1. Chapter 5: Homeostasis, Adaptation & Stress Carolyne Richardson-Phillips PNU 145 Fall 2015 Pages 60 – 71

2. Learning Outcomes By 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 holism 3. Identify the purpose of the adaptation and two possible outcomes of unsuccessful adaptation 4. Explain the structural process thru which adaptive changes take place 5. Differentiate between the sympathetic and parasympathetic nervous systems adaptive responses 6. Define stress and list factors that effect the stress response 7. Discuss the 3-stages & consequences of the general adaptation syndrome 8. Identify and describe anxiety/fear 9. 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 disorders 11. Explain psychological adaptation and two possible outcomes 12. Describe nursing activities helpful to care of clients prone to stress & approaches for preventing, reducing, or eliminating a stress response 13. 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

3. 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

4. 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

5. 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

6. 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

7. 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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9. 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

10. 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)

12. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. Defense Mechanism

20. 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

21. 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

22. Coping Mechanisms (cont’d) Projection: attributing that which is unacceptable in oneself onto another Somatization: manifesting emotional stress thru a physical disorder Compensation: excelling at something to make up for a weakness of another kind Sublimation: channeling one’s energies into an acceptable alternative Reaction formation: acting just the opposite of one’s feelings Identification: taking on the characteristics of another

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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)

30. 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

31. 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

33. 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). (10 th ed.). Fundamental Nursing Skills and Concepts. Philadelphia: PA. Lippincott Williams & Wilkins