-solving is not an option. It won't be effective.

Move your patient to a quiet setting, remain with them, use simple, clear language and speak slowly. Provide for the patient's physical needs, like food, rest, and safety.


Full Transcript

Hi. I'm Cathy with Level Up RN. In this video, we are going to talk about stress as well as anxiety. And these may be two topics that you know something about if you are in nursing school. At the end of the video, I'm going to do quick little knowledge check, give you guys a quiz to see if you picked up on some of the key concepts that I'll be going over.

All right. So stress is the body's physical and emotional reaction to pressure. And one framework used to describe how the body reacts to stress is something called general adaptation syndrome.

And this syndrome has three stages.

The first stage is the alarm reaction stage. This is where your body has a fight-or-flight response to a stressor.

During this time, cortisol levels will increase as well as your heart rate and your blood pressure.

And then, from the alarm reaction stage, we go into the resistance stage. So after the initial shock of the stressor subsides, your body attempts to normalize its vital signs and its hormone levels.

So some signs and symptoms of the resistance stage can include poor concentration, irritability, and frustration.

Then, if the stress continues, you would enter the exhaustion stage. During this time, really, that stress that's been going a long time depletes the body's resources, and it really weakens the immune symptoms.

So symptoms associated with the exhaustion stage include fatigue, depression, anxiety, and actually, disease, because your immune system is not functioning at full capacity.

All right. Next, let's talk about anxiety. So I'm going to talk about the four levels of anxiety, which include mild, moderate, severe, and panic-level anxiety. And I'm going to talk about the characteristics and the symptoms of each level, and then we'll talk about the nursing care of patients who have anxiety.

So first, we have mild anxiety. Mild anxiety is a normal, expected response to daily events in our life. It heightens your awareness, it increases your perceptual field, and it actually allows for optimal functioning. And it is also beneficial for learning.

So signs and symptoms of mild anxiety can include restlessness and irritability. However, it also increases an individual's motivation. So it's not really such a bad thing.

However, if we get to moderate anxiety, this causes decreased concentration, and it also decreases an individual's attention span and their perceptual field. So it may hinder problem-solving at this point.

Signs and symptoms of moderate anxiety include increased heart rate and respiration rate, GI discomfort, as well as muscle tension.

Then if we get to severe anxiety, this is where the perceptual field has greatly decreased. So patients who have severe anxiety will have difficulty completing even a simple task, and really, effective learning is not possible at all at this level of anxiety.

Symptoms of severe anxiety can include a feeling of dread, headache, nausea, diarrhea, insomnia, palpitations, as well as hyperventilation.

Then if we get to a severe level of anxiety, really, the patient has loss of contact with reality at this point, and functioning and communication are really ineffective. So learning, of course, is not possible at all at this level of anxiety, and it can be life-threatening.

So symptoms of severe-level anxiety can include a feeling of terror or impending doom, hallucinations or delusions, dilated pupils, severe trembling, or diaphoresis, which is a fancy name for sweating. So, at this point, this is a very dangerous level of anxiety.

Now, let's talk about nursing care of a patient with anxiety. If your patient has mild to moderate anxiety, you can help your patient with problem-solving. You can evaluate what coping mechanisms they've used in the past that have been successful because maybe they can use those coping mechanisms again for the current situation.

You can help provide an outlet that will relieve their tension and anxiety, so this definitely includes exercise. Exercise, getting that heart rate up, brings down the cortisol levels and really can help with anxiety. So that's good advice for not only your patient but also you.

If your patient has severe or panic-level anxiety, problem-solving is not an option, is not going to be effective, so really, you need to move your patient to a quiet setting. You need to remain with the patient and use simple, clear language and speak slowly and provide for the patient's physical needs, such as food, rest, and safety, that type of thing.

All right. That is it as far as nursing care of anxiety.

And next up, we'll have our quiz. Quiz time. I have three questions for you guys. First question, which stage of the general adaptation syndrome is characterized by increased cortisol levels and an increase in heart rate and blood pressure? All right. If you said the alarm reaction stage, you are correct. Second question. This is a true or false question. Mild anxiety is beneficial for learning. The answer is true. Now, if you get over to severe or panic level, that is definitely not going to be beneficial for learning. What level of anxiety is characterized by a feeling of terror or impending doom? If you said panic-level anxiety, you are correct. So hopefully, this video's been helpful. If you haven't subscribed to our channel already, be sure to do so. And I'll see you with more mental health topics in my next video.


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