Homeostasis

Creates a stable environment coordinated by processes that respond to change; respond to maintain a normal or near normal internal environment. 

Stress

Change in normal balance

A nonspecific response to a nonspecific threat

Our body responds in a nonappropriate way to stressors

Stressor

Something that stimulates or evokes stress.

Psychosocial - guilt, fear, money,grief, isolation, working in a bad environment.

Physiological - pain, illness

Physical - heat and cold, being immobile

Heartiness-clear personal values, strong locus of control (who is in charge).

Resilience-being resourceful, flexible, be a problem solver.

Optimism - people who can laugh and smile and say things are gonna be OK.

These three things will help you cope better with stress.

Name three major things that Holmes and Ray said will help you cope better with stress.

Stress

May be internal or external; may arise frtom relationships, the environment, un,et emotional and physical needs.

 Very individual based on a variety of factors: age, sex, previous experiences, culture, knowledge level, socio-economics.

Chronic Intermittent Stressor

A type of stress that causes the most problems for people.  An example would be asthma.

Chronic Enduring Stress

An example would be chronic pain.

What type of stress is this?

Acute Time-Limited Stress

Something that happens quickly and is over with quickly.  An example would be a fire alarm going off at school.  It takes you a second to figure out what it is, your senses are heightened, then you figure it out and are not stressed anymore.

What type of stress is this?

A Series of Events Stress

This is something that is stressing all along, ongoing, and leads up to something.

Adaptation

A response to a stressor.

A continuous  process requiring change throughout the life span.

Physiological nand behavioral.

General Adaptation System

Three stages of stress:

Alarm (shock) - ANS takes charge and things start happening in your body.

Resistance

Exhausion

Alarm Stage

A Sympathetic response

Body perceives a stressor

ANS initiates fight or flight & endocrine system heightens hormonal response

Things that go up: Heart Rate, BP, Respirations, Endorphins, Production of corticoids (adrenaline, noradrenaline, cortisol), Fluid & Na retention, Glucagon, Growth Hormone (uptake of amino acids), your senses sharpen, eyes dilate.

Things that go down:  Blood flow to GI, Kidneys, Skin & Liver, Immune system & sex drive.

Name things that happen during the alarm phase, when the ANS initiates fight or flight & the endocrine system heightens hormonal response 

Sympathetic Response

The response that happens during the alarm phase?

Parasympathetic Response

The response that happens during the resistance phase?

Continuous or Regular stressors, NOT intermittent

It is easier for your body to deal with what kind of a stressor?

Resistance Phase

(Parasympathetic response)

This is the opposing phase to the alarm phase.  It brings vitals, hormones and energy production to normal again. 

Example: starvation - eventually your body will decrease energy output and increase nutrient absorption.  Its a reaction of what to do about the to the stressor. 

Exhaustion

Phase

The third phase of Hans Selye's view on stress.

He believes that everyone has finite resources to deal with a stressor.  When we adapt, we lose energy and can't get it back.  If stressor persists or addl stressors are added, adaptation reserves are depleted.  This leads to physical exhausion, illness, and in worst case scenario - death.

Catecholamines

Sympathetic nervous system - norepinephrine, epinephrine, dopamine, neurotransmittors

All of these cause the fight or flight to happen

Also called Sympathetomimec, Adrenergic Response

Adrenergic Fibers

When the sympathetic system gets charged, it stimulates the ??? to produce fight or flight symptoms?

Adrenergic

Fibers

Alpha Receptors

Beta Receptors

Dopamine Receptors

What are these called?

Heart rate, myocardial contractility, cardiac output, blood pressure, vasodilation to major organs (brain, heart, skeletal muscles, lungs), cellular metabolism, breakdown of liver glycogen, blood glucose, mental activity and clear thinking, muscle strength, coagulation of blood, pupil dilation, lipolysis (fat breakdown for energy retreival).

Immune response goes DOWN.

Name some things that increase/go up & decrease/go down when adrenergic fibers are stimulated.

Acetylcholine

This stuff gets sent out, is the neurotransmitter, that responds and makes your body do the opposite of what the sympathetic nervous system does.

Parasmypathetic Nervous System

This stimulates the cholinergic fibers to return the body back to a normal state after fight or flight

Cholinergic Fibers

75% of all cholinergic receptors are in the vagus nerve and branches: supplies the heart, lungs, GI system, gallbladder, pancreas, bladder and eye

Parasympathetic Nervous System

Cholinergic Fibers

Makes all of these decrease: heart rate, contractility, platelet production, inflammatory process.  Also, this constricts pupils, bladder and bronchioles.

This shunts blood back to unimportant organs (GI, kidney, skin).

Increases: digestion, GI tone, salivary gland activity, nausea and vomiting go back to normal.

Mild Anxiety

Moderate Anxiety

Severe Anxiety

Panic

Name the four stages of anxiety

Anxiety

What is the most common response to stress?

Anxiety

A vague, uneasy feeling of apprehension or dread.

Produces an autonomic response.

alertness is increased

sleep is decreased, not sleeping well

restlessness

the kind of anxiety you experience before a test

Name some signs of mild anxiety

Your focus is on immediate concerns

tremors, increased muscle tension, butterflies,

increased pulse rate, respirations and blood pressure

The kind of anxiety you experience on test day

Name some signs and symptoms of Moderate Anxiety

Decreased learning, headache, nausea & vomiting, dizziness, tachycardia hyperventilation.

Holy Shit Man - you've got some major anxiety

Name some signs and

symptoms of Severe Anxiety.

A feeling of "loss of control", dread, terror, trembling, sweating, loss of rational thought, impending doom, agitation, dyspnea, chest pain, palpitations, poor motor control.

Name some signs and

symptoms of panic.

Teach the patient to: Exercise (helps maintain physical & emotional health, relieves tension, enables you to cope better)

Rest & sleep help maintain homeostasis, restore energy levels

Nutrition increases resistance to stress 

Encourage use of support systems

Encourage use of stress mgmt techniques (relaxation, meditation, anticipatory guidance, duided imagery, biofeedback)

What can you teach to a patient to do about their perceptions of and reactions to stressors?

Relaxation

A technique that is useful in many situations like childbirth, pain, anxiety, sleeplessness, illness and anger.  It promotes a body reaction opposite to the fight-or-flight response.  It allows a person to control his/her feelings and behaviors.

Which stress dealing technique is this?

Meditation

This stress mgmt technique has four components: quiet surroundings, a passive attitude, a comfortable position, and a word or mental image on which to focus. 

This should be performed for 20-30 minutes, twice daily.

Which type of stress management techniques is this?

Anticipatory Guidance

This stress mgmt technique focuses on psychologically preparing a person for an unfamiliar or painful event (ex: a dressing change, surgery).

When patients know what to expect, their anxiety is reduced and coping mechanisms are more effective.

Which type of stress mgmt techniques is this?

Guided Imagery

 A person creates a mental image, concentrates on the image and becomes less responsive to stimuli (including pain).

The nurse sits with a patient and reads a description of a scene or experience that is happy for the patient.

Which stress managing technique is this?

Biofeedback

A method of gaining mental control of the autonomic nervous system and regulating body responses (BP, heart rate, headaches).  A measurement device is used.

Which type of stress mgmt technique is this?

There are plenty of indicators of stress.

Name a few.

• Hypertrophy - enlargement (cardiac, skeletal muscle)
• Atrophy - decreased size (demineralization of bone, muscle and blood loss)
• Hyperplasia - change in appearance in cell (cancer)
• Cellular death - infection, ischemia

Cellular changes are generally not obvious until function or structure are altered.

There were four cellular changes mentioned in our notes and lecture.  What are they? 

Illness

This is a maladaptation to stress.

What is it?

Coping

Cognitive and behavioral skills to assist with adaption process

• Avoid the stressor
• Decrease your response to stressor
• Stress reduction activities
• Cognitive reappraisal - learning, altering attitude, use your brain to help you resolve some of the issues.

Things you can do to cope with stress

Anxiety

Sleep pattern disturbance

Caregiver role strain

Ineffective coping

Fear

Hopelessness

Name some nursing diagnoses related to stress

Adrenergic Drugs

Adrenergic Agonist drugs

Sympathetomimec Drugs

All of these do the same - they act to mimic or increase the effects of the SNS

What are drugs that increase the effects of the SNS called?

• Anorexiant (weight loss, appetite suppressant)
• Bronchodilators (asthma, bronchitis)
• Mydriatics (glaucoma, drugs that cause dilation)
• Peripheral vasoconstrictors (nasal, opthalmic, decongestant)
• Inotropes (cardiac failure, shock - makes heart beat stronger & more effectively)
• Other uses (CPR, anaphylaxis)

Name some of the Adrenergic drugs

Palpitations, tachycardia, vasoconstriction, hypertension, loss of appetite, nausea & vomiting, restlessness, insomnia, headache

(Adrenalin, Pseudophedrine, Albuterol, Epinephrine)

Name some of the side effects of Adrenergic drugs (sympathetomimec drugs/Adrenergic Agonist drugs)

Cholinergic drugs increase or enhance the effects of the PSNS.

These are also known as Parasympathomimetics

We don't give these a lot of these drugs

Parasympathetic Nervous System Drugs

Also refered to as Cholinergic Drugs

What do these drugs do?

• Urinary retention
• Post-op bowel atony
• Blocks anticholinesterase (Alzheimer's, Myasthenia Gravis)

These drugs are not tolerated well, that is why we don't use them often.

Name a few of the Parasympathomimetic, Cholinergic Drugs

Miosis (pupil constriction), increased gastric motility and secrections, urinary frequency, bronchoconstriction,

bradycardia

Name some of the side effects of Cholinergic drugs.

What should we be watching for?

Anti-adrenergics

Adrenergic-Blockers

Beta-Blockers

Adrenergic-antagonists

Sympathetic Nervous System Drugs that decrease or inhibit the effects of the SNS

What are they called?

Constrict arteries to brain (migraine headache)

Constrict arteries to uterus (oxytocin - increases contractions)

Vasodilator to major vessels (decrease BP)

Decrease heart rate (arrhythmias, tachycardia)

Decrease myocardial oxygen demand (angina)

Decrease formation of aqueous humor (glaucoma)

Decrease contractility (makes it not pump so hard)

What do the Adrenergic-blockers do?

Hypotension, sedation

drowsiness, edema

impotence, bradycardia

bronchospasm

fatigue

What are some of the side effects of Adrenergic-blockers, Beta-blockers, Adrenergic-antagonists,

Anti-adrenergics?

Also known as Anticholinergic drugs or

Anti-cholinergic drugs

They decrease or inhibit the effects of the PSNS

Parasympathetic Nervous System Drugs

What are some other names for them?

What do they do?

Given pre-operative (minimizes bradycardia and decreases secretions, Atropine-dries up saliva B4 surgery)

Relax GI tract (peptic ulcer disease, colitis, nausea assoc w/motion sickness)

Genitourninary - antispasmodic for overactive bladder

Bronchodilator

Increase heart rate (bradycardia & heartblock)

What are some of the effects that Anti-cholinergic drugs do?

Tachycardia, constipation

urinary retention, dry mouth

occular effects: dilated pupil (mydraisis)

and photophobia

What are some side effects of Anti-cholinergic drugs?

Panic

What is it called when a person loses control and experiences dread and terror?

The person may have difficulty communicating, be agitated, have dyspnea, palpitations, a choking sensation, etc. ....??? 

Pacing, tremors, rapid speech, pupil dilation,

lack of facial expression,

restlessness

Objective data related to anxiety

may include what ???