PNE 101 Lec. Ch 5-Homeostasis, Adaptation, & Stress Fundamental Nursing Skills and Concepts Timby 11th Ed.

Sensory manipulation

Altering moods, feelings, and physiologic responses by stimulating pleasure centers in the brain using sensory stimuli

Adaptive Activities (3)

1. Alternative thinking - reframe thinking 2. alternative behavior - remain confident; prioritize; say no 3. Alternative lifestyles - surround yourself by those that are supportive/objective

Which neurotransmitters are responsible for coordinating movement? (2)

1. Dopamine 2. Acetylcholine

Stressors

Changes with the potential to disturb equilibrium

Secondary prevention

Included screening for risk factors and providing a means for early diagnosis of disease

Reticular Activity System (RAS)

Network of nerves. Communication link between body & mind. Internal & external environment goes through RAS to cortex on both unconscious and conscious level.

Stress Management interventions include: (7)

1. Modeling - promotes the ability to learn an adaptive response by exposing a person to someone who demonstrates a positive attitude/behavior 2. Progressive relaxation - eases tense muscles by clearing the mind of stressful thoughts/focusing on consciously relaxing specific muscle groups 3. Imagery - uses the mind to visualize calming; pleasurable, & positive experiences 4. Biofeedback - alters ANS functions by responding to electronically displayed physiologic data 5. Yoga - Reduces physical/emotional tension thru postural changes, muscles stretching, and focused concentration 6. Meditation/prayer - reduces physiologic activation by placing one's trust in a higher power 7. Placebo effect - alters a negative physiologic response thru the power of suggestion

What is the main difference between negative and positive feedback systems?

1. Negative feedback loops restore 2. Positive feedback loop ends or stops an change

Types of Coping mechanisms for stress

1. Repression 2. Suppression 3. Denial 4. Rationalization 5. Displacement 6. Regression 7. Projection 8. Somatization 9. Compensation 10. Sublimation 11. Reaction formation 12. Identification

Review Coping Mechanisms (7)

1. Repression-Forgetting about the stressor 2. Suppression-Purposely avoiding thinking about a stressor 3. Denial-Rejecting information 4. Rationalization-Relieving oneself of personal accountability by attributing responsibility to someone or something else 5. Displacement-Taking anger out on something or someone else who is less likely to retaliate 6. Regression-Behaving in a manner that is characteristic of a much younger age 7. Projection-Attributing that which is unacceptable in oneself onto another

Common neurotransmitters include: (5)

1. Serotonin (mood, sleep, & temp) 2. Dopamine & acetylcholine (movement) 3. Epinephrine (arousal & energy) 4. Norepinephrine (non-adrenaline) 4. Gamma-aminobutyric (GABA) (excitement/anxiety) 5. Glutamate

What two things always happen according to Hans Salye's general adaptation syndrome?

1. The body's physical response is always the same 2. Follows a 3-stage pattern

Sympathetic Nervous System (SNS) (2)

1. accelerates the physiologic function that endure survival through enhanced strength or rapid escape 2. fight-or-flight response; functions as an emergency system

How the body responds to change? (2)

1. adaptation 2. body uses

What are the three stages of the general adaptation syndrome?

1. alarm stage 2. stage of resistance 3. stage of exhaustion

Holism is the foundation of two commonly held beliefs:

1. both the mind/body directly influence humans 2. the relationship btwn. mind/body can potentially sustain health as well as cause illness.

Examples of psychological stressors (7)

1. fear 2. powerlessness 3. jealousy 4. rivalry 5. bitterness 6. hatred 7. insecurity

Examples of social stressors (12)

1. gender 2. racial 3. age discrimination 4. isolation 5. abandonment 6. poverty 7. conflict in relationships 8. political instability 9. denial of human rights 10. threats to safety 11. illiteracy 12. infertility

Examples of spiritual stressors (7)

1. guilt 2. doubt 3. hopelessness 4. conflict in values 5. pressure to join 6. abandon or change religions 7. religious discrimination

Types of stress related disorders:

1. headaches 2. hypertension 3. asthma 4. irritable bowel syndrome 5. bruxism 6. gastritis 7. rheumatoid arthritis 8. skin orders 9. depression disorders 10. cancer 11. low back pain 12. allergies 13. Hyper/hypoinsulinism 14. Hyper/hypothyroidism 15. anxiety disorders 16. infertility 17. erectile dysfunction

Therapeutic Coping Strategies (3)

1. help a person to acquire insight 2. gain confidence to confront reality 3. develop emotional maturity

List 10 factors that may affect a person's response to stress:

1. intensity of the stressor 2. number of stressors 3. duration of the stressor 4. physical health status 5. life experiences 6. coping strategies 7. social support 8. personal beliefs 9. attitudes 1.0. values

Examples of Non Therapeutic Coping Strategies (5)

1. mind and mood altering substances 2. hostility and aggression 3. excessive sleep 4. avoidance of conflict 5. abandonment of social activities

List 5 interventions for stress management:

1. music 2. exercise 3. yoga 4. creating art 5. breathing exercises

Examples of some physiologic stressors (11)

1. prematurity 2. aging 3. injury 4. infection 5. malnutrition 6. obesity 7. surgery 8. pain 9. fever 10. fatigue 11. pollution

Stress reduction techniques include: (7)

1. providing adequate explanations in understandable language 2. keeping the client/family informed 3. demonstrating confidence/expertise when providing nursing care 4. responding prompting to the client's signal for assistance 5. encouraging family interaction 6. advocating on behalf of the client 7. referring the client/family to organizations/people who provide post-discharge assistance

How can a coping mechanism become maladaptive?

1. reality may become distorted to a point where the patient fails to recognize or correct his/her mistakes; 2. consequently, the person may avoid taking responsibility for their own actions

Parasympathetic Nervous System (PNS) (2)

1. restores equilibrium after danger is no longer apparent 2. dominates control of many visceral effectors under normal, everyday conditions.

Examples of Therapeutic Coping Strategies (5)

1. seeking professional assistance in a crisis 2. using problem solving techniques 3. demonstrating assertive behavior 4. practicing progressive relaxation 5. turning to a comforting person or higher power

Serotonin (3)

1. stabilizes mood 2. induces sleep 3. regulates temp.

Autonomic nervous system consists of two divisions:

1. sympathetic division 2. parasympathetic division

How does neurotransmitters mediate homeostasis adaptive responses?

BY coordinating functions of the CNS, autonomic nervous system, & endocrine system.

CNS

Central Nervous System - composed of brain (cortex & subcortex) and spinal cord

Neurotransmitters

Chemical messengers synthesized in the neurons (allow communication across the synaptic cleft btwn. neurons, subsequently affecting thinking, behavior, & bodily functions)

Coping mechanisms

Define: Unconscious tactics to defend the psyche to prevent the ego or reality based from feeling inadequate 1. Psychological first aid; allows people to temporarily avoid emotional effects of stress; (manipulations of reality). 2. Used appropriately & moderately, coping mechanisms enable people to maintain mental equilibrium

Stress related disorders

Diseases that result from prolonged stimulation of the autonomic nervous and endocrine systems

Sustains response of autonomic nervous system. Hormones - chemicals produces, whose actions have physiologic effects on target cells.

Endocrine System

Which neurotransmitters are responsible for interrupt the transmission of Substance P?

Endorphins and Enkephalins

Which neurotransmitter is responsible for increased arousal and energy?

Epinephrine

What is the difference between epinephrine and norepinephrine?

Epinephrine and norepinephrine are very similar neurotransmitters and hormones. 1. Epinephrine has slightly more of an effect on your heart 2. Norepinephrine has more of an effect on your blood vessels. NOTE: Both play a role in your body's natural fight-or-flight response to stress and have important medical uses as well.

Positive feedback

Feedback that tends to magnify a process or increase its output.

Cortex

Higher functioning portion of brain: -thinking abstractly -Usage of language & understanding -Accumulate & store memories -Make decisions about information received

Explain homeostasis and list categories of stressors that affect homeostasis.

Homeostasis is a relatively stable state of physiologic equilibrium; it literally means "staying the same." Although it sounds contradictory, staying the same requires constant physiologic activity

Primary prevention

Involves eliminating the potential for illness before it occurs

Pituatary Gland

Master gland in brain producing hormones.

Stress reduction techniques

Methods that promote physiologic comfort and emotional well being

Tertiary prevention

Minimizes the consequences of a disorder through aggressive rehabilitation or appropriate management of the disease

Mediate homeostatic adaptive responses by coordinating functions of CNS,ANS, & Endocrine system

Neurotransmitters

Hypothalamus pituitary adrenal (HPA) axis

Pathway of physiologic communication among the central nervous, endocrine, and immune systems

Fight or flight response

Physiologic process used to attack a stressor in an effort to overcome the danger it represents or flee from the stressor to escape its threat

Neuroendocrine Control

Pituatary Gland in brain - producing hormone - master gland - Cortex stimulates hypothalamus - subconical structure in brain-which in turn activates pituatary gland to release hormones to cells.

What is also referred to as the "master gland"

Pituitary Gland

Adaptation

Response of an organism to change. Ongoing process as person strives to maintain balance (requires the use of self-protective properties/mechanisms for regulating homeostasis).

What is the communication link between the body and the mind?

Reticular Activating System (RAS)

S/S of sympathetic and parasympathetic systems

Signs and Symptoms = S/S: 1. Sympathetic System: prepares the body for a fight-or-flight response. It accelerates the physiologic functions that ensure survival through enhanced strength or rapid escape. The person becomes active, aroused, and emotionally charged. 2. Parasympathetic System: restores equilibrium after danger is no longer apparent. It does so by inhibiting the physiologic stimulation created by its counterpart, the sympathetic nervous system. The parasympathetic nervous system, however, does not produce an opposite reaction for every sympathetic effect. For this reason, some believe that the parasympathetic nervous system offers an alternate but equally effective mechanism for responding to threats from the internal or external environment..

Unsuccessful adaptation results in

Stress

sublimation

channeling one's energies into an acceptable alternative EX) turning to sportscasting when an athletics career is not realistic

Epinephrine (E)

heightened arousal/increase energy (adrenaline)

Homeostasis is also referred to as

"staying the same" NOTE: Homeostasis is the changes that your body make to stay the same.

Principles of Holism (4)

Stressors that affect homeostasis 1. Physical 2. Emotional 3. Social 4. Spiritual

Sub-cortex (brain)

Structure: midbrain/brainstem; Functions (7): 1. regulates breathing 2. heart contraction 3. BP 4. body temp, 5. sleep 6. appetite 7. stimulation and inhibition of hormone production

Which neurotransmitter is responsible for pain sensation?

Substance P

Stress

The physiologic and behavioral responses to disequilibrium

Stress management techniques

Therapeutic activities used to reestablish balance between the sympathetic and the parasympathetic nervous systems

Neuropeptides (chemical messengers/neuromodulators)

They help neurons communicate w/each other.

Cerebral cortex

Thinking

Neuropeptides includes:

Types of neurotransmitters 1. substance P - transmits pain sensation 2. endorphins 3. enkephalins 4. neurohormones - interrupt transmission of substance-P - promote a sense of well being

Holism (sums of all parts)

Whole person. Includes physical status, emotional, social, and spiritual. NOTE: Based on the principles of holism, stressors may be physiologic, psychological, social, or spiritual.

Autonomic Nervous System (ANS) (involuntary)

a division/set of nerves that carries involuntary and automatic commands that control blood vessels, body organs, and glands EX). heart rate, contractions of the stomach and intestines).

Negative feedback

a mechanism of response in which a stimulus initiates reactions that reduce the stimulus

reaction formation

acting just the opposite of one's feelings EX) being extremely nice to someone who is intensely disliked

Effector

an organ or cell that puts nerve signals "in effect"

projection

attributing that which is unacceptable in oneself onto another EX) accusing a person of another race of being prejudiced

regression

behaving in manner that is characteristic of a much younger age EX) wanting to be bottle-fed like a newborn sibling

What is the central nervous system composed of?

brain and spinal cord

Catastrophize

choosing to focus on all the potentially negative outcomes that may result from stressors thus perpetuating and intensifying their response to stress

brainstem

consists of three parts of brain: 1. medulla oblongata 2. pons 3. midbrain NOTE: ALL help with vitals

Acetylcholine

coordinated movements

Dopamine

coordinated movements

What are the two parts the brain is divided into called?

cortex and subcortex

Holism implies that

entities in all these area's (physicals status, emotional, social, & spiritual) contributes to the whole person.

compensation

excelling at something to make up for a weakness of another kind EX) becoming motivational speaker; although physically handicapped

repression

forgetting about the stressor EX). removing the experience of being sexually abused from conscious memory.

Gamma-aminobutyric acid (GABA)

inhibits nerve impulses, implicated in anxiety/excitement

Alarm Stage

initial reaction-adaptive responses are mobilized via ANS (fight-or-flight to overcome danger). NOTE: If the stressor is not controlled move to stage 2. EX) Fight or flight response stimulated, Hormones cause release of cortisol from adrenal cortex, known as shock phase

Enkephalins

interrupt the transmission of Substance P

Endorphins

interrupt the transmission of Substance P (Natural body chemicals that produce effects similar to those of opiate drugs such as morphine)

Stage of Exhaustion

last stage in the general adaptation syndrome and occurs when one ore more adaptive or resistive mechanisms are no longer able to protect the person experiencing a stressor

somatization

manifesting emotional stress through a physical disorder EX) developing diarrhea that conveniently excuses one from going to work

Pituitary Gland

master gland producing hormones that influence other endocrine glands

Norepinephrine (NE)

noradrenaline

What is the name of the nervous system that restores the body to equilibrium after danger is no longer present?

parasympathetic nervous system

suppression

purposely avoiding thinking about a stressor EX) resolving to "sleep on a problem" or turn the problem over to a higher power, such GOD.

denial

rejecting information EX) refusing to believe something like a life-threatening diagnosis

Homeostasis

relatively stable state of internal physical and chemical conditions in the body (staying the same). The body continuously adapts to stressors. Responses to changes in internal & external environment

rationalization

relieving oneself of person accountability by attributing responsibility to someone or something else EX) blaming failure on a test to the manner in which the test was constructed

Stage of Resistance

second stage in the general adaptation syndrome and is characterized by physiologic changes designed to restore homeostasis (Body attempts to cope with stressor).

What is homeostasis?

stable state of physiologic equilibrium

General Adaptation Syndrome

stress response: collective physiologic processes in response to a stressor (health, injury, physical, mental) body's physical response is always the same. 1-2-3 stage pattern.

Which nervous system prepares the body for the "fight or flight" response?

sympathetic nervous system

displacement

taking anger out on something or someone else who is less likely to retaliate EX). kicking the wastebasket after being reprimanded by the boss

identification

taking on the characteristics of another EX) imitating the style of dress; speech, or behavior of another person

Hans Selye's general adaptation syndrome

the body's reaction to stress is always the same, and it follows a one, two, or three stage pattern

Feedback Loop

the mechanism for controlling hormone production (which turns hormone production off/on)

Nerve impulse

they have to be initiated by stimulus, a change in the neuron's environment. Pressure, temperature, and chemical changes are the usual stimuli.

Substance P

transmits pain sensation

Identify two beliefs about the body and mind based on the concept of holism

1) both the mind and the body directly influence humans 2) the relationship between the mind and the body can potentially sustain health as well as cause illness

Three physiological stress responses include:

1. Alarm stage 2. Stage of resistance 3. Stage of exhaustion NOTE: First 2 help with trying to maintain homeostasis. If stage of resistance is prolonged, can lead to stress-related disorders UP to death

Endocrine System

1. Group of glands throughout the body 2. Most work by the neg. feedback system; hormones becomes low; gland is simulated to release hormone

Nursing implications for helping a person w/stress:

1. Identify the stressors 2. Assess the client's response to stress 3. Eliminate/reduce the stressors 4.Prevent additional stressors 5. Promote the client's physiologic adaptive response 6. Support the client's psychological coping strategies 7. Assists in maintaining a network of social support 8. Implement stress reductions/stress management techniques

Body Uses

Self protective properties & mechanisms for regulating homeostasis

Which neurotransmitter is responsible for mood, sleep, and temperature regulation?

Serotonin

Discuss the s/s of stress, and stages of stress (alarm, resistance & exhaustion).

Signs & Symptoms of Stress: - Physical: ex. rapid heart rate - Emotional: Irritable - Cognitive- Impaired attention and concentration Stages of Stress (3): 1. Alarm stage- the immediate physiologic response to a stressor "fight or flight. The SYMPATHETIC nervous system takes action 2. Resistance stage- physiological changes designed to restore homeostasis 3. Exhaustion Stage- when one or more adaptive or resistive mechanisms are no longer able to protect the person experiencing a stressor.

Physiologic exhaustion - one or more adaptive resistive mechanisms no longer protect the person under stress. They may have become destructive - no longer able to help the body. Effects of stress-related neurohormones suppress immune system and there is a reduction of killer cells that help attack viruses/cancer cells.

Stage of exhaustion

Coping strategies

Stress reduction activities selected consciously (help people to deal w/stress-provoking events/situation.

Discuss therapeutic and nontherapeutic methods to manage stress

Stress-reduction techniques are methods that promote physiologic comfort and emotional well-being. Include: adequate explanations in understandable language, keeping the client and family informed, demonstrating confidence and expertise when providing nursing care, remaining calm during crises, being available to the client, responding promptly to the client's signal for assistance, encouraging family interaction, advocating on behalf of the client, and referring the client and family to organizations or people who provide post-discharge assistance. Stress-management techniques are therapeutic activities used to reestablish balance between the sympathetic and the parasympathetic nervous systems. Techniques that counter sympathetic stimulation have a calming effect; stimulating tactics counterbalance parasympathetic dominance