Chapter 5: Homeostasis, Adaptation & Stress

Carolyne Richardson-PhillipsPNU 145 Fall 2015

Pages 60 – 71

Learning OutcomesBy the end of the session, the PN Students will be able to: 1.Explain homeostasis & list categories of stressors that affect homeostasis 2.Identify 2 beliefs about the body & mind based on the concept of holism3.Identify the purpose of the adaptation and two possible outcomes of unsuccessful adaptation4.Explain the structural process thru which adaptive changes take place5.Differentiate between the sympathetic and parasympathetic nervous systems adaptive responses6.Define stress and list factors that effect the stress response7.Discuss the 3-stages & consequences of the general adaptation syndrome 8.Identify and describe anxiety/fear9.Discuss stress-related disorders 10.Name the three levels of prevention that nurses use to help with severe or accumulated stressors to help reduce the disorders11.Explain psychological adaptation and two possible outcomes12.Describe nursing activities helpful to care of clients prone to stress & approaches for preventing, reducing, or eliminating a stress response13.Using nursing process, discuss assessment and interventions used in caring for a stress-prone client 14.Discuss examples of stress & stress abuse for younger & older generation

Homeostasis

• Relatively Stable state of physiologic equilibrium• Body continuously adapts to stressors• Responses to changes in internal & external environment

• Principles of Holism are affected-stressors that effect homeostasis• Physical• Emotional• Social • Spiritual

Holism

• Whole person includes physical status,

emotional, social, & spiritual

(Table 5-1, see page 61 for list• Two commonly held beliefs

• Both mind and body directly influence humans• Relationship between mind and body can

potentially sustain health or cause illness• Gerontological considerations: older persons’ perception of

stress may be different from a younger person d/t life experiences

Adaptation• Response of an organism to change

• How Body responds to change• Body uses: self-protective properties & mechanisms for

regulating homeostasis• Adaptation: ongoing process as person strives to maintain

balance• Neurotransmitters: mediate homeostatic adaptive responses by

coordinating functions of• Central nervous system (CNS)• Autonomic nervous system (ANS)• Endocrine system

• Unsuccessful adaptation results in stress

Structures that Mediate Adaptive Response• Neurotransmitters: Chemical messengers synthesized in neurons

• Allows communication between neurons affecting thinking, behavior, body functions• Common neurotransmitters

• Serotonin (mood, sleep, temperature)• Dopamine-& acetylcholine (movement)• Norepinephrine (arousal & energy)• Gamma-aminobutyric (catecholamines)• Glutamate

• Neuropeptides: types of neurotransmitters• Substance P: transmits pain sensation• Endorphins, Enkephalins, neurohormones: interrupt

transmission of Substance P-promote a sense of well being

Structures that Mediate Adaptive Response (cont’d)

• Central nervous system (CNS): composed of brain (cortex & subcortex) and spinal cord

• Cortex: higher functioning portion of brain• Think abstractly• Usage of language & understanding• Accumulate & store memories• Make decisions about information received

• Subcortex: regulating & maintaining physiologic activities that promote survival (breathing, heart contractions, blood pressure, temperature, sleep, appetite, hormone production)

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Structures that Mediate Adaptive Response (cont’d)• Recticular activating system (RAS) -

Network of nerves • Communication link between body

& mind• Internal & external environment

goes thru RAS to cortex on both unconscious & conscious level

• Corte: processes information-generates behavioral & physiologic responses via hypothalmus

• In turn activates endocrine & autonomic system

CORTEX

Structures that Mediate Adaptive Response (cont’d)• Autonomic nervous system (ANS): composed of peripheral nerves

-affect physiologic functions that are largely automatic & beyond voluntary control• Provides the initial & immediate response to a perceived threat

thru either sympathetic or parasympathetic nervous system• Sympathetic:

• Mind perceives a situation as dangerous• Prepares body for fight or flight• Increases physiological functions that ensure survival-

increased strength, rapid escape• Person becomes active, aware, emotionally active

• Parasympathetic: • Restores equilibrium after danger • Inhibiting physiologic stimulation caused by sympathetic

nervous system (Most of the time)

Endocrine System • Group of glands throughout body:

• Sustains response of autonomic nervous system • Hormones-chemicals produced-whose actions have physiologic

effects on target cells • Neuroendocrine control: HPA

• Pituitary gland-in brain –producing hormones-master gland-Cortex stimulates hypothalamus-subcortical structure in brain-which in turn activates pituitary gland to release hormones to cells

• Feed back loop -mechanism for controlling hormone production-either negative or positive• Negative response-decrease in hormone- releasing gland is

stimulated to release hormone• Positive response-opposite occurs- keeping concentration of

hormones within a stable range at all times --Homeostasis

Stress• Stress: physiologic and behavioral responses to disequilibrium • Internal & external changes overwhelm homeostatic adaptation• How are physical, emotional & cognitive effects of stress displayed in

individuals, see Box 5-2 on page 65• Not everyone responds to stressors in the same way• Stress Differences:

• Intensity of the stressor• Number of stressors• Duration of the stressor• Physical health status• Life experiences• Coping strategies• Social support• Personal beliefs• Attitudes• Values

• Outcomes: adaptive or maladaptive-depending on person’s response-focus on all negative

Physiologic Stress Response• General Adaptation Syndrome

• Stress Response: Collective physiologic processes in response to a stressor (health, injury, physical, mental)• Body’s physical response to stress is always the same• Body follows-one-two-three-stage pattern• Alarm Stage• Stage of Resistance• Stage of Exhaustion

• First two help with trying to maintain homeostasis• If stage of resistance is prolonged: can lead to stress-related

disorders and possibly death

Alarm Stage• Initial reaction: stress-threat maybe either conscious or

subconscious-alert’s body’s defenses• Sympathetic nervous system releases norepinephrine

(hormone)• Adrenal glands (endocrine system)release more norepinephrine

& epinephrine (hormones)• Stimulate “Fight or Flight Response” (fight or run)• Hypothalamus and Pituitary glands- release hormones- these

cause the Release of cortisol-stress hormone -from adrenal cortex

• Cortisol raises blood glucose as a reserve for meeting increased energy

• Known as shock phase- cause-increase in energy levels, O2 intake, BP, mental alertness

Stage of Resistance• Body attempts to cope with stressor

• Characterized by physiological changes to restore homeostasis• Neuroendocrine hormones compensate for the physiologic changes

of alarm stage• Outcome: Return to homeostasis• VS, hormone levels and energy production return to normal• If stress continues (severe injury or a major illness) -resistance

efforts continue • One or more organs or physiologic processes may eventually

increase vulnerability to stress-related disorders or progression to stage of exhaustion

Stage of Exhaustion: Last phase• Physiologic exhaustion- One or more adaptive resistive mechanisms

no longer protect the person under stress • They may become destructive-no longer able to help body

• Effects of stress-related neurohormones suppress immune system and there is a reduction of killer cells that help attack viruses/cancer cells• Client at risk for frequent or severe infections or cancer- other

organs affected• Resistance dwindles, physical and mental deterioration,

illness and possible death

Defense Mechanism

Coping Mechanisms• Unconscious tactics to defend (defense mechanisms) self-esteem -prevent

ego from feeling inadequate• Act as psychological first aid in allowing temporary avoidance of

emotional effects of stress• If appropriate & moderate, it can help to maintain mental equilibrium

• Therapeutic: help with acquiring insight, gain confidence to confront reality & develop emotional maturity; Ex: Seeking professional assistance• Using problem-solving techniques• Use of assertive behavior• Practicing relaxation techniques• Comfort from others or higher power

• If overused or overextended, it may become maladaptive; distort reality• Person fails to recognize & correct weaknesses • Avoids responsibility for solving problems

• Nontherapeutic: maladaptive results in negative coping techniques-provide temporary relief from stressor-but will cause problems later• Ex: Mind & mood altering substance

• Hostility & aggression; excessive sleep; avoiding conflict; abandonment of social activities

Types: Coping Mechanisms (cont’d)• Repression: voluntarily forgetting about stressor= wiping out

stressor from conscious mind • Suppression: purposely avoiding thinking about a stressor• Denial: rejecting information & refusing to believe something • Rationalization: trying to give a logical or socially acceptable

explanation for questionable behavior, relieving oneself of personal accountability by attributing responsibility to someone or something else

• Displacement: transfer an emotional reaction from one object person to another

• Regression: behaving in a manner that is of a younger age

Stress Related Disorders

• Diseases that result from prolonged stimulation of autonomic nervous & endocrine systems• Many involve allergic, inflammatory, or altered immune

responses• Brain-immune connection suggests changes in body chemistry

during periods of stress may trigger• Autoimmune (self-attacking) response • Failure to respond-immunosuppression• Weakened immune response-leads to infections cancer• Prolonged anger, feelings of helplessness, and worry can

influence progression of immune system-mediated diseases

Anxiety: Indicator of Stress, Page 171-172

• Overwhelming feeling of discomfort, dread, apprehension, unease, sometimes helplessness, insecurity

• May have physical changes as well:• Sweating, racing heart, palpitations, rapid breathing,

sad or worried, restless, ↓ appetite, difficulty sleeping• Rarely lasts long; most people are able to cope• Continued anxiety can cause physical & mental

problems

Anxiety Levels

• Four levels of anxiety• Mild- slight arousal state

• Enhances perception, productivity & learning

• Moderate - feelings of tension, nervousness, concern• Perception narrowed• Attention focused on one aspect of a situation

• Severe – perception decreased more• Consumes most of a person’s energies• Requires intervention

• Panic: person loses control; person can distort events; overwhelming anxiety that interferes with daily life is not normal; may be a symptom of another problem, i.e. depression

• Nursing care plan (NCP): Anxiety, p. 173

Fear

• Emotion or feeling of apprehension • Aroused by impending or seeming danger, pain or other

perceived threat• Fear: Something may have already occurred

• Response to an immediate threat• Response to something the person believes will happen• Object of fear - May or may not be based in reality

Nursing Process: Assessment & Interventions • When a person is experiencing a stressor• Nurses:

• Identify stressors• Assess the client’s response to stress• Eliminate or reduce the stressors• Promote the client’s physiologic adaptive responses• Support the client’s psychological coping strategies• Assist in maintaining a network of social support• Implement stress reduction and stress management techniques

• Social Readjustment Rating Scale, Table 5-4, p. 68

Stressor Types • Stress

• Retirement/laid off from work

• Financial• Health/Hospitalization• Death (family/friends)• Change in status• Medications• Loneliness• Facility placement

• Stress/Abuse• Physical• Emotional• Sexual • Neglect (by self or

caregiver) • Abandonment• Financial• Healthcare Fraud

Prevention of Stressors: Interventions• Three levels of prevention

• Primary prevention: involves eliminating the potential for illness before it occurs (teaching-education-nutrition, weight)

• Secondary prevention: screening for risk factors & providing a means for early diagnosis (Regular Blood pressure monitoring)

• Tertiary prevention: minimizes consequences of a disorder thru aggressive rehabilitation or appropriate management of disease (frequent turning, positioning, & exercising a stoke client)

Stress Reduction Techniques: Methods • Nsg interventions: promote physiologic comfort & emotional well-being

of client• Adequate explanations/education using appropriate language• Keeping family/client informed• Demonstrating confidence/expertise • Remaining calm in a crises• Being available for the client• Responding quickly to call light• Advocating for client• Referring client & family to people &/or organizations to help with

discharge care• Therapeutic activities: reestablish balance between sympathetic &

parasympathetic nervous system• Modeling• Progressive relaxation• Imagery• Biofeedback & Yoga• Meditation & Prayer; Placebo effect

Other Stress Management Techniques• Endorphins: body’s own chemicals-promote a sense of well-being

• Activities- massage, aerobic exercise, laughter• Sensory Manipulation: altering moods, feelings and physiologic

responses by stimulating pleasure centers in brain using sensory stimuli – colors, specific aromas, light, music

• Adaptive Activities: adopt techniques- help with stress • Alternative Thinking: change in perceptions from negative to

positive • Alternative Behaviors: take control rather than be immobilized-

making choices/pursuing actions• Alternative Lifestyle: change diet, humor, exercise, music, pets,

power naps, schedule breaks

References• Anxiety Retrieved 9/10/2015 from web site:

http://www.mayoclinic.org/diseases-conditions/anxiety/basics/definition/CON-20026282

• Images retrieved from web site googleimages.com on June 14, 2015

• Timby, B. K. (2013). (10th ed.). Fundamental Nursing Skills and Concepts. Philadelphia: PA. Lippincott Williams & Wilkins