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 body’s response to disruptions in homeostasis

Effector mechanism acts to restore homeostasis

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 mechanismnegative feedback and positive feedback

Feedback MechanismsNegative Works to restore homeostasis by

correcting a deficit within the systemPositive Hormone secretion triggers additional

hormone secretion

Negative Feedback= Positive ResultHigh blood glucose Sensor

MechanismControl center Effector Mechanism Pancreas Insulin Normal

glucose

Types of Cell Injury: ToxicEndogenous (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: PhysicalThermal Electrical/

Radiationradiation therapy, x-rays, ultraviolent radiation

Mechanical Trauma

MVA, frostbite, ischemia

Surgery

Types of Injury: DeficitLack of basic requirement = cell disruption

or death Water Oxygen Nutrient Constant temperature & adequate waste

disposal aren’t maintained Cellular synthesis can’t take place

Illness Occurs when a person is no longer in a

state of “normal” health Enables a person’s 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, psychologicalstressors

Internal Stressors: Originate within

Negative self talk Self-criticism Unrealistic

expectations Taking things

personally

Caffeine

Overloaded schedule

External Stressors:Originate outside body

Noise Bright lights Trauma Fires

Daily hassles Isolation

Stress ResponseAdaptive (+) Healthy Develop emotional

tolerance for negative life events

Maladaptive (-) Chronic recurrent

responses Precursors to disease

Defense mechanism determine response

Alarm Reaction (Flight-or-flight responseCNS aroused

Increases heart rate, force of heart contractionsoxygen intake, & mental activity.

Alarm Reaction

Resistance

Body responding to the stressor & attempts to return to homeostasis

Coping mechanism used

If stress resolves, the body should be able to return to normal state (recovery)

If stress doesn’t stop, the Exhaustion stage begins

ExhaustionMarks the onset of disease

The body no longer producehormones as in the alarm stage

Organ damage begins

Disease DevelopmentSigns & Symptoms

Increase or decrease inmetabolismor cell division

hypofunction

hyperfunction

Increase mechanical function:seizure

Disease Stages1. 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 Stages5. Remission

occurs in some diseases; followed by another acute phase.

6. ConvalescenceRehabilitation; progress towards recovery

7. Recoveryregains health or normal functioning; no s & s

Stress & DiseaseCV disorders Coronary artery

disease Essential

hypertension Congestive heart

failure

Gastrointestinal disorders

Constipation Diarrhea Duodenal ulcer Anorexia nervosa Obesity Ulcerative colitis

Stress & DiseaseRespiratory

disorders Asthma Hay fever Tuberculosis

Skin disorders Eczema Pruritus Urticaria Psoriasis

Stress & DiseaseMusculoskeletal

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

Microorganisms Inflammation Impaired blood flow Invasive tumor Radiation Heat Obstruction Spasms

Example 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

• Warns the client

that damage or injury has occurred in the body

• Subsides as healing occurs

• Associated with

increased pulse & blood pressure, sweating, pallor.

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 toorgans. 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: Client’s 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

Ischemia & ↓ tissue perfusion

Allergens

Spinal cord injury

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 ShockImmediate

Intervention Notify MD Aid volume

restoration by monitoring IV infusion

Septic ShockCause: 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 45°promote

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 Narcotics interfere with

vasoconstriction

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