STRESS & ADAPTATION

C Washington RN MSNEd

Homeostasis

Medulla oblongata: respiration & circulation Pituitary gland: regulates other glands-growth, maturation, reproduction Reticular formation: nerve cells help control vital reflexes such as cardiovascular function & respiration

Homeostasis: Feedback Mechanisms

Sensor mechanism: senses disruptions in homeostasis Control center: regulates bodys response to disruptions in homeostasis

Effector mechanism acts to restore

Feedback mechanisms

An endocrine gland usually controls the sensor sensor mechanism. Signal sent to the control center in the CNS, which initiates the effector mechanism Feedback mechanism negative feedback and positive feedback

Feedback Mechanisms
Negative Works to restore homeostasis by correcting a deficit within the system Positive Hormone secretion triggers additional hormone secretion

Negative Feedback= Positive Result

High blood glucose Sensor Mechanism Control center Effector Mechanism Pancreas Insulin Normal glucose

Types of Cell Injury: Toxic

Endogenous (inside body) Metabolic errors Gross malformations Hypersensitivity reactions Exogenous (outside body) Alcohol Lead Carbon monoxide drugs

Types of Cell Injury: Infectious

Viruses Fungi

Protozoa bacteria

Affect cell integrity by interfering with cell synthesis, producing mutant cells. Example: HIV alters the cell when the virus is replicated in the cells RNA.

Types of Injury: Physical

Thermal Electrical/Radiation radiation therapy, x-rays, ultraviolent radiation Mechanical Trauma MVA, frostbite, ischemia Surgery

Types of Injury: Deficit

Lack of basic requirement = cell disruption or death Water Oxygen Nutrient Constant temperature & adequate waste disposal arent maintained

Illness

Occurs when a person is no longer in a state of normal health Enables a persons body to adapt to the disease Example: patient has CAD, DM, or asthma but not ill all the time because their body has adapted to the disease (able to perform ADLs)

Cause of Disease

Etiology = cause Cause may be intrinsic-inside the body extrinsic-outside the body Idiopathic = diseases with no known cause

Causes of Disease

Intrinsic -hereditary, age, gender Extrinsic -infectious agents or behaviors: nutritional problems, temperature extremes, inactivity, drug use, infectious agents, smoking, trauma, chemical exposure, psychological stressors

Internal Stressors: Originate within

Negative self talk Self-criticism Unrealistic expectations Taking things personally
Overloaded schedule Caffeine

External Stressors:Originate outside body

Noise Bright lights Trauma Fires

Daily hassles Isolation

Stress Response
Adaptive (+) Healthy Develop emotional tolerance for negative life events Maladaptive (-) Chronic recurrent responses Precursors to disease

Defense mechanism determine response

Alarm Reaction (Flight-or-flight response CNS aroused

Increases heart rate, force of heart contractions oxygen intake, & mental activity.

Alarm Reaction

Resistance

Body responding to the stressor & attempts to return to homeostasis If stress resolves, the body should be able to return to normal state (recovery)

Coping mechanism used

If stress doesnt stop, the Exhaustion stage begins

Exhaustion Marks the onset of disease

Organ damage begins

The body no longer produce hormones as in the alarm stage

Disease Development Signs & Symptoms Increase or decrease in metabolism or cell division

Increase mechanical function: seizure

hyperfunction

hypofunction

Disease Stages
1. Exposure to injury: target tissue exposed to a causative agent or is injured 2. Incubation period: no signs & symptoms evident 3. Prodromal period: mild nonspecific signs & symptoms

Disease Stages
4. Acute phase Disease reached its full intensity & complications commonly arise If pt can function its call the subclinical acute phase

Disease Stages
5. Remission occurs in some diseases; followed by another acute phase. 6. Convalescence Rehabilitation; progress towards recovery 7. Recovery regains health or normal functioning; no s & s

Stress & Disease

CV disorders Coronary artery disease Essential hypertension Congestive heart failure Gastrointestinal disorders Constipation Diarrhea Duodenal ulcer Anorexia nervosa Obesity Ulcerative colitis

Stress & Disease

Respiratory disorders Asthma Hay fever Tuberculosis Skin disorders Eczema Pruritus Urticaria Psoriasis

Stress & Disease

Musculoskeletal disorders Rheumatoid arthritis Low back pain Migraine headache Muscle tension Metabolic Disorders Hyperthyroidism Hypothyroidism Diabetes

Stress & Disease

Cancer Accident proneness Decrease immune response Menstrual irregularities

STRESS RESPONSE: PAIN

C Washington RN, MSNEd

Pain

Pain is an unpleasant sensation Entirely subjective Produces discomfort, distress, or suffering.

Pain Stimuli

Causative Factor

Example

Microorganisms Inflammation Impaired blood flow Invasive tumor Radiation Heat Obstruction Spasms

Menigitis Sore throat Angina Colon cancer Radiation for cancer Sunburn Kidney stone Colon cramping

Pain Stimuli

Causative factor
Compression Decreased movement Stretching or straining Fractures Swelling Deposits of foreign tissue Chemicals Electricity Conflict, difficulty in life

Example

Carpal tunnel syndrome Pain after cast removal Sprained ankle Fractured hip Arthritis Endometriosis Skin rash Electrical burn Psychogenic pain

Acute pain

Short duration; split second to about six months

Subsides as healing occurs Associated with increased pulse & blood pressure, sweating, pallor.

Warns the client that damage or injury has occurred in the body

Chronic pain

Prolonged duration; six months or longer Unresponsive to medical treatment

Persists long after injury has healed

Rarely accompanied by autonomic nervous system activity

Central Pain

Related to lesion in brain Produce high frequency bursts of impulses perceived as pain Cause: -Vascular lesion -tumor -trauma -inflammation

Phantom Pain

Occurs following amputation of body part Pain may include -itching -tingling -pressure sensations -burning -stabbing sensations - States amputed limb is twisted or cramped

Psychogenic Pain

Absence of diagnosed physiologic cause/event Long history of severe pain Emotional needs prompt pain sensations Pain is real May lead to physiologic changes (muscle spasms) May result from interpersonal conflicts Depression present

STRESS RESPONSE: SHOCK

C Washington RN, MSNEd

Shock

Widespread serious reduction of tissue perfusion

Lack of O2 & nutrients If prolonged, leads to generalized impairment of cellular functioning

Shock & Arterial Pressure

Arterial pressure is driving force of blood flow to organs. Dependent on Cardiac output to perfuse body Peripheral vasomotor tone to return blood & other fluids to heart Amount of circulating blood cardiac output or perpheral vascular tone with compensatory elevation in the other hypotension

Shock: Clients at Risk

Very young & very old MI patients Severe dysrhythmia Adrenocortical dysfunction H/O recent hemorrhage or blood loss Burns Massive or overwhelming infection

Early signs: agitation & restlessness

Blood loss

Allergens

Spinal cord injury

Ischemia & tissue perfusion

Hypovolemic Shock

80 yr old woman Bowel obstruction Minimal urine output NGT 1500 mL bloody aspirate

Becomes comatose BP 80/doppler HR 140 & thready Resp 8 Temp 94F

Hypovolemic Shock
Immediate Intervention Notify MD Aid volume restoration by monitoring IV infusion

Septic Shock
Cause: Release of bacterial toxins

Act directly on the blood vessels producing massive vasodilation and pooling septicemia

Factors Favoring Septic Shock

development of antibiotic-resistant organisms invasive procedures gram-negative rods in blood immunosuppression old age trauma presence of blood in peritoneal cavity increases likelihood of peritonitis

Shock: Nursing Interventions

Maintain patent airway and adequate ventilation Establish and maintain airway Administer oxygen as ordered Monitor respiratory status, blood gases Start resuscitative procedures as necessary

Shock: Nursing Interventions

Administer fluid and blood replacement as ordered

Diuretics to increase urine output after IVFs

Shock: Nursing Interventions

Sodium bicarbonate to treat acidosis Calcium to replace Ca+ loss due to blood transfusions Antiarrthythmic agents to stabilize heart rhythm

Shock: Nursing Interventions

Antibiotics to suppress organisms responsible for septic shock Cardiotonic glycosides, such as, digitalis, to treat cardiac failure

Steroids to treat anaphylactic shock

Shock: Nursing Interventions

Minimize factors contributing to shock. Elevate lower extremities to 45promote venous return to heart; improves cardiac output
Avoid

Trendelenburg's position: increases respiratory impairment

Shock: Nursing Interventions

Minimize factors contributing to shock. Promote rest- conserves energy measures

Keep

client warm

Shock: Nursing Interventions

Relieve

pain by cautious use of narcotics

interfere with vasoconstriction

Narcotics When

circulation improves, overdose may

occur

Shock: Nursing Interventions

Maintain continuous assessment of the client Check vital signs frequently Report urine output less than 30 ml/hour Observe color and temperature of skin Monitor CVP Monitor ECG

Shock: Nursing Interventions

Monitor lab studies: CBC with differential Electrolytes BUN creatinine blood gases blood cultures cardiac enzymes Psychological support: reassure client to relieve apprehension

keep family advised