1. Stress & Adaptation C Washington RN MSNEd

2. 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

3. 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

4. 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

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

6. Negative Feedback= Positive Result High blood glucose Sensor Mechanism Control center Effector Mechanism Pancreas Insulin Normal glucose

7. Types of Cell Injury: Toxic Endogenous (inside body) Metabolic errors Gross malformations Hypersensitivity reactions Exogenous (outside body) Alcohol Lead Carbon monoxide drugs

8. 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.

9. Types of Injury: Physical Thermal Electrical/Radiation radiation therapy, x-rays, ultraviolent radiation Mechanical Trauma MVA, frostbite, ischemia Surgery

10. Types of Injury: Deficit Lack of basic requirement = cell disruption or death Water Oxygen Nutrient Constant temperature & adequate waste disposal aren’t maintained Cellular synthesis can’t take place

11. 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)

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

13. 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

15. Unrealistic expectations

16. Taking things personallyOverloaded schedule Caffeine

17. External Stressors:Originate outside body Noise Bright lights Trauma Fires Daily hassles Isolation

18. Stress Response Adaptive (+) Healthy Develop emotional tolerance for negative life events Maladaptive (-) Chronic recurrent responses Precursors to disease Defense mechanism determine response

20. Alarm Reaction (Flight-or-flight response CNS aroused Increases heart rate, force of heart contractions oxygen intake, & mental activity.

21. Alarm Reaction

22. 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) If stress doesn’t stop, the Exhaustion stage begins Coping mechanism used

23. Exhaustion Marks the onset of disease Organ damage begins The body no longer produce hormones as in the alarm stage

24. Disease Development Signs & Symptoms Increase mechanical function: seizure Increase or decrease in metabolism or cell division hyperfunction hypofunction

25. 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

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

27. 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

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

29. Stress & Disease Respiratory disorders Asthma Hay fever Tuberculosis Skin disorders Eczema Pruritus Urticaria Psoriasis

30. Stress & Disease Musculoskeletal disorders Rheumatoid arthritis Low back pain Migraine headache Muscle tension Metabolic Disorders Hyperthyroidism Hypothyroidism Diabetes

31. Stress & Disease Cancer Accident proneness Decrease immune response Menstrual irregularities

32. Stress Response: Pain C Washington RN, MSNEd

35. Entirely subjective

37. Example

38. Microorganisms

39. Inflammation

40. Impaired blood flow

41. Invasive tumor

42. Radiation

43. Heat

44. Obstruction

45. Spasms

46. Menigitis

47. Sore throat

48. Angina

49. Colon cancer

50. Radiation for cancer

51. Sunburn

52. Kidney stone

54. Example

55. Carpal tunnel syndrome

56. Pain after cast removal

57. Sprained ankle

58. Fractured hip

59. Arthritis

60. Endometriosis

61. Skin rash

62. Electrical burn

63. Psychogenic pain

64. Compression

65. Decreased movement

66. Stretching or straining

67. Fractures

68. Swelling

69. Deposits of foreign tissue

70. Chemicals

71. Electricity

73. Associated with increased pulse & blood pressure, sweating, pallor.

74. Short duration; split second to about six months

76. Unresponsive to medical treatment

77. Persists long after injury has healed

79. Produce high frequency bursts of impulses perceived as pain

80. Cause: -Vascular lesion -tumor -trauma -inflammation

82. Pain may include -itching -tingling -pressure sensations -burning -stabbing sensations - States amputed limb is ”twisted or cramped”

84. Long history of severe pain

85. Emotional needs prompt pain sensations

86. Pain is real

87. May lead to physiologic changes (muscle spasms)

88. May result from interpersonal conflicts

90. Shock Widespread serious reduction of tissue perfusion Lack of O2 & nutrients If prolonged, leads to generalized impairment of cellular functioning

91. 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

92. 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

93. Early signs: agitation & restlessness

94. Blood loss Allergens Spinal cord injury Ischemia & ↓ tissue perfusion

96. 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

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

98. Septic Shock Cause: Release of bacterial toxins Act directly on the blood vessels producing massive vasodilation and pooling septicemia

100. invasive procedures

101. gram-negative rods in blood

102. immunosuppression

103. old age

104. trauma

106. 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

107. Shock: Nursing Interventions Administer fluid and blood replacement as ordered Diuretics to increase urine output after IVFs

108. Shock: Nursing Interventions Sodium bicarbonate to treat acidosis Calcium to replace Ca+ loss due to blood transfusions Antiarrthythmic agents to stabilize heart rhythm

109. 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

110. 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

111. Shock: Nursing Interventions Minimize factors contributing to shock. Promote rest- conserves energy measures Keep client warm

112. Shock: Nursing Interventions Relieve pain by cautious use of narcotics Narcotics interfere with vasoconstriction When circulation improves, overdose may occur

113. 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

115. Electrolytes

116. BUN

117. creatinine

118. blood gases

119. blood cultures

120. cardiac enzymes Psychological support: reassure client to relieve apprehension keep family advised