Stress & Adaptation

Assessment (subjective & objective data)

•Signs and symptoms of stress •Risk factors, coping methods, support systems •Diagnostic tests, laboratory data

Inflammation response to injury

•Signs of inflammation •Redness •Hot •Swelling •Pain •Loss of function •Cellular Response: Specialized white blood cells (phagocytes) migrate to the site of injury and engulf bacteria, other foreign material, and damaged cells and destroy them. •Vascular response: Immediately after injury, blood vessels at the site constrict (narrow) to control bleeding. •Exudate formation: The fluid and white blood cells that move from the circulation to the site of injury. •Healing: replacement of tissue by regeneration or repair

Risk factors for Stress

•Working full time •With children: one or both parents •Unemployed •Divorced or widowed individuals •Isolated individuals •Targets of discrimination •Those lacking health insurance •Low socioeconomic status

Adrenals

EPI, NE, Cortisol

Hypochondriasis

•person is preoccupied with the idea that he is or will become seriously ill. The person is abnormally concerned with his health and interprets his real or imagined symptoms unrealistically, fearing that they will get worse or become incurable.)

Allostatic Load

-Allostatic Load represents the cumulative, physiological dysregulation to stressful life demands -Cumulative effect of experiences in daily life that involve ordinary events and major events, but also health-damaging behaviors (poor sleep, lack of exercise, smoking, etc) -May be adaptive in short term but increases over time or in the presence of additional stressors -AL can be assigned a score- Made up of 8 biomarkers- HR, BP, total cholesterol, HDL- waist to hip ratio, Hb A1c, CRP (inflammation), the higher the score- the higher the mortality

Allostatic overload

-Allostatic load exceed capacity of the individual to cope -Leads to secondary outcomes and increased risk for disease -Increased risk for CV diseases (coronary heart disease, ischemic heart disease)

Interventions and implementation

-Establish a trusting and caring relationship with your patient -Tell patients what to expect when any procedure or diagnostic is being done to them -Ask them to take deep breaths during uncomfortable or painful procedures •social support/THERAPY GROUPS •Nutrition •Exercise •Sleep and Rest •Leisure Activities (hobbies, interests) •Time Management • Music/Art • Journal Writing

stage #3: exhaustion (3 stages of seyle's adaptation syndrome)

1. Once it reaches the exhaustion stage, a person's body is no longer equipped to fight stress. They may experience: -tiredness -depression -anxiety -feeling unable to cope -If a person does not find ways to manage stress levels at this stage, they are at risk of developing stress-related health conditions (e.g. Myocardial infarction, stroke) or even death. If stressor continues beyond body's capacity, organism exhausts resources and becomes susceptible to disease and death.

Stage 1: Alarm Reaction (3 stages of seyle's general adaptation syndrome)

1.a distress signal is sent to The hypothalamus the release of Glucocorticoids release of adrenaline (epinephrine) and cortisol. The adrenaline gives a person a boost of energy. Their heart rate increases, blood pressure rises and digestion slows. Meanwhile, blood sugar levels also go up. (Fight or Flight reaction). Upon encountering a stressor, body reacts with "fight-or-flight" response and sympathetic nervous system is activated. Hormones such as cortisol and adrenalin released into the bloodstream to meet the threat or danger. The body's resources now mobilized.

Stage2: Resistance (3 stages of seyle's general adaptation syndrome)

1.the body tries to counteract the physiological changes that happened during the alarm reaction stage. parasympathetic branch of the AUTONOMIC NERVOUS SYSYTEM reduces the amount of cortisol produced. The heart rate and blood pressure begin to return to normal. If the stressful situation comes to an end, during the resistance stage, the body will then return to normal. if the stressor remains, the body will stay in a state of alert, and stress hormones continue to be produced. Parasympathetic nervous system returns many physiological functions to normal levels while body focuses resources against the stressor. Blood glucose levels remain high, cortisol and adrenalin continue to circulate at elevated levels, but outward appearance of organism seems normal. Increase HR, BP, breathing Body remains on red alert.

Burnoir

Burnout occurs when a person cannot cope effectively from the physical and emotional demands of the workplace. This experience is very real and impacts nurses. •Burnout that is not addressed can lead to physical illness and/or negative attitude, feelings of helplessness, hopelessness and depression. •Recognize the signs and get help to be healed.

Somatoform disorders

Can also be called somatic symptom disorder, psychiatric disorders that cause unexplained physical symptoms

Anterior Pituitary

GH and prolactin

Hypothalamic-pituitary-adrenal axis

The HPA axis relies on a series of hormonal signals to keep the sympathetic nervous system — the "gas pedal" — pressed down. If the brain continues to perceive something as dangerous, the hypothalamus releases corticotropin-releasing hormone (CRH), which travels to the pituitary gland, triggering the release of adrenocorticotropic hormone (ACTH). This hormone travels to the adrenal glands, prompting them to release cortisol. The body thus stays revved up and on high alert. When the threat passes, cortisol levels fall. The parasympathetic nervous system — the "brake" — then dampens the stress response.

Stress response in the brain

When someone experiences a stressful event, the amygdala, an area of the brain that contributes to emotional processing, sends a distress signal to the hypothalamus. This area of the brain functions like a command center, communicating with the rest of the body through the nervous system so that the person has the energy to fight or flee. The hypothalamus is like a command center. This area of the brain communicates with the rest of the body through the autonomic nervous system, which controls such involuntary body functions as breathing, blood pressure, heartbeat, and the dilation or constriction of key blood vessels and small airways in the lungs called bronchioles. The autonomic nervous system has two components, the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system functions like a gas pedal in a car. It triggers the fight-or-flight response, providing the body with a burst of energy so that it can respond to perceived dangers. The parasympathetic nervous system acts like a brake. It promotes the "rest and digest" response that calms the body down after the danger has passed. After the amygdala sends a distress signal, the hypothalamus activates the sympathetic nervous system by sending signals through the autonomic nerves to the adrenal glands. These glands respond by pumping the hormone epinephrine (also known as adrenaline) into the bloodstream. As epinephrine circulates through the body, it brings on a number of physiological changes. The heart beats faster than normal, pushing blood to the muscles, heart, and other vital organs. Pulse rate and blood pressure go up. The person undergoing these changes also starts to breathe more rapidly. Small airways in the lungs open wide. This way, the lungs can take in as much oxygen as possible with each breath. Extra oxygen is sent to the brain, increasing alertness. Sight, hearing, and other senses become sharper. Meanwhile, epinephrine triggers the release of blood sugar (glucose) and fats from temporary storage sites in the body. These nutrients flood into the bloodstream, supplying energy to all parts of the body. As the initial surge of epinephrine subsides, the hypothalamus activates the second component of the stress response system — known as the HPA axis. This network consists of the hypothalamus, the pituitary gland, and the adrenal glands.

Why do we get a stress response after an injury or trauma?

due to the hormonal and metabolic changes that occur as a result

Catecholamines

substances released into the blood in response to physical or emotion stress (NE, epi, dopamine)

PTSD

•A response to a specific violent, traumatizing event or to physical or emotional abuse that results in anxiety and flashbacks for years after the event. -Symptoms may not appear for months to years after an event Re-experiencing trauma (flashbacks, nightmares) Emotional numbness, avoidance of places, people, activities that remind them of the trauma Increased arousal (difficulty sleeping, concentrating, feeling jumpy, easily irritated or angered)

Allostasis

•Allostasis literally means "maintaining stability (or homeostasis) through change" •Allostatic load was proposed to refer to the wear and tear that the body experiences due to repeated cycles of allostasis •Including inefficient turning-on or shutting off of these responses -ability to achieve stability through change

Nursing diagnosis

•Emotional responses to stresS •Coping-stress-tolerance level •Coping, effective or ineffective

Evaluation

•If outcomes not achieved, nurse and patient explore reasons •Revise interventions

Causes of mechanical injury

•Mechanical trauma •Radiation and electrical shock •Chemical agents •Infectious agents Mechanical trauma is injury caused by a cut, crush, blow, or penetrating wound

Planning outcomes/interventions

•Plan/EDUCATION with patients, family, member of healthcare team •Tailored to individual •Stress management •Adaptive coping strategies •

Somatoform disorders

•Psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition

Somatization

•anxiety and emotional turmoil are expressed in physical symptoms, loss of physical function, pain that changes location often, and depression.)

Malingering

•conscious effort to use his symptoms to escape unpleasant situations or gain something (e.g., calling in sick because the person does not want to go to work).