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Structures That Mediate Adaptive Response

VIEWS: 4 PAGES: 26

									                                   Chapter 5



    Homeostasis, Adaptation, and
              Stress


Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A   1
  Health is a tenuous (fragile) state.
  To sustain health the body continuously
   adapts to stressors.
  Weak stressors lead to un noticed effects.
  Intense and strong stressors lead to
   uncomfortable signs and symptoms.
  Prolonged stress may lead to death.



Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A   2
                                   Homeostasis
  A relatively stable state of physiologic equilibrium

      Staying the same.

      Body maintains homeostasis by adjusting and readjusting to
         changes in internal and external environment

      It is affected by 4 health aspects ( physical, mental, social,
         and spiritual)



Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A   3
                                       Holism
   Implies that entities in physiologic, psychological, social,
    and spiritual areas contribute to the whole of a person
   Two commonly held beliefs of holism:
        Both the mind and body directly influence
         humans
        Relationship between the mind and body can
         potentially sustain health as well as cause
         illness


Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A   4
                                   Stressors
Stressors are factors that cause stress

 Physiologic          Psychological Social                     Spiritual
 Prematurity          Fear          Isolation                  Guilt
 Aging                Powerlessness Poverty                    Doubt
 Injury               Anger         Illiteracy                 Hopelessness
 Infection            Jealousy      Infertility                Religious bias
 Obesity              Hatred        Conflict in                Conflict in
 Pain                 Insecurity    Relationship               values
 Fever                Suspicion     Abandonment
 Fatigue                            Neglect
                                    Rejection


Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A       5
                                      Adaptation
   How an organism responds to change.
   Use of self-protective properties and mechanisms
   Purpose of adaptation is to regulate homeostasis
   Neurotransmitters mediate homeostatic adaptive responses
   Neurotransmitters:
        Chemical messengers synthesized in the neurons.
        Allow communication between neurons
                e.g Serotonin, dopamine, nor epinephrine, acetylcholine, gamma-
                 aminobutyric acid, and glutamate



Feb / 05 /2012      Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A       6
Structures That Mediate Adaptive Response (cont’d)
  • Central nervous system
       Composed of brain and spinal cord.
       Brain divided into cortex and sub cortex
                Cortex: considered the higher functioning portion of the
                 brain, enables people to think abstractly, use and
                 understand language, accumulate and store memories,
                 make decisions
                Sub-cortex consists of the structures in mid-brain and
                 brain-stem.
                    Mid-brain: includes (ganglia, thalamus, and hypothalamus).
                    Brain stem contains (cerebellum, medulla, and pons).

Feb / 05 /2012       Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A     7
      Central Nervous System




Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A   8
 Structures That Mediate Adaptive Response (cont’d)
• Autonomic nervous system
  – Composed of peripheral nerves that affect
    physiologic functions that are largely automatic and
    beyond voluntary control
  – Subdivided into:
    1. Sympathetic nervous system
    2. Parasympathetic nervous system.




Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A   9
Sympathetic and Parasympathetic Adaptive Response

In dangerous situations:
 1. Sympathetic response: prepares body for fight
   or flight; accelerates physiologic functions that
   ensure survival
2. Parasympathetic response: restores equilibrium
   after danger is no longer perceived; inhibits
   physiologic stimulation created by sympathetic
   response


Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A   10
                                          Question
   Is the following statement true or false?

     The sympathetic response restores equilibrium after
   danger is no longer perceived.


                                       Answer
 False.
 The sympathetic response prepares body for fight or
 flight and accelerates physiologic functions that ensure
 survival.

Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A   11
Structures That Mediate Adaptive Response (cont’d)
  • Endocrine system
       • Group of glands found throughout the body
       • Sustains the response of the autonomic
         nervous system
       • Maintains homeostasis by releasing and
         inhibiting hormones as needed



Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A   12
                                         Stress
•Physiologic and behavioral responses to disequilibrium
•Caused by:
     −Physical, physiologic, or emotional internal or external changes
     that disrupt homeostasis

• Effects :
     1.    Physical ( rapid heart rate, loss of appetite or excessive eating).
     2.    Emotional (irritability, withdrawal, depression….) and
     3.    Cognitive ( impaired attention and concentration, poor judgments)

Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A        13
Factors That Affect Response to Stress

1.   Intensity of stressors.
2.   Number of stressors.
3.   Duration of stressors.
4.   Physical health status.
5.   Life experiences.
6.   Coping strategies.
7.   Personal beliefs.
8.   Attitudes.
9.   Values.


Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A   14
Physiologic Stress Response

•General adaptation syndrome: propounded by
Hans Selye
•Study: collective physiologic processes of the
stress response
     Body’s physical response is always the same
     Syndrome follows one-, two-, or three-stage
     pattern

Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A   15
 Stages of the Physiologic Stress Response
 1. Alarm stage (secretion additional
       nor epinephrine and epinephrine )




 2. Resistance stage
       (restoration to normal)



 3. Exhaustion stage

                      Bader EL Safadi  BSN , MSc
Feb / 05 /2012        Fundamental of Nursing - A   16
                                          Question
    Is the following statement true or false?

     The alarm stage is the last stage according to the
   general adaptation syndrome.


                                       Answer
 False.
 The alarm stage is the first stage according to the
 general adaptation syndrome.


Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A   17
Psychological Stress Response
1. Coping Mechanisms
   “Unconscious tactics used to protect the psyche (mind)”.
          e.g. ( denial, regression, displacement, ……)
2. Coping strategies
     "Stress reduction activities selected consciously“ help people to deal with
           stress-provoking events or situations, They can be
               A. Therapeutic coping strategies usually help the person to acquire
                   insight , gain confidence to confront reality (e.g. using problem-
                   solving technique).
               B. Non therapeutic coping strategies when used by people may
                   lead to Mal adaptation
     e.g. ( excessive sleeping, avoidance of conflict, smoking, alcohol drinks…..)


Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A         18
Coping Strategies

Coping strategies can be:
     1. Therapeutic: help the person to acquire
        insight, gain confidence to confront reality,
        develop emotional maturity (e.g. using problem-
           solving technique).
     2. Non therapeutic: using mind/mood-altering
        substances, excessive sleep; conflict
        avoidance, smoking, alcohol drinks…..

Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A   19
Stress-Related Disorders

• Result from prolonged stimulation of autonomic nervous
          and endocrine systems
•Many stress-related diseases involve allergic,
          inflammatory, or altered immune responses
•Prolonged anger, feelings of helplessness, and worry can
          affect immune-system
( e.g. hypertension, headache, gastritis, asthma, rheumatoid arthritis, anxiety, impotence)

Feb / 05 /2012   Bader EL Safadi   BSN , MSc     Fundamental of Nursing - A               20
       Nursing Implications
•Caring for stressed clients
  1. Identify the stressors
  2. Assess the client’s response to stress
  3. Eliminate or reduce the stressors
  4. Prevent additional stressors
  5. Promote client’s physiologic adaptive responses
  6. Support client’s psychological coping strategies
  7. Assist in maintenance of social support
  8. Implement stress reduction/management
     techniques

Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A   21
  Nursing Implications (cont’d)
1. Assessment of stressors
     •Social Readjustment Rating Scale tool to assess the
     level of stress of patients
2.        Prevention of stressors
     A. Primary prevention:
         Involve eliminating the potential for illness before it occurs
            (e.g. teaching principles of nutrition to maintain normal
            weight).
     B. Secondary prevention
         Includes screening for risk factors (e.g. regularly measuring
            blood pressure).
     C. Tertiary prevention ( rehabilitation)

Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A   22
   Nursing Implications (cont’d)
•Caring for stressed clients (cont’d)
    1.     Promote client’s physiologic adaptive responses
    2.     Support client’s psychological coping strategies
    3.     Assist in maintenance of social support
    4.     Implement stress reduction/management techniques




Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A   23
     Stress-Reduction Techniques
1.      Provide adequate explanations in understandable
        language
2.      Keep client and family informed
3.      Demonstrate confidence and expertise when providing
        nursing care
4.      Remain calm during crises
5.      Be available to the client
6.      Respond promptly to the client’s signal for assistance
7.      Encourage family interaction
8.      Advocate on behalf of the client
9.      Refer the client and family to organizations or people
        who provide post-discharge assistance
Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A   24
    Stress-Management Techniques
•       Therapeutic activities that reestablish
        balance between sympathetic and
        parasympathetic nervous systems
    •e.g. modeling, progressive relaxation, imagery,




Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A   25
Feb / 05 /2012   Bader EL Safadi   BSN , MSc   Fundamental of Nursing - A   26

								
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