Stress is the body’s response to dangerous circumstances, whether they are actual or only perceived as such. When a person feels threatened, the body experiences a hormonal change that enables it to respond and prevent harm. This stress response, or the “fight-or-flight” response, is when the body prepares to defend itself and reacts by increasing the heart rate, breathing rate, muscle tension, and blood pressure.
While some stress can be healthy and valuable, excessive stress can lead to physical and mental illness. Human bodies are built to handle stress in moderation. However, humans cannot manage persistent, long-term stress without adverse effects. Stress overload occurs when there is excessive stress or demands to be met.
The following are causative factors of stress overload:
- Being abused, injured, or subjected to violence
- Conflicts in families, relationships, or immense grief or loss
- Ongoing work-related stress, disputes with co-workers, or job discontentment
- Intensive schedules, insufficient downtime, and constant decision-making
Stress overload can impact a person’s health and welfare, and general productivity if it is not controlled or adequately managed. Stress management skills vary from person to person. Stress is not always bad. Stress can, in moderation, help the person achieve goals and keep them safe.
Stress overload can cause emotional, behavioral, physical, and cognitive changes:
Emotional symptoms include:
- Mood changes
- Feelings of overwhelm
- Difficulty relaxing and calming the mind
- Poor self-esteem
- Avoidance of others
Physical symptoms include:
- Fatigue
- Headaches
- Gastrointestinal (GI) upset, nausea, diarrhea, or constipation
- Muscle pain
- Chest pain and tachycardia
- Insomnia
- Compromised immune system and increased infections
- Loss of sexual desire
- Nervousness and shaking, ringing in the ears (tinnitus), and cold or sweaty hands and feet
- Xerostomia (dry mouth) and dysphagia (difficulty swallowing)
- Clenched jaw and bruxism (teeth grinding)
Cognitive symptoms include:
- Anxiety
- Flustered thinking
- Forgetfulness
- Disorganization
- Difficulty concentrating
- Faulty judgment
- Pessimistic or negative-thinking
Behavioral symptoms include:
- Changes in appetite
- Avoiding obligations and procrastination
- Increased consumption of alcohol, drugs, or tobacco
- Anxious habits, including fidgeting, nail-biting, and pacing
Stress cannot be measured objectively with testing. Its presence and severity are only discernible to the individual experiencing it. To rule out specific medical issues, the healthcare provider typically performs several tests, which may include a personal and family health history, blood and urine tests, and other evaluations.
Numerous methods can evaluate stress, including questionnaires, biochemical tests, and physiologic procedures. The most practical approach is a thorough, face-to-face medical interview.
Nursing Process
Reduced and controlled stress and improved coping are the goals of stress management. These techniques are ones that nurses may employ in their personal lives and with their patients. It is imperative to work to reduce stress because doing so can help avoid sickness, enhance the quality of life, and reduce the cost of medical treatment.
Numerous stress-related symptoms can result in other health issues. Cardiovascular disease, chronic pain, and psychiatric illness strongly correlate with stress. If stress is to blame, refer to a mental health specialist, therapist or counselor to help patients cope more effectively.
The management of stress relies heavily on patient education. Stress cannot be avoided entirely, but it can be controlled. The patient must be encouraged to actively participate in developing the treatment plan, selecting the appropriate therapies, and identifying any significant adverse effects.
Nursing Care Plan
Stress overload can be caused by excessive demands that require action.
Related to:
- Inadequate resources (such as financial, social, and knowledge)
- Repeated stressors
As evidenced by:
- Impaired decision-making
- Impaired functioning
- Increasing strain
- Impatience
- Aggression
- Adverse effects of stress (such as sickness, physical complaints, and psychological suffering)
- Tension
Expected outcomes:
- Patient will demonstrate strategies to reduce stress
- Patient will be able to meet psychological needs as demonstrated by adequate emotional expression and resource utilization
- Patient will be able to verbalize or manifest a diminished stress response
Assessment:
1. Identify the causative factors.
Stress overload can result from demands that are too severe, prolonged, or handled by only one person. Changes can be stressful and cause extreme stress reactions.
2. Determine repetitive events.
Inquire about tragic or challenging events in the present or past (violence, poverty, grief, etc.) to help determine the quantity, length, severity, and perception of overwhelmingly stressful occurrences.
3. Assess the physical, mental, and emotional effects.
Analyze the patient’s reports of any physical, mental, or emotional issues that may be the body’s response to stress.
4. Consider the patient’s gender, age, and developmental stage.
Although everyone experiences stress and stressors, women, children, young adults, divorced and separated couples, and the elderly may struggle the most with stress overload.
5. Recognize the patient’s cultural norms, religious beliefs, and expectations.
These may impact the patient’s ability to seek assistance from others and their expectations for themselves in handling situations.
6. Determine the patient’s locus of control.
Recognizing the patient’s locus of control and whether they believe they are responsible or not for their health and what happens to them will aid in developing a realistic care plan.
7. Identify the patient’s self-talk and feelings of stress.
Stress overload results from negative self-talk, all-or-nothing or pessimistic thinking, exaggeration, or high expectations.
8. Assess the patient’s relationships.
Divorce, the death of a family member, and family conflict can disrupt the type of support that a patient is used to receiving and make it more difficult for them to manage their situation.
9. Assess the patient’s stress level.
Use tools or questionnaires to evaluate stress levels. The patient can also be asked on a 1-10 scale how stressed they feel.
10. Review the patient’s medication.
Some of the most common medications that can exacerbate stress are those that manipulate the brain, such as stimulants or antidepressants. That includes adverse side effects, such as jitteriness, a pounding heart, shaking, or insomnia.
Interventions:
1. Actively listen to the patient.
Actively listen to worries and be empathetic, employing both words and silence as necessary. Listening can be a simple intervention that allows the patient time to express themselves and unload.
2. Assist the patient in adapting to change.
Assist the patient in deciding whether they can alter the stressor or their response. Enable the patient to identify factors over which they have control (internal locus of control) and decide on actions that can be changed.
3. Manage immediate threats.
If stress is related to abuse or violence, this requires intervention through appropriate channels such as law enforcement involvement.
4. Ask for help.
We can’t be expected to do everything ourselves. The need to “feel in control” only creates an environment for failure. Encourage the patient to rely on family, spouses, friends, and co-workers and delegate tasks to others.
5. Allow the patient to reflect on their coping mechanisms.
Discuss safe and effective coping mechanisms. Then, let the patient evaluate whether their coping mechanisms are positive or negative (avoidance, substance abuse, smoking).
6. Make time for fun and relaxation:
- Exercise
- Reading
- Journaling
- Time outside
- Games
- Massage
- Crafting
- Music
- Sleep
- Time with friends/family
7. Inform the patient about available resources.
Identify and inform the patient about available community resources. Resources include career counseling, educational opportunities, child and elder care, Women, Infants, or Children (WIC) or food assistance, and in-home or respite care that reduce the burden of caretaking.
8. Educate that stress affects the entire body.
The stress hormone cortisol can have detrimental effects on the body and cause weight gain, high glucose levels, and reduce the immune system’s ability to fight infections.
9. Block out time alone.
“Me time” and time to do things we enjoy is a requirement for happiness. Advise the patient that time each day to focus on themselves is not selfish and will allow them to handle daily stressors better.
10. Promote deep breathing exercises and meditation.
Deep breathing and meditation can reduce tension and stress by getting more oxygen and slowing down the heart rate.
11. Refer to a mental health specialist.
Talk therapy and mental health services can work with patients on overcoming and managing stress.
12. Refer to stress management group therapy.
Integrating mindfulness with group therapy reduces stress and boosts positivity and resilience.
References
- American Heart Association. (2021). 3 tips to manage stress. www.heart.org. https://www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/3-tips-to-manage-stress
- Amirkhan, J. H. (2011). Stress overload: A new approach to the assessment of stress. American Journal of Community Psychology, 49(1-2), 55-71. https://doi.org/10.1007/s10464-011-9438-x
- Bhandari, S. (2021). Stress symptoms: Effects of stress on the body. WebMD. https://www.webmd.com/balance/stress-management/stress-symptoms-effects_of-stress-on-the-body
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, interventions, and rationales (15th ed.). F A Davis Company.
- Lunney, M. (2006). Stress overload: A new diagnosis. International Journal of Nursing Terminologies and Classifications, 17(4), 165-175. https://doi.org/10.1111/j.1744-618x.2006.00035.x
- Mayo Clinic. (2022). Stress management stress basics. https://www.mayoclinic.org/healthy-lifestyle/stress-management/basics/stress-basics/hlv-20049495
- Silvestri, L. A., & Silvestri, A. E. (2022). Saunders comprehensive review for the NCLEX-RN examination (9th ed.). Elsevier Inc.
