Stress & Adaptation

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Stress & Adaptation

  1. 1. Stress & Adaptation<br />C Washington RN MSNEd<br />
  2. 2. Homeostasis<br />Medulla oblongata: respiration & circulation<br />Pituitary gland: regulates other glands-growth, maturation, reproduction<br />Reticular formation: nerve cells help control vital reflexes such as cardiovascular function & respiration<br />
  3. 3. Homeostasis: Feedback Mechanisms<br />Sensor mechanism: senses disruptions in homeostasis<br />Control center: regulates body’s response to disruptions in homeostasis<br />Effector mechanism acts to restore homeostasis<br />
  4. 4. Feedback mechanisms<br />An endocrine gland usually controls the sensor sensor mechanism.<br />Signal sent to the control center in the CNS, which initiates the effector mechanism<br />Feedback mechanism<br /> negative feedback and positive feedback<br />
  5. 5. Feedback Mechanisms<br />Negative<br />Works to restore homeostasis by correcting a deficit within the system<br />Positive<br />Hormone secretion triggers additional hormone secretion<br />
  6. 6. Negative Feedback= Positive Result<br />High blood glucose Sensor Mechanism<br />Control center Effector Mechanism <br />Pancreas Insulin Normal glucose<br />
  7. 7. Types of Cell Injury: Toxic<br />Endogenous (inside body)<br />Metabolic errors<br />Gross malformations<br />Hypersensitivity reactions<br />Exogenous (outside body)<br />Alcohol<br />Lead<br />Carbon monoxide<br />drugs<br />
  8. 8. Types of Cell Injury: Infectious<br /> Viruses<br />Fungi<br />Protozoa<br />bacteria<br />Affect cell integrity by interfering with cell synthesis, producing mutant cells. <br />Example: HIV alters the cell when the virus is replicated in the cells RNA.<br />
  9. 9. Types of Injury: Physical<br />Thermal<br />Electrical/Radiation<br /> radiation therapy, x-rays, ultraviolent radiation<br />Mechanical<br />Trauma<br /> MVA, frostbite, ischemia<br />Surgery<br />
  10. 10. Types of Injury: Deficit<br />Lack of basic requirement = cell disruption or death<br />Water<br />Oxygen<br />Nutrient<br />Constant temperature & adequate waste disposal aren’t maintained<br />Cellular synthesis can’t take place<br />
  11. 11. Illness<br />Occurs when a person is no longer in a state of “normal” health<br />Enables a person’s body to adapt to the disease<br />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)<br />
  12. 12. Cause of Disease<br />Etiology = cause<br />Cause may be <br /> intrinsic-inside the body <br /> extrinsic-outside the body<br />Idiopathic = diseases with no known cause<br />
  13. 13. Causes of Disease<br />Intrinsic -hereditary, age, gender<br />Extrinsic -infectious agents or behaviors: <br /> nutritional problems, temperature extremes, inactivity, drug use, infectious agents, smoking, trauma, chemical exposure, psychological<br /> stressors<br />
  14. 14. Internal Stressors: Originate within<br />Negative self talk<br /><ul><li>Self-criticism
  15. 15. Unrealistic expectations
  16. 16. Taking things personally</li></ul>Overloaded <br />schedule<br />Caffeine<br />
  17. 17. External Stressors:Originate outside body<br />Noise<br />Bright lights<br />Trauma<br />Fires<br />Daily hassles<br />Isolation<br />
  18. 18. Stress Response<br />Adaptive (+)<br />Healthy<br />Develop emotional tolerance for negative life events<br />Maladaptive (-)<br />Chronic recurrent responses<br />Precursors to disease<br />Defense mechanism determine response<br />
  19. 19.
  20. 20. Alarm Reaction (Flight-or-flight response<br />CNS aroused<br />Increases heart rate, force of heart contractions<br />oxygen intake, & mental activity.<br />
  21. 21. Alarm Reaction<br />
  22. 22. Resistance<br />Body responding to the <br />stressor & attempts <br />to return to homeostasis<br />If stress resolves, the body should be able to return to normal state (recovery)<br />If stress doesn’t stop, the <br />Exhaustion stage begins<br />Coping mechanism used<br />
  23. 23. Exhaustion<br />Marks the <br />onset <br />of <br />disease<br />Organ damage <br />begins<br />The body no longer produce<br />hormones as in the alarm stage<br />
  24. 24. Disease Development<br />Signs & Symptoms<br />Increase <br />mechanical <br />function:<br />seizure<br />Increase or <br />decrease in<br />metabolism<br />or cell <br />division<br />hyperfunction<br />hypofunction<br />
  25. 25. Disease Stages<br />1. Exposure to injury: target tissue exposed to a causative agent or is injured<br />2. Incubation period: no signs & symptoms evident<br />3. Prodromal period: mild nonspecific signs & symptoms<br />
  26. 26. Disease Stages <br />4. Acute phase<br />Disease reached its full intensity & complications commonly arise<br />If pt can function its call the subclinical acute phase<br />
  27. 27. Disease Stages<br />5. Remission<br /> occurs in some diseases; followed by another acute phase.<br />6. Convalescence<br /> Rehabilitation; progress towards recovery<br />7. Recovery<br /> regains health or normal functioning; no s & s<br />
  28. 28. Stress & Disease<br />CV disorders<br />Coronary artery disease<br />Essential hypertension<br />Congestive heart failure<br />Gastrointestinal disorders<br />Constipation<br />Diarrhea<br />Duodenal ulcer<br />Anorexia nervosa<br />Obesity<br />Ulcerative colitis<br />
  29. 29. Stress & Disease<br />Respiratory disorders<br />Asthma<br />Hay fever<br />Tuberculosis<br />Skin disorders<br />Eczema<br />Pruritus<br />Urticaria<br />Psoriasis<br />
  30. 30. Stress & Disease<br />Musculoskeletal disorders<br />Rheumatoid arthritis<br />Low back pain<br />Migraine headache<br />Muscle tension<br />Metabolic Disorders<br />Hyperthyroidism<br />Hypothyroidism<br />Diabetes<br />
  31. 31. Stress & Disease<br />Cancer<br />Accident proneness<br />Decrease immune<br />response<br />Menstrual irregularities<br />
  32. 32. Stress Response: Pain<br />C Washington RN, MSNEd<br />
  33. 33.
  34. 34. Pain<br /><ul><li>Pain is an unpleasant sensation
  35. 35. Entirely subjective
  36. 36. Produces discomfort, distress, or suffering.</li></li></ul><li>Pain Stimuli<br /><ul><li>Causative Factor
  37. 37. Example
  38. 38. Microorganisms
  39. 39. Inflammation
  40. 40. Impaired blood flow
  41. 41. Invasive tumor
  42. 42. Radiation
  43. 43. Heat
  44. 44. Obstruction
  45. 45. Spasms
  46. 46. Menigitis
  47. 47. Sore throat
  48. 48. Angina
  49. 49. Colon cancer
  50. 50. Radiation for cancer
  51. 51. Sunburn
  52. 52. Kidney stone
  53. 53. Colon cramping</li></li></ul><li>Pain Stimuli<br /><ul><li>Causative factor
  54. 54. Example
  55. 55. Carpal tunnel syndrome
  56. 56. Pain after cast removal
  57. 57. Sprained ankle
  58. 58. Fractured hip
  59. 59. Arthritis
  60. 60. Endometriosis
  61. 61. Skin rash
  62. 62. Electrical burn
  63. 63. Psychogenic pain
  64. 64. Compression
  65. 65. Decreased movement
  66. 66. Stretching or straining
  67. 67. Fractures
  68. 68. Swelling
  69. 69. Deposits of foreign tissue
  70. 70. Chemicals
  71. 71. Electricity
  72. 72. Conflict, difficulty in life</li></li></ul><li>Acute pain <br /><ul><li>Subsides as healing occurs
  73. 73. Associated with increased pulse & blood pressure, sweating, pallor.
  74. 74. Short duration; split second to about six months
  75. 75. Warns the client that damage or injury has occurred in the body</li></li></ul><li>Chronic pain <br /><ul><li>Prolonged duration; six months or longer
  76. 76. Unresponsive to medical treatment
  77. 77. Persists long after injury has healed
  78. 78. Rarely accompanied by autonomic nervous system activity </li></li></ul><li>Central Pain<br /><ul><li>Related to lesion in brain
  79. 79. Produce high frequency bursts of impulses perceived as pain
  80. 80. Cause:</li></ul> -Vascular lesion<br /> -tumor<br /> -trauma<br /> -inflammation<br />
  81. 81. Phantom Pain<br /><ul><li>Occurs following amputation of body part
  82. 82. Pain may include</li></ul> -itching<br /> -tingling<br /> -pressure sensations<br /> -burning<br /> -stabbing sensations<br /> - States amputed limb is ”twisted or cramped”<br />
  83. 83. Psychogenic Pain<br /><ul><li>Absence of diagnosed physiologic cause/event
  84. 84. Long history of severe pain
  85. 85. Emotional needs prompt pain sensations
  86. 86. Pain is real
  87. 87. May lead to physiologic changes (muscle spasms)
  88. 88. May result from interpersonal conflicts
  89. 89. Depression present</li></li></ul><li>Stress Response: Shock<br />C Washington RN, MSNEd<br />
  90. 90. Shock<br /> Widespread serious reduction of tissue perfusion<br />Lack of O2 & nutrients<br />If prolonged, leads to generalized impairment of cellular functioning<br />
  91. 91. Shock & Arterial Pressure <br />Arterial pressure is driving force of blood flow to<br />organs. Dependent on<br />Cardiac output to perfuse body<br />Peripheral vasomotor tone to return blood & other fluids to heart<br />Amount of circulating blood<br />↓ cardiac output or perpheral vascular tone with compensatory elevation in the other -> hypotension<br />
  92. 92. Shock: Client’s at Risk<br />Very young & very old<br />MI patients<br />Severe dysrhythmia<br />Adrenocortical dysfunction<br />H/O recent hemorrhage or blood loss<br />Burns<br />Massive or overwhelming infection<br />
  93. 93. Early signs: agitation & restlessness<br />
  94. 94. Blood loss<br />Allergens <br />Spinal cord injury<br />Ischemia & ↓ tissue perfusion<br />
  95. 95.
  96. 96. Hypovolemic Shock<br />80 yr old woman<br />Bowel obstruction<br />Minimal urine output<br />NGT 1500 mL bloody aspirate<br />Becomes comatose<br />BP 80/doppler<br />HR 140 & thready<br />Resp 8 Temp 94F<br />
  97. 97. Hypovolemic Shock<br />Immediate Intervention<br />Notify MD<br />Aid volume restoration by monitoring IV infusion<br />
  98. 98. Septic Shock<br />Cause:<br />Release of bacterial toxins<br />Act directly on the blood vessels producing massive vasodilation and pooling septicemia<br />
  99. 99. Factors Favoring Septic Shock<br /><ul><li>development of antibiotic-resistant organisms
  100. 100. invasive procedures
  101. 101. gram-negative rods in blood
  102. 102. immunosuppression
  103. 103. old age
  104. 104. trauma
  105. 105. presence of blood in peritoneal cavity increases likelihood of peritonitis</li></li></ul><li>
  106. 106. Shock: Nursing Interventions<br />Maintain patent airway and adequate ventilation <br />Establish and maintain airway<br />Administer oxygen as ordered <br />Monitor respiratory status, blood gases<br />Start resuscitative procedures as necessary <br />
  107. 107. Shock: Nursing Interventions<br />Administer fluid and blood replacement as ordered <br />Diuretics to increase urine output after IVFs<br />
  108. 108. Shock: Nursing Interventions<br />Sodium bicarbonate to treat acidosis<br />Calcium to replace Ca+ loss due to blood transfusions<br />Antiarrthythmic agents to stabilize heart rhythm<br />
  109. 109. Shock: Nursing Interventions<br />Antibiotics to suppress organisms responsible for septic shock<br />Cardiotonic glycosides, such as, digitalis, to treat cardiac failure<br />Steroids to treat anaphylactic shock<br />
  110. 110. Shock: Nursing Interventions<br />Minimize factors contributing to shock. <br />Elevate lower extremities to 45°promote venous return to heart; improves cardiac output<br />Avoid Trendelenburg&apos;s position: increases respiratory impairment<br />
  111. 111. Shock: Nursing Interventions<br />Minimize factors contributing to shock. <br />Promote rest- conserves energy measures<br />Keep client warm<br />
  112. 112. Shock: Nursing Interventions<br />Relieve pain by cautious use of narcotics <br />Narcotics interfere with vasoconstriction<br />When circulation improves, overdose may occur<br />
  113. 113. Shock: Nursing Interventions<br />Maintain continuous assessment of the client <br />Check vital signs frequently <br />Report urine output less than 30 ml/hour<br />Observe color and temperature of skin<br />Monitor CVP<br />Monitor ECG <br />
  114. 114. Shock: Nursing Interventions<br />Monitor lab studies:<br /><ul><li>CBC with differential
  115. 115. Electrolytes
  116. 116. BUN
  117. 117. creatinine
  118. 118. blood gases
  119. 119. blood cultures
  120. 120. cardiac enzymes </li></ul>Psychological support: <br />reassure client to relieve apprehension<br /> keep family advised<br />

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