PERSONAL BACKGROUND

Name: Dan Drazen Lagmay

Age: 18

Birthdate: July 19, 1995

Civil Status: Single

Address: Brgy. 6, San Julian, Batac City, Ilocos Norte

Religion: Aglipayan

Educational Attainment: College level

Occupation: N/A

For most persons, everyday life includes its share of stressors and life demands, ranging

from family, work, school, responsibilities, pressure and whatnot. The client, Mr. Lagmay was

chosen for the reason that he is currently a Level IV student of BS Nursing in Mariano Marcos

State University College of Health Sciences and since it is only the beginning of the semester,

the subjects are, if not new, harder than the previous correlated subject. Mr. Lagmay is also an

active student in their class and the pressure to remain in his position is high. The previous

semester was, as stated by the client, was very hard on him, which took away his college

scholarship, which he plans to regain this semester which means that he has to double his efforts

and might lead to a higher level of stress.

The primary stressor identified by Mr. Lagmay is school, which he rated as 10 and stated

that he has been dealing with this stressor since his first year in secondary until today, which can

be calculated to 8 years. The client is subjected to the stressor since studying and stress always

come hand in hand, especially if the coping and adaptation is ineffective. Also, as stated by the

client, the pressure from his parents, mentors and the subjects are quite overwhelming.

The client is in the Stage of Resistance as evidenced by his efforts to cope with the

stressors as manifested by his efforts to control the stressors or adapt to it through talking to

people such as his parents about the things that are bothering him. He also mentioned that he

usually tries to structure the situation such as when he thinks that he is not well-versed with the

topics that are going to be in the examination, he tries to work really hard to comprehend the

topics in order for him to avoid threatening events, such as failing the examination. The client

stated that as much and as soon as possible, he tries to arrive to a solution regarding the problems

and stressors that he encounters in order to prevent the situation from getting worse. He also

asserted that he never fails to pray to God for wisdom, guidance and patience for him to resolve

any conflicts that he is currently experiencing or might encounter in the future. He also pointed

out that his most effective and most often relaxation technique that he uses is by relaxation, and

he does this by surfing the Internet and watching the television, especially those shows that are

for children to divert his senses for a while for him to come up with a better solution to his

problems.

These coping strategies that the client uses are, if not totally eradicate, results to a feeling

of relief from the stressors that he encounters.

The stress situation of the client can be supported by the Stress as a Response theory,

which states that stress is a response to the disruption caused by a noxious stimuli or a stressor.

The pressure caused by academics is the stressor that is highly being felt by the client and he

underwent stages to cope with the stress brought about by this stressor. The first stage is the

Alarm reaction, wherein the body is being alerted to act against the stressor, and it’s main goal is

to protect the individual from this stress. This can be seen when the client stated that he assesses

himself if he is well-versed with the lessons that are going to be a part of their examination,

which makes way for the second stage, which is the Stage of Resistance wherein the body

attempts to cope with the stressor, which can be observed in the client as he asserted that he

makes sure that he works really hard to read, study and comprehend the lesson in order to avoid

getting a failing grade in the exam. The third stage, which is the Stage of Exhaustion is where the

body can no longer resist the effects of the stressors, which has not been reached by the client

yet, since he affirmed that his coping mechanisms are effective enough to adapt to the stressors

he encounters.

Nurse-Patient Interaction

N: Hello kuya, good evening. I’m Danielle Quigao, currently a Level 3 Student of BS Nursing at

Mariano Marcos State University. I am here to ask for your cooperation for me to gather

information regarding our current concept in NCM103, which is stress. And since it is only

the start of the semester and you are already in your level IV, I thought that maybe you are

currently being bombarded by a lot of stressors. Can I please interview you about this?

P: Sure ading, ma-is-stress nak talaga so go lang.

N: First kuya may I just ask some personal data such as your whole name, age, birthdate, civil

status, address and religion.

P: Dan Drazen Lagmay, 18 years old, born on July 19, 1995, currently single, living at Brgy. 6,

San Julian, Batac City and Aglipayan nak ngem mapmapanak makimismisa jay Romano.

N: Apay met jay Romano ka nga makimismisa kuya?

P: Agkasabali ngamin religion ni parents ko ket sursurutek latta nukwa ni mamak.

N: Ay sige kuya. Irugik ngarod ti agdamagen. First question, ana met dagitay pakais-stress’am

ita nga panawen?

P: School ti pinaka-paka-is-stressak. Ayna.

N: Apay met mais-stress ka ti school kuya?

P: Nagrigat agbalin nga level IV, ket agad’adapt kami paylang ti new subjects ken

responsibilities. Tapos jay research nga subject mi, nag rigat grabe. Tapos ag review kam to pay

para board’en. Tapos jay pressure nga dapat haan nga bumaba ti grades ko or haan nak nga

mabagsak kasi jak kayat nga madisappoint ni parents ko ken dagijay mentors ko nga

mangsupsupporta kanyak. Ken jak ngamin naka scholar idi last sem kasi nagrigat dagijay

subjects ket kayat ko kuma nga isubli, saying met tay stipend.

N: Kaanum pay nga narikna ti panagadda daytoy nga stressor kuya? Ken kasanu nga nag-arise

detoy nga stressor?

P: Idi payla first year high school, kasi idi elem, jak pulos agrevreview. Ket idi highschool,

ammom met nu kasano karigat nu periodical exam ta MMSU diba, ket kaslang na culture shock

nak. Although mais-stress nak since idi paylang about school, jak met pay ketdi nag-give-give-

up. Kayak met paylang.

N: Ana pay dagijay sabali nga paka-is-stressam kuya?

P: Nu dadduma ket agproblema ak met ti kwarta, nagadut paggastwak ta nu dadduma ket

nalaingak nga mangan, stress-eating kumbaga. Tapos nu dadduma ket dagijay responsibilidad ko

jay balay, kaspagarigan dagijay ubra nga dapat ko kuma ubraen ket jak maaramid kasi nagadut

araramidek nga academics, kasjay. Tapos dagijay friends ko idi highschool ken dagijay best

friends ko ket jak unay makasarsaritan kasi busy busy met ditoy school Isu, mais-stress nak nga

mangpanpanunut nukwa.

N: Ana met ngarud nukwa dagitay marikriknam kuya nu mais-stress ka?

P: Adu, stress eating ti kanayun, naglaing nak nga mangan nukwa, nu dadduma agsakit bagbagik,

jak makatalna, agkalkaling-etan nak, marigatan nak umanges, jak makasau nga nasayaat ken

mabulbulol nak, ag palpitate nak, aglamlamiis ti imimak, ken marigatanak ag concentrate.

N: Ana met nukwa dagijay ububraem kuya tapno ma-alleviate mo dagitoy nga manifestations

ken tapnu maka-adapt ka kadagijay marikriknam nga stressors ?

P: Ti nangnangruna nga ububraek ket ag relax paylang nukwa. Agbuya ak TV, kasjay, tay

Spongebob, Chowder, kakasjay. Dagitay pang-ubing, kasi kasla makapaawan nukwat problema.

Tapos nu dadduma ket ag-Internet nak, agkita ti latest ken makidamag kadagijay friends ko. I-

divert ko payla nukwa ti atensyon ko sa kun to sublyanan tay stressor tapnu mas fresh to tay

mind kon nga maki-deal with it. Tapos nu dadduma kasarsaritak ni parents ko tapnu met makaala

ak ti moral support, nu dadduma ag walkwalking nak nga meymeysa tapnu agpanunut ti

solusyon kadagiti pakaprobproblemaak ti byag, tapos agkararag nak.. Dumawatak ti guidance

ken patience, kasjay. Dumawatak ti sign ken God nu kasanut pamay-ak tapno masolusyonak

wenno maiwasak jay stressor tapno madi unay dumakkel nga agbalin nga problema.

N: Adda kad met instances kuya nga mariknam nga madi mo masulbar ti stress mun? Ken ana

met nukwat ubraem nu mapasamak daytoy?

P: Adda met nu dadduma. Kumaru nukwa daguijay manifestations ti stress ko, jay kaslang

marigatanak umanges, ag palpitate nak, marigatanak agsao, kasjay. Nagrigat nukwa lalo nu tay

talaga agsasabay amin ti stress ti school, tapos financial, tapos addan to pay problema mi jay

balay, or friends, jakammot ubraek. Ngem eventually, masulsulbar ko met lata.

N: Ti panagkitam kuya, epektibo metlang dagitoy nga coping mechanisms mo? Ken kasanum

nga maibaga nga epektibo?

P: Ay ket most of the time, effective met. Ngem jak met pay ketdi napadasan nga haan nga

nasolusyonan dagita probproblemaek. Maka-aramid nak met nukwat way tapno ma-eradicate ko

jay stressor, or nu man madi maawan, kayak nga labanan habang adda paylang. Pumaspasa ak

met ti exams kaasi ni Apo, ken haan nak met pay ketdi nga ag-give’up kideta reseach juray

nakarigrigat. Nu haan kuma nga epektibon ah ket nabagsak nak payla idi first year.

NURSING CARE PLAN

Nursing Diagnosis:

Stress overload related to multiple coexisting stressors as evidenced by patient verbalizing,

“nagrigat nukwa lalo nu tay talaga agsasabay amin ti stress ti school, tapos financial, tapos addan

to pay problema mi jay balay, or friends, jakammot ubraek” and reports of physical symptoms of

stress such as difficulty of breathing, slurred speech, palpitations and eating too much.

Nursing Inference:

Stress is a non-specific response to any demand placed on a person to adapt or change, and can

come from physical, emotional, social, spiritual, cultural, chemical or environmental sources

(Stacy, 2013). Although just enough stress can be a good thing, stress overload is a different

story - too much stress isn't good for anyone. Pressures that are too intense or last too long,

troubles that are shouldered alone, and multiple stressors affecting the person at once can cause

people to feel stress. Stress overload does not occur because the patient or family members have

coping deficits or psychological disorders. Rather, the stressors are too numerous and severe that

people tend to become overwhelmed.

Nursing Goal:

After 4-5 hours of appropriate nursing interventions, the client will be able to categorize the

stressors according to modifiability, identify successful behavior change to cope with or

eliminate current multiple stressors as evidenced by verbalization or demonstration of reduced

stress reaction.

Nursing Interventions:

1. Identify the events that have occurred over remote or recent past that are perceived by the

client to be stressful.

Rationale: To determine the number, duration and intensity of events causing perception of

overwhelming stress.

2. Identify the client’s level of stress in each of the stressors being identified.

Rationale: Stress is highly individualized, normal, physical, and psychological response to

internal and external life events. Knowing the level of stress will aid in the planning of

appropriate interventions to deal with the stressors.

3. Identify the client’s locus of control: internal or external.

Rationale: Knowing client’s locus of control will help in developing a plan of care reflecting

client’s ability to realistically make changes that will help in the management of stress.

4. Evaluate resources and support systems available to patient.

Rationale: Resources may include significant others, health care providers such as home health

nurses, community resources, spiritual counseling, and the like.

5. Encourage client to identify his own strengths and abilities.

Rationale: Assisting the client to develop appropriate strategies for coping based on personal

strengths and previous experiences improves the client’s self concept and sense of ability to

manage such stressors.

6. Assist the client to categorize stressors as modifiable or non-modifiable by listing the

stressors and pondering over them and recording the coping mechanisms that can be done

based on the client’s strengths and abilities.

Rationale: Removing or minimizing some stressors, changing responses to stressors, and

modifying the long-term effects of stress are all actions that can assist those clients with stress

overload.

7. Assist the client to use his locus of control to develop his possible coping mechanisms to

deal with the stressors.

Rationale: To develop care plan that is individualized and is specific for the client to facilitate

faster intervention and to ensure compliance. For clients with internal control, encourage client

to take control of his own care; for those with external control, begin with small tasks as

tolerated.

Nursing Evaluation:

After 5 hours of appropriate nursing interventions, the client is be able to categorize the stressors

according to modifiability, identify successful behavior change to cope with current multiple

stressors as evidenced by verbalization of “naikkak metlat solusyon na tay problemakon” and

disappearance of manifestations such as difficulty of breathing and palpitation.

Republic of the PhilippinesCOLLEGE OF HEALTH SCIENCES

MARIANO MARCOS STATE UNIVERSITYBatac, 2906 Ilocos Norte, Philippines

Stress

Presented by:Danielle B. Quigao

Group IV, BSN III-A

Presented to:Ms. Judith P. Valenzuela

Clinical Instructor

June 2014