Homeostasis , Stress and Adaptation and Implication to Nursing Care

Review of Health and Illness Concept

Health ( WHO 2006)

Physical

Wellness
Activities

Psychological

Spiritual

( Clark, Stuifbergen, Gottlieb, et al.,2006)

Components of Wellness
Excellence

Adaptability

WELLNESS

State of well-being

Harmony ( Clark, Stuifbergen, Gottlieb, et al.,2006)

Illness

A sickness or deviation from healthy state

Disease
Specific Problems
Biological Malfunction Body system Psychological

Organ

clinical manifestations

STRESS AND ADAPTATION

Definition of Terms
Stress A state produced by a change in the environment that is perceived as challenging, threatening, or damaging to the persons dynamic balance or equilibrium. Stressor Any event or stimulus that causes an individual to experience stress

Adaptation A change or alteration designed to assist in adapting to a new situation or environment Homeostasis A steady state within the body; the stability of the internal environment Coping The cognitive & behavioral strategies used to manage the stressors

Categories of stressors
Physical Physiological

Psychosocial

Classifications of stressors
Day-to-day frustrations Major complex occurrences involving large groups Stressors that occurs less frequently and involve fewer people

Stress as a Stimulus for Disease

Indicators of Stress Brunner and Suddarths Page 85 chart 6-1

Physiologic Response to Stress

Increased HR and B/P Increased blood glucose level Mental acuity Dilated pupils Increased tension of skeletal muscles Increased ventilation Increased coagulability of blood

Psychologic Response to stress

Anxiety Depression Anger

Fear

Psychologic Response to Stress

Unconscious ego defense mechanism e.g. -Denial -Displacement -rationalization -regression

Maladaptive Responses to stress

What do you think will happened if a person is unable to adapt to stress?

MODELS OF STRESS
Stimulus -Based Models Response -Based Models Transaction- Based Models

Stimulus Based Models - Stimulus life event, or set of circumstances that arouses a physiologic and/or psychological reactions that may increase the individual vulnerability to illness

Response-Based Models
Stress may be considered as a response The body could also react Locally this is referred to as local adaptation syndrome (LAS) a) Reflex Pain Response b) Inflammatory Response Characterized by chain of events called the general adaptation syndrome ( GAS)

Three stages of GAS & LAS

Alarm Reaction Resistance Exhaustion

Cognitive Appraisal Model of Stress ( Lazarus)

Two process model: Primary appraisal Secondary appraisal

Stress Appraisal Model

Stress stimulus Appraisal response

Personal characteristics

Nursing intervention Effective coping

Adaptation

Ineffective coping

Illness

Cellular Adaptation to Stressor

Control of the steady state

Negative feedback mechanism Positive feedback mechanism

CAUSES OF CELLULAR INJURY

Hypoxia Nutritional imbalance Physical agents Chemical agents

Cont.
Immune mechanisms Infectious agents Genetics defects Psychogenic factors

Cellular Response to Injury

Disruption of tissue integrity

Injury

Ischemic damage

Immune reaction

Inflammatory response
Vascular changes: Vasodilation Capillary permeability Blood flow Local tissue congestion

Cellular changes:
Phagocytosis Leukocytes Release of Chemical mediators

Body responses