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01/06/2025
BY: Asmare G 1
UNIT 2
BIO-PSYCHOSOCIAL CONCEPTS RELATED TO HEALTH
BY:Asmare getie(assistant professor in AHN)

01/06/2025
BY: Asmare G 2
At the end of this lesson students will be able to:
 Define Stress
 Identify physiologic and psychosocial stressors.
 Identify nursing actions that promote effective coping of stress
 Define stress
 Compare characteristics of acute pain, chronic pain, and
cancer pain.
 Describe the negative consequences of pain.
Session objectives

01/06/2025
BY: Asmare G 4
“The only person without
stress is the dead person”
Hans Seyle

01/06/2025
BY: Asmare G 5
The word stress is derived from the Latin word
"stringi", which means, "to be drawn tight".
A bodily or mental tension resulting from factors that
tend to alter an existent equilibrium (Merriam-
Webster’s Collegiate Dictionary, 2011).
According to Randy and David “Stress is the
subjective feeling produced by events that are
uncontrollable or threatening."
Definition of stress

01/06/2025
BY: Asmare G 6
 Stress, a universal experience, can be the catalyst for
positive change or it can be the source of discomfort
and pain.
 People experience stress as a sequence of daily life
events & experiences.
 Stress is helpful by stimulating thinking processes &
helping people stay alert to their environment.

01/06/2025
BY: Asmare G 7
 A stressor defined as an internal or external event or situation
that creates the potential for physiologic, emotional, cognitive,
or behavioral changes in an individual.
 A stressor can be:
 Physical stressors: ones that pose a direct threat to our physical
well-being. E.g., cold, heat, infection, toxic substances
 Psychological stressors: events that challenge our safety, not
because they are physically dangerous, but because of our
thoughts, perceptions, and interpretations.
 E.g. failing a test, sound of footsteps on a dark street

01/06/2025
BY: Asmare G 8
 Social pressures (deadlines, competing priorities,
interpersonal conflicts, financial problems...etc.)
 Physiological (inadequate sleep, illness, poor
nutrition, lack of exercise, etc…).
 Your thoughts, Your appraisal of events either relaxes
or stresses you.
Sources of Stress

01/06/2025
BY: Asmare G 9
Canon’s fight-or-flight theory
Selye’s General adaptation syndrome
Lazarus’ Cognitive appraisal model
Main Theories of Stress


Fight-or-Flight Theory
 Studied how stressors affect the sympathetic
nervous system (SNS).
 “fight or flight” response (Physiological
response to stress):
 perception of stress
 activation of the SNS
 body prepared for intense motor
activity for attack, defense, or
escape.

01/06/2025
BY: Asmare G 11
 Increased respiration rate
 Increased heart rate
 Higher blood pressure
 Increased metabolic rate
 Dilation of pupils
 Tensing of muscles
 Secretion of endorphins and ACTH
 Release of extra sugar from the liver
Physiological reactions to stress (activation of the SNS)



Fight or flight response
 Occurs through two routes:
 Adrenomedullary axis
Sympathetic nervous system
Adrenal medulla
Catecholamines (containing
epinephrine and
norepinephrine)
Cardiovascular, digestive,
respiratory


2. Hypothalamic-pituitary-adrenal axis
Hypothalamus
CRH
anterior pituitary
ACTH
Adrenal Cortex
Glucocorticoids (cortisol)
Cardiovascular, digestive,
respiratory

01/06/2025
BY: Asmare G 15
General adaptation syndrome
 Our innate response to stress was the same as,
getting cut off in traffic, having to sit for an exam
or having an argument with your spouse.
 Stress is stress, and always triggers the same innate
survival mechanism.

01/06/2025
BY: Asmare G 16
GAS describes how the body responds to stressors thru 3
stage
Stage -1- alarm reaction
 When stressors are threatening or perceived to be
threatening, the body activate physiological changes that
ready it for fight or flight.
 Rising hormone levels resulting
↑sed blood volume,
↑ blood glucose,
↑ levels epinephrine, and nor epinephrine,
The General Adaptation Syndrome (GAS)

01/06/2025
BY: Asmare G 17
Stage-2 – resistance
 The fight-or-flight response occurs.
 Long-term coping with stressors depletes adaptive
energy, resulting in exhaustion.
 The body stabilizes & responds in an opposite manner
to the alarm reaction.
 Hormone levels, HR, BP
, & cardiac output return to
normal and
 the body repairs any damage that has occurred.

01/06/2025
BY: Asmare G 18
Stage- 3 exhaustion stage
When the body has used up its adaptive energy and
can no longer cope with stressors,
The body cannot defend itself against the impact of
the event
A prolonged state of stress causes disease.
If the stressor continues death will result.


General Adaptation
Syndrome

01/06/2025
BY: Asmare G 20
 The local adaptation syndrome (LAS)is the
physiological response to a stressor (e.g., trauma,
illness) affecting a specific part of the body.
 For example, if a person experiences a puncture
wound on the foot, the LAS is initiated and leads
to localized inflammation.
Local adaptation syndrome

01/06/2025
BY: Asmare G 21
 Stress includes work stress, family stress, chronic stress, acute
stress, trauma, and crisis.
 Stress also can be
Distress -damaging stress
Eu-stress is used to describe a type of stress that results in
positive outcomes.
 It protects health by motivating energy such as happiness,
hopefulness, and purposeful movement.
Types of stress

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BY: Asmare G 22
 Strategies that individuals use to manage the
distressing problems and emotions in their lives.
 Refers to a person’s active efforts to resolve stress and
create new ways of handling new situations at each
life stage.
 The process by which a person attempts to manage
stressful demands.
Coping

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BY: Asmare G 23
Relaxation Training
 People learn techniques to deeply relax muscles and
slow down and focus their thoughts.
 Progressive Muscle Relaxation —Form of training
that reduces muscle tension through a series of
tensing and relaxing exercises
 Deep Breathing and Visualization
Managing stress

01/06/2025
BY: Asmare G 24
Psychological Effects of Exercise
 Enhanced sense of well-being
 Decreased anxiety
 Exercise offers time out, boost to
self-esteem (e.g., improves appearance)
 Reduces depression by elevating low serotonin
level —similar to effect of antidepressant drugs
Exercise

01/06/2025
BY: Asmare G 25
“Pain is a more terrible lord of
mankind than death itself.”
Albert Schweitzer

01/06/2025
BY: Asmare G 26
According to the International Association for the
Study of Pain is defined as:
 “an unpleasant sensory and emotional experience
associated with actual or potential tissue damage.”
Pain from poena ---> Latin means punishment

01/06/2025
BY: Asmare G 27
 “whatever the person says it
is, existing whenever the
experiencing person says it
does” – McCaffery &
Pasero, 1999
 Emphasizes the highly
subjective nature of pain

01/06/2025
BY: Asmare G 28
Pain is an almost universal experience, yet difficult to
define.
Pain is the most common reason people seek medical
treatment.
Pain occurs as the result of
many disorders,
diagnostic tests, and
treatments;
it disables and distresses more people than any single
disease.

01/06/2025
BY: Asmare G 29
Pain is categorized according to its duration, location,
and etiology.
 Acute Pain
 Usually of recent onset and
 commonly associated with a specific injury,
 it indicates that damage or injury has occurred.
 E.g. needle sticks, surgical incisions, burns, and
fractures.
Types of Pain

01/06/2025
BY: Asmare G 30
 Chronic Pain
 Chronic pain is constant or intermittent pain that
 persists beyond the expected healing time and that
 can seldom be attributed to a specific cause or injury.
 It may have a poorly defined onset, and
 It is often difficult to treat because the cause or origin
may be unclear.

01/06/2025
BY: Asmare G 31
Pain Classified by Location
 Pain can also be categorized according to location (e.g.,
pelvic pain, headache, chest pain).
 This type of categorization aids in communication about
treatment of the pain.
 For example, chest pain may suggest acute coronary
syndrome (ACS).
Pain Classified by Etiology
 Pain can also be categorized by etiology.
 E.g. Burn pain and post herpetic neuralgia.

01/06/2025
BY: Asmare G 32
 Nociceptors also called as pain receptors are free
nerve endings in the skin that respond only to
intense, potentially damaging stimuli (mechanical,
thermal, or chemical)
 The joints, skeletal muscle, fascia, tendons and cornea
also have nociceptors
Pain Transmission

01/06/2025
BY: Asmare G 33
 Large internal organs do not contain nerve endings
 Histamine, bradykinin, acetylcholine, and serotonin, are
chemicals that increase transmission of pain.
 Prostaglandins are chemical substances that are believed to
increase the sensitivity of pain receptors by enhancing the pain
provoking effect of bradykinin
 Chemicals that reduce or inhibit the transmission or perception
of pain include endorphins and enkephalins

01/06/2025
BY: Asmare G 34
 Transduction
Transmission
Modulation
Perception
The Pain Pathway

01/06/2025
BY: Asmare G 35
 The process by which afferent nerve endings translate
noxious stimuli (e.g., a bee sting) into nociceptive
impulses.
 There are three types of primary afferents:
 A-beta: carry information related to touch
 A-delta: information related to pain and temperature
 C-fibers: information related to pain, temperature and
itch.
Transduction

01/06/2025
BY: Asmare G 36
 Is the process by which impulses are sent to the dorsal
horn of the spinal cord, and then along the sensory
tracts to the brain.
 Pain impulses are transmitted by two fiber systems:
 fast, sharp and well localized sensation (first pain)
which is conducted by A-delta fibers.
 duller slower onset and often poorly localized
sensation (second pain) which is conducted by Fibers.
Transmission

01/06/2025
BY: Asmare G 37
 It is the process of either dampening or amplifying the
pain-related neural signals.
 Periaqueductal gray (PAG) in the midbrain is involved
in modulating of pain.
 This system is always active; it prevents continuous
transmission of painful stimuli, partly through the
action of the endorphins.
 As nociception occurs, the descending control system
is activated to inhibit pain.
Modulation

01/06/2025
BY: Asmare G 38
The conscious awareness of the experience of pain.
Perception results from the interaction of
transduction, transmission, modulation, psychological
aspects, and other characteristics of the individual.
Perception

01/06/2025
BY: Asmare G 39
 Past experience
 Anxiety and Depression
 Culture
 Gender
 Genetics
 Placebo effect
Factors influencing pain response

01/06/2025
BY: Asmare G 40
Obtain a Pain History
 Allow the client to describe the pain to establish a trust
relationship between you and the client
 Discover the effects of pain on the client's quality of life
 Assess for emotional and spiritual distress and coping
abilities
 Ask about previous pain experience and what measures
have been effective as well as those who have not
PAIN ASSESSMENT

01/06/2025
BY: Asmare G 41
 Useful in assessing the intensity of pain
 Includes a horizontal 10cm line, with anchors
indicating the extremes of pain
 The client is asked to place a mark indicating where
the current pain lies on the line
 Left: none or no pain
 Right: severe or worst possible pain
Visual Analogue Scales

01/06/2025
BY: Asmare G 43
This instrument has six faces showing expressions that
range from contented to obvious distress
The client is asked to point to the face that most
closely resembles the intensity of his or her pain.
Faces Pain Scale

01/06/2025
BY: Asmare G 45
Non pharmacologic interventions
Non-pharmacologic nursing activities can assist in pain
relief
Not a substitute for medication
Combining non pharmacologic interventions with
medications may be the most effective way to relieve
pain
Pain Management Strategies

01/06/2025
BY: Asmare G 46
 Massage is a generalized cutaneous stimulation of
the body that often concentrates on the back and
shoulders
 Massage have an impact in the descending control
system and does not merely stimulate non pain
receptors
 Promotes comfort through muscle relaxation
Cutaneous stimulation and massage

01/06/2025
BY: Asmare G 47
 Proponents believe that ice and heat stimulate the
non pain receptors in the same receptor field as the
injury
 Ice should be placed on the injury site immediately
after injury or surgery
 Ice therapy after joint surgery can significantly
reduce the amount of analgesic medication required
Thermal therapies

01/06/2025
BY: Asmare G 48
 Assess skin first before applying ice
 Ice should be applied on an area for no longer than
15 to 20 minutes at a time and
 should be avoided in clients with compromised
circulation
 Application of heat increases circulation to an area
and contributes to pain reduction by speeding
healing

01/06/2025
BY: Asmare G 49
 Both ice and heat therapy must be applied carefully
and monitored closely to avoid injuring the skin
 Neither therapy should be applied to areas with
impaired circulation or used in clients with impaired
sensation

01/06/2025
BY: Asmare G 50
 Involves focusing the client’s attention on something
other than the pain
 Thought to reduce the perception of pain by
stimulating the descending control system
 Effectiveness depends on the client’s ability to receive
and create sensory input other than pain
 Examples are watching TV, listening to music, complex
physical and mental exercises
Distraction

01/06/2025
BY: Asmare G 51
Believed to reduce pain by relaxing tense muscles
that contribute to the pain
Consists of abdominal breathing at a slow,
rhythmic rate
The client may close both eyes and breathe
slowly and comfortably
Relaxation techniques

01/06/2025
BY: Asmare G 52
Premedication assessment
 The nurse should ask the client about allergies to
medications and the nature of any previous allergic
responses
 The nurse obtains the client’s medication history,
along with a history of health disorders
Pharmacologic interventions

01/06/2025
BY: Asmare G 53
 Generally the first class of drugs used for treatment of
pain
 Useful for acute and chronic pain from a variety of
causes such as: surgery, trauma, arthritis, and cancer
 Have a maximum effect to analgesia
Nonopioids

01/06/2025
BY: Asmare G 54
 Examples are salicylates (aspirin); NSAIDS (ibuprofen,
ketorolac, naproxen); COX-2 inhibitors (celecoxib);
acetaminophen
 Celecoxib (Celebrex)
 Inhibition of prostaglandin synthesis, primarily through
inhibition of cyclooxygenase-2 (COX2).
 This results in anti-inflammatory, analgesic, and
antipyretic activities
 For osteoarthritis, rheumatoid arthritis, and acute pain
in adults.

01/06/2025
BY: Asmare G 55
The goal of administering this medication is to
relieve pain and improve quality of life
Opioids are classified as full agonists, partial
agonists, or mixed agonists and antagonists
Full agonists have complete response at the
opioid receptor site.
Opioids

01/06/2025
BY: Asmare G 56
Partial agonists has lesser response
The mixed agonists and antagonists activates one
type of opioid receptor while blocking another
Controlled-release opioids such as oxycodone
(Oxycontin) and morphine (MS Contin) are
effective for prolonged, continuous pain.

01/06/2025
BY: Asmare G 57
 Common adverse effects of opioids are: CRINCS!
C- constipation
R- respiratory depression
I- itching
N- nausea, vomiting
C- constricted pupils
S- sedation

01/06/2025
BY: Asmare G 58
 Midazolam (Versed) or diazepam (Valium) are
effective for the treatment of anxiety or muscle
spasms associated with pain
 These drugs do not provide pain relief except in the
treatment of muscle spasms
 May cause sedation
Benzodiazipines

01/06/2025
BY: Asmare G 59
Tricyclic antidepressants
 Amitriptyline, imipramine, desipramine, and doxepin
have been shown to relieve pain related to neuropathy
and other painful nerve related conditions
 Instruct clients to continue taking the medications even
if they seem ineffective at first.
 Additional benefits of this class of medications may
include mood elevation and improved ability to sleep

01/06/2025
BY: Asmare G 60
THANK YOU

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