NURS 115 Stress and Adaptation (Chapter 7).pdf

NURS 115 TEST ONE STUDY GUIDE

Stress and Adaptation (Chapter 7)

Stress response – what does it look like and how does it work? How does adaptation function?

Stress- a state brought on by coordinated activation of the neuroendocrine and immune

systems

Stress response regulation

oPsychology, Neurology, Immunology

Adaptation- Response to challenges to homeostasis (mental or physical), and the return to

a balanced state

General Adaptation Syndrome (G.A.S.)

oInvolves whole person, systemic

oThree stages:

Alarm- activation of sympathetic nervous system

Resistance- Body response to stress

Exhaustion OR Recovery-

E: Body overwhelmed, and body resources are depleted. A.k.a.

Onset of illness or disease

R: Body overcomes challenge

Stressors- Agents responsible for initiating stress response; response depends on

condition of person and properties of stressor

oEndogenous- Internal

oExogenous- External

oEustress (Positive stress)- Mild, brief, controlled i.e.: Becoming a parent

oDistress (Negative stress)- Sever, uncontrolled i.e.: losing a parent

Stress Response:

oSNS- Sympathetic Nervous System

Fight or flight- activator of SNS

Activation causes medulla of adrenal gland to release Epinephrine and

Norepinephrine

A.k.a. catecholamines: help body with stress response and

prepare for fight or flight

oLocus Coeruleus

Neurons produce norepinephrine (NE)

Central integration site for ANS response

Know the various physiological and psychological responses to stress, effects of hormones &

receptors

Stress Hormones:

oGrowth Hormone: stress induced production

oThyroid Hormone: slows metabolism

oReproductive Hormones- suppresses sperm count, ovulation, and sexual activity

oAntidiuretic Hormone (ADH)- suppressed by cortisol

LC/NE  ANS SNS

oGlycogen- Stored form of glucose

oGlucagon- Pancreatic hormone that promotes glycogenolysis

oGlycogenolysis- process to breakdown glycogen to release glucose

oGluconeogenesis- synthesis of amino acids, glycerol, and lactic acid for new

glucose

Catecholamine stimulate A1, A2, B1, and B2 adrenergic receptors

oAlpha 1- constricts blood vessels, increased glycogenolysis

oAlpha 2- lowers blood pressure, Renin release

oBeta 1- Increases heart rate, stroke volume, and cardiac output; lipolysis: fat

breakdown

oBeta 2- Bronchodilation, increased hepatic gluconeogenesis and hepatic + muscle

glycogenolysis

CORTISOL

oLiver gluconeogenesis

oEnsures glucose is available during stress

oEffect on immune system

Suppresses immune system to conserve energy for balance against

stressor

Adipose lipolysis

Decrease leukocytes at inflammation- delayed healing

Deposits adipose around face and neck

Effects of SNS on body

oIncr. Heart rate and contraction

oBronchodilation

oSkeletal muscle contractions

oImmunosuppression

oIrritable bowel

oRenin-angiotensin-aldosterone system:

Fluid and electrolyte balance

Decreased Blood flow to kidneys  kidneys release renin into blood  renin reacts with angiotensin  angiotensin coverts to angiotensin 1 and 2 

stimulates adrenal cortex to secret aldosterone  aldosterone activates NA+/K+ pump in nephrons  NA+ and H2O reabsorbed (Incr. Blood volume) and

K+ excreted (K+ loss)

oPallor and coolness to skin

oCortisol release

oHeightened arousal, awareness, agitation

Non-pharmacological stress relief methods

Debriefing, counseling, relaxation, massage, music therapy, biofeedback, imagery

Thermoregulation (portion of Chapter 14 as stated on Canvas)

Thermoregulation: methods of heat loss, retention

Heat Loss: Transfer of body core heat to surface through circulation

oRadiation- transfer of heat through the air

oConduction- transfer of heat through direct contact; temp. adaptation

oConvection- movement of heated fluid; dense material sink, less dense rises

oEvaporation- conversion of water to gas i.e., sweat

Heat conservation- shivering and vasoconstriction

Patterns and physiologic behaviors of fever

Pyrogen: “Fire maker”, produces fever

Fever Patterns:

oIntermittent- temp is normal at least once every 24 hours

oRemittent- temp does not stabilize, varies in either direction

oSustained or Continuous- Temp remains above normal, little variation

oRecurrent or Relapsing- Episodic fevers with normal temp between episodes

Fever Stages

oProdromal- Headache, fatigue, pain, ill feeling

oChill- Shaking sensation

oFlush- Cutaneous vasodilation, warm and flushed skin

oDefervescence- Sweating

Hormones (Mechanisms & Disorders) (Chapters 40 & 41, not including Diabetes Mellitus)

Function of Anti-diuretic hormone (ADH)

Conserves body water

Regulation: plasma osmolality, B.P drops, vomit

Action of hypo and hypersecretion of the adrenal medulla and cortex – disorders, physical effects,

treatments

Hyposecretion:

oAddison’s disease

Decreased cortical hormones, increased acth (adrenocorticotropic)

Signs: vitiligo, hyperpigmentation, anorexia, fatigue, arthralgia, hair loss,

hyperkalemia, hyponatremia

Nursing considerations: history and physical

Treatment: hormone replacement therapy, replace glucose and sodium,

monitor meals and exercise

oAcute Adrenal Crisis

Life threatening insufficiency

Could cause adrenal hemorrhage

Signs- weakness, hypotension, dehydration, vascular collapse

Treatment- the 5 S’s

Salt replacement

Sugar replacement

Steroid Replacement

Support of physiologic function

Search for/treat underlying condition

Hypersecretion

oCushing’s syndrome

Excess glucocorticoid hormone

Causes: pituitary or adrenal tumor

Signs: “moon face”, “buffalo hump”, altered fat and glucose metabolism,

incr. facial hair (hirsutism), thinning scalp

Diagnosis: 24 hr. cortisol excretion in urine, acth levels, MRI, or CT

Treatment: Radiation/ tumor removal, medication (ketoconazole),

immunosuppression

Action of mineralocorticoids on maintaining blood pressure

Regulates salt and water

Too much salt = hypertension

Hormones which raise blood glucose and how they work

Glucagon- promotes breakdown of glycogen, increase glucose

Cortisol- makes fat and muscle insulin resistant, increase glucose

Amylin- decreases glucagon levels, lowers glucose

Epinephrine- acts directly on liver to produce glucose, increase glucose

Growth hormone- counterbalances insulin on fat and muscle

Symptoms of hypo and hyperthyroidism on various systems

Hypothyroidism- Low and Slow

oCongenital:

Cretinism- untreated will lead to intellectual disability

Diagnosis- High TSH and Low thyroid hormone (T4)

Treatment- Thyroid hormone replacement and monitor growth,

development, and thyroid levels

oAcquired

Myxedema- presence of non-pitting edema (swelling)

Causes

oPrimary- destruction of thyroid gland, thyroidectomy,

goiter

oSecondary- impaired pituitary function

oTertiary- impaired hypothalamic function

Hashimotos Thyroiditis- autoimmune disorder

Signs- decreased BMR, mental sluggishness, bradycardia, weight gain,

cold intolerance, course skin, brittle hair

Treatment- Check Thyroid and TSH levels, thyroid replacement and

watch response

Hyperthyroidism- High and Fast

oThyrotoxicosis- hyperactivity of thyroid gland

oMultinodular goiter

oThyroid adenoma

oSigns- Inc. BMR, tachy, heat intolerance, sweating, thin hair and skin,

exophthalmos (bulging eyes)

oTreatment- reduce thyroid level, antithyroid drugs, beta blockers for HR

oGrave’s Disease- A hyperthyroid state

Goiter, exophthalmos, ages 20-40, mostly women, autoimmune

Hypersecretion of the anterior pituitary – what disorders may occur

GH-

oGigantism, enlargement of heart and other organs, metabolic disturbances

oAcromegaly- caused by tumor

Signs- Barrel chest, enlarged heart, goiter, thickened skin, enlarged

respiratory tracts

Treatment- Normalize GH response, remove tumor

Prolactin

oIn women

Amenorrhea (absence of cycle), galactorrhea (excessive mil production)

oIn men

Decreased sex drive and sperm count

Gynecomastia- man boobs

Hyposecretion of the anterior pituitary – what disorders may occur

GH-

oChildren

Dwarfism, pituitary tumor

Signs- short stature, obesity, delay of skeletal maturation, delayed puberty

Treatment- administer growth hormone

oAdults

Cause- lack of GH as a child or an adult

Signs- Incr. body fat, insulin resistance, dyslipidemia

Treatment- Growth hormone

Hormones secreted by the posterior and anterior pituitary gland

Anterior

oACTH- Adrenocorticoid Hormone

oGH- Growth Hormone

oTSH- Thyroid Stimulating Hormone

oProlactin

oLH- Luteinizing Hormone

oFSH- Follicle Stimulating Hormone

Posterior

oOxytocin

oADH- Anti Diuretic hormone

Difference between Primary, secondary, tertiary disorders

Primary- Originates from gland that produces the hormone

Secondary- Target gland is normal, defective levels of stim. Hormone or releasing factors

Tertiary- Hypothalamic dysfunction, pituitary, and target organ under stimulated

Myxedema coma, signs and symptoms, treatment

Extreme hypothyroidism

Life threatening

Cardiovascular collapse

Hypoventilation and hypothermia

Three factors

oHypoxia, fluid and electrolyte imbalances, hypothermia

Treatment- Cardiovascular and ventilation support, correct hypothermia + hyponatremia

+ hypoglycemia, correct thyroid imbalance

Thyroid storm

Hyperthyroid crisis

Life threatening

Signs- high fever, tachy, heart failure, restless, delirious

HIGH MORTALITY RATE

Treatment- cooling blanket, reduce fluids, glucose, and electrolytes, Beta blockers,

glucocorticoids

NO ASPIRIN

Diagnostic tests and treatments for endocrine disorders

Tests

oFine Needle Aspiration, MRI, Ultrasound

Treatment

oSynthetic hormones or radiation/chemo for tumors

Concerns with a patient post-operative- thyroidectomy

Thyroid Storm- high mortality rate

Injury to laryngeal nerves

Airway obstruction

Parathyroid hormone, Signs and symptoms of hypo and hyper states

Hypo-

oLow Serum calcium

oTetany (muscles spasms) and seizures

Hyper-

oHigh Serum Calcium

oArrythmia

oMuscle-bone weakness

SIADH and DI and effects on serum and urine osmolality, signs and symptoms, priority nursing

diagnoses/interventions

SIADH

oHypersecretion of ADH

oCauses- Pancreatic cancers, disease or injury to CNS, meningitis, stress, surgery

oCan be Chronic or transient

oSigns: Hypotonic hyponatremia, natriuresis, high urine osmolality, low plasma

osmolality, confusion, coma, seizures

oTreatment: fluid restriction, mannitol (swelling reduction), 3% Sodium Chloride

oWET inside. Serum> Urine

Diabetes Insipidus

oD.I.= DRY INSIDE

oLabs= HIGH and DRY

oSerum<Urine

oDeficient ADH

oKidneys don’t respond

oSigns- sever dehydration, polydipsia, Excessive Urination (2L-20L vs .8L-2L),

fever

oDiagnostics- 24hr urine output, measure ADH, Urine and serum osmolality

oTreatment: Hormones, salt reduction, excess water

Stimulation for release of ADH

Increase in blood osmolality or decrease in blood volume

Normal blood glucose range

140 mg/dL and below

Test blueprint:

Stress & Adaptation 28%

Thermoregulation 12%

Hormones (Mechanisms & Disorders) 60%

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